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Big Man Down and the Procession of Life

There was a man in New Haven known for his size, his vast appetite for food and drink, his violence, and he feared not man nor God.  He stood six-foot-six and weighed an estimated 400 pounds.

One night he angered his girlfriend.  She revved his car, a sizable 1970’s style sedan, and threatened to run him down on Howard Avenue.  He stood in the middle of the street and dared her to do it.  She made one pass and swerved at the last minute narrowly missing him.  She turned the car around, and he laughed, daring her to try again.  This time she didn’t swerve and she didn’t miss.  After the impact he was dragged another full city block before falling free in front of the ER entrance at Yale-New Haven Hospital.  An ambulance still had to be called because none of the hospital personnel who rushed out could lift his massive frame onto a hospital gurney.

Once in the emergency room, he proved equally difficult to evaluate.  He was too large for the CT scanner, and X-Rays penetrated his thick flesh poorly leaving blurry images and much guessing about internal injuries. Cervical spine x-rays had been able to penetrate only as low as C-3.  Normally all seven cervical vertebrae can be seen on x-ray, or in very large individuals perhaps only five or six, but in his case the lower four vertebrae were completely obscured by his massive shoulders.

One thing that was clear: he was paralyzed from the waist down from a fracture at the lower thoracic/upper lumbar spine.  Surgery was scheduled for the following day.

The operation was long and difficult with much blood loss. Whether it was successful or not became quickly irrelevant when he woke in the recovery room now paralyzed from the neck  down.  Further efforts at x-rays of his cervical spine determined that he had a fracture at C-4 and now a new cervical spinal cord injury.  Unable to breathe adequately, he was left on the respirator, an endotracheal tube placed during surgery remaining as his airway.

Up until this point I had little involvement in his care.  My primary responsibilities were in the research labs, and I covered the clinical patients only one night per week and one weekend per month.  But when Saturday rolled around, he was still intubated, and dependent on the respirator in the Neuro ICU, and I was the sole resident on-call for the weekend.

On Saturday morning rounds, the staff neurosurgeon, also covering for the weekend, told me the patient needed a tracheostomy and we should do it that day.  I had done enough tracheostomies–the procedure itself didn’t intimidate me–but this case frightened me.  I argued that the procedure would be difficult, and ENT consult should be considered, and it wasn’t an emergency.  The procedure could be done the following week when plenty of back-up help was available, perhaps even in the OR where adequate light and and equipment would be available.

The surgeon would have none of it.  Back then, neurosurgeons did tracheostomies on their own patients.  To consult ENT or another surgical service would a sign of weakness, and neurosurgeons never admit to weakness.  Why mess up a busy operating room schedule with an annoying procedure like a tracheostomy that could be done off hours in the ICU?

I argued my other responsibilities to the seventy-odd patients under my care.  He simply said to call him as soon as my routine work was done.

My routine work was not done until six PM.  I called the staff physician, hoping the late hour would put him off, but he remained undeterred.  He showed up a the NICU at eight PM determined to help.

A trachea is normally immediately beneath the surface of the skin at the throat, often less than a quarter inch from the surface.  In this patient the trachea was a good four inches deep in the neck.  The standard retractors and indeed the tracheostomy tubes themselves were too small.  The light was poor, and we struggled for two hours over a procedure that normally takes thirty minutes.

At last he had an airway in the trachea.  I sutured it in place and tied it around his neck for good measure.  The staff physician went home, and after fielding the calls and tasks that had accumulated during the time I was involved in the procedure, I went to bed.

At two AM, the phone rang.  The patient had coughed out his airway and was now in respiratory distress.  I ran to the NICU and tried to replace the tube, but after the recent procedure the path from the skin to the trachea is no longer easy.  All the recently dissected tissue planes provide false passageways even in normal individuals.

I struggled to find the trachea and a tube large enough to reach it, but working alone and with poor light, I was frustrated and unsuccessful.  His breathing became more and more labored.  I called the resuscitation team, but they too were unable to re-intube him in the conventional manner.  His heart rate slowed and he lost consciousness as I struggled to find his trachea.

Then he died.

It’s a great thing to do a good tracheostomy.  Lives are saved in hospitals (and sometimes restaurants) frequently.  But sometimes it doesn’t work.  It’s been over forty years.  I stood between the big man and his death, and I failed.

I didn’t kill him exactly.  His girlfriend in her fury bore the legal responsibility.  Alcohol intoxication, lust, anger, and hubris (standing in front of a speeding car twice!) had a lot to do with it.  And I was only the last person in a line of medical providers who failed to stand between him and the hereafter, and between the girlfriend and a murder charge.

There is a poignant story in the Luke 7:11-16 in which Jesus and his followers are entering the town of Nain just as a funeral procession meets them on the road.  The dead man is the only son of a widow. Jesus, against all common sense and against the Jewish tradition that to touch the dead that renders one ritually unclean, stops the procession, touches the body, and raises the young man to life.

It’s an easy story to slide over.  Jesus was healing people all the time; now he stepped up the game and healed a dead kid, a widow’s son no less.

And it is all of that.

But Jeff Hoy in his Words of Faith (Stopping the Procession. Words of Faith.5-11-18.Dr.Jeffrey D. Hoy © 2018 jeff.Hoy@faithfellowshipweb.com) draws attention to the metaphor.  Normal life in the world is a procession toward death.  It’s where we’re all headed.  We fear it, we avoid thinking about it–we don’t touch it.

We handle our despair in different ways.  Some of us party–eat, drink and be merry, for tomorrow we die.  Some of us exercise, diet, take vitamins, avoid germs, obsess about safety, putting off for today the looming disaster of our end.  Some of us become religious, earning our place in heaven so we don’t have to worry about our end on earth.

Some of us, for example, me, learn about medicine and how to cheat disease and death, and, as we win daily battles, we hold onto the illusion that we will win the war.  But sooner or later, we meet the procession of death.

Backed by 2500 years of medical tradition, a 500 year history of surgery, an armamentarium of drugs and surgical procedures, my medical procession is powerful against impending death.  I put out my hand, I touch the corpse, the boy rises, the procession stops.

Sometimes.  This time I put up my hand, I touched the corpse, and the procession rolled over me.

Because I’m not Jesus.

In reality, the death procession never stops.  The medical procession can only slow it down.  The death procession only stops when the people weeping and wailing and those carrying the coffin stop believing in chaos and death and start believing in purpose and life.  Believe you are a child of God, believe you are loved, believe you are made for a purpose, believe that when your body dies you will exist on a new plane of experience–even when all that belief is beyond your intellect and your sensory experience.  Then the procession stops.  Then you can turn around and join the procession of life.  You can walk with Jesus.

The death of the big man with the failed tracheostomy is but one of many experiences that haunt me after forty years in medicine.  The sense of failure is pretty big when someone dies and you feel like you could have, should have, done something better to prevent that death.  It is easy to slip into despair camouflaged as a supposed “realism,” which is only cynicism after all.  One learns to go on, live in the moment, do the good one can do, and let the rest go.  It’s possible to live like that.

But if I want to live with joy instead of despair, I have to turn around and join the procession of life.  I have to walk with Jesus.

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Some Kind of Miracle

Dean

Denise was nineteen and had been married for two weeks.  Her husband said they had been together that afternoon when she suddenly complained of a headache and lost consciousness.  He called rescue who resuscitated and intubated her at the scene and transported her to the hospital.  A CT scan demonstrated hemorrhage in an area of the brain that was both critical and inoperable, the brainstem.  She was placed on a respirator sent to the ICU.

I saw her there, a tiny black woman, not more than five feet tall, weighing no more than a hundred pounds, beautiful still in spite of the distortion from the endotracheal tube and other lines and monitors.  An EEG had just finished, and the technician was leaving.  An official reading would take a few hours, but I saw the flat lines consistent with no brain activity.  Her neurological exam was also consistent with brain death.

She met all the criteria for a diagnosis of brain death except a repeat confirmatory examination to be performed eight to twenty-four hours later.  Once the diagnosis was confirmed she could be removed from the respirator without any further ethical concerns, either before or after her organs were harvested to be donated.

The family entered as I finished my exam.  Denise lay between us like a sarcophagus.  I replaced the gauze pads that covered her eyes.  The cardiac monitor beat out a steady string of slow beeps.  Every five seconds the respirator made a clunk-wheeze sound and Denise’s chest rises and falls beneath the thin, white sheet.

Her husband, not much older than she, is so diminished by shock that he stands like a mute child with large, fearful eyes.  Her mother, a formidable looking woman flanked by a small army of family and friends, takes charge.

Color separates us: my white coat and white skin, her dark dress and dark skin.  Language separates us: my Midwest accent, her Southern drawl.  I see in her eyes the sins of  generations of white men and know that trust would not be earned easily, and my authority would be recognized only grudgingly.

“Doctor?” she says.

I ask what happened, although I already knew.  I ask about her prior health, though it mattered little now.  I ask because I want to listen to their voices and I need to earn their trust.

And I don’t want to talk.  I don’t want to tell her that her daughter is dead in every sense except that her heart beats on.  I listen to the story of her short life, her childhood illnesses, her graduation from high school, her recent marriage.  I hear, as she describes Denise’s plans for the future, the hopes and dreams of her whole family.

Finally there is silence, and they look at me.  I tell them that she likely had been born with something that now caused bleeding in her head.  This is nobody’s fault; it could not have been prevented.  An act of God.

“She’s in a coma,” I say.

Mother’s face steels.  “She going to get better?”

The monitor beeps, the respirator wheezes, and Denise’s chest rises and fells.  I shake my head.

Mother’s face almost crumbles before it steels again.  “We a praying people, Doctor,” she says.  Soft voices behind her murmur assent.

“I pray, too,” I say.  I pray for forgiveness, I pray for comfort for Denise’s family, I pray I can leave this tragedy and go home to my wife and children.

I tell Mother about coma and brain death, how brain death is not only a diagnosis; it is the end of hope.  I speak about transplantation, how life and hope can be salvaged from death and despair.  I am met with stony looks.

“We be praying for a miracle, Doctor.”

I nod and look down at Denise, small enough to be a child, then explained about repeating her EEG and exam the following day.  We set a time to review the results.

The following day her exam is unchanged.  The EEG is still flat.  Her vitals signs are normal and her labs are normal.  She is brain dead, I tell her family.

“What now?” Mother asks.

I explain how transplantation works, how she can remain on the respirator until her organs are harvested then the body is released to the undertaker.

“No,” she says, “No transplants.”

I want to explain again but the steel has returned to her face, and I am forced to agree.  Denise is my patient; I am responsible only to her, and by extension, her family, not the unknown recipient of a transplant.  I nod.  “Then we can remove the respirator.”

“My son is a preacher up in Georgia.  We need him to lay on hands and pray over Denise.”

Technically, Denise is dead.  A death certificate could legally be filled out now, but I am in no hurry. Death and grief are hard enough without inflicting more wounds with technicalities.  “When?” I ask.

“Tomorrow morning.  Ten o’clock.”

Sunday.

I wonder what happens when you pray with such certainty for something that is so impossible.  Do you give up God?  Do you give up prayer?

And I wonder what happens if you pray for the impossible, and your prayer is answered.  Do you give up your faith in the expected?   Is the science of medicine so frail?  Does reality and experience know no boundary?

The next morning I enter the ICU and feel like I am in the wrong church.  Twenty souls are gathered in their Sunday best, including Denise’s brother.  Her mother introduces him, and we shake hands over the bed.  I examine her, self-conscious of the audience.  No change, brain dead, I tell them, and step back into a corner, uncertain what to do with my hands.  I cross one over the other and stand with my head slightly bowed but eyes open.  Respectful, but I feel like an alien.

Her brother lays a hand on her forehead.  He begins murmuring a prayer and the room fills with others praying out loud or saying amen.  A babbling hum fills the room and competes with the heart monitor and the respirator.  His prayers become louder with the cadence of a practiced orator.

“We love our sister,” he calls out, one hand on her forehead and one raised to the heavens.  “Now, in the name of Jesus, rise and walk.”

The room falls silent except for the monitor and respirator.  He begins again, the small congregation joining with encouraging words.  Again he cries for his sister to rise and walk, and again she does not.  A third time he cries out in the name of Jesus for his sister to rise.

I find myself praying with him.  I find myself willing to sacrifice all the certainty of the medical science for the life of this young woman.

The monitor beeps, the respirator wheezes, and no one moves, least of all Denise.  A tear streaks down her mother’s cheek.  Her brother’s hand rests still on her forehead.  A minute passes, maybe two, maybe three.

This is the moment, I think.  This is when we admit that God doesn’t answer prayers, at least not this one, at least not now.  And if not now, when?  Surely He must care.  But if He cares, does He not act because the power that raised the only son of the widow of Nain was for that time, those people?  Not now, not us.  Is now the time for bitterness and grief?

Her brother whispers something.  Then repeats himself, now loud enough that I can just make out the words.  I hear, “Thank you, Jesus.”

But why?  For what?

“Thank you, Jesus,” he says again, louder, the words unmistakeable now.  And again, even louder.  Murmurs of assent and soft amens from the family rise like a chorus to his solo as I stand to the side, puzzled and dumb.

“Thank you, Jesus,” he says one more time.  “For we loved our sister.”

I hear the chorus of amens.

“But You loved her more.  Thank you, Jesus.”

He lifts his hand from her head and steps away.  Family members file by, touching Denise, hugging her mother, shaking the brother’s hand, then leaving one by one until only the brother and his mother remain.  He nods to me as he turns to leave, surrendering the ground.

I shook his hand as he passed.  “I’m sorry,” I said.  Sorry your sister died.  Sorry your prayers weren’t answered.  Sorry that I, in spite all my scientific knowledge and skill, am completely helpless.

“Thank you,” he said.

Then I am alone with Denise and the ICU nurse.  We disconnect the lines and turn off the respirator and the clunk-wheeze stops.  The heart monitor beeps on.  I secretly hope that she will breathe and we will call back the family and celebrate a miracle.  But her chest no longer rises.  The beeps slow, then become irregular, then stop.

I sign the death certificate and go to church, joining my wife and children in a quiet Methodist congregation where all the men wear suits, all the women wear dresses, and we all pray for the will of God to be done, but never for the dead to be raised.  We are safe from disappointment that way.

But I wonder if we don’t ask for too little.  Though Denise did not rise from the dead, at least not in this world, I feel that because her family had prayed for something I wouldn’t have risked, we witnessed some kind of miracle.

Before their prayers, her family was lost in grief.  Her family asked God for more time with Denise in this world of suffering and sorrow; God assured them that Denise was living a perfect life now and they would see her again someday.  Because they prayed for a miracle in the hear-and-now, they witnessed a miracle in eternity.

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The Best Thing

Being cured and being healed are usually the same thing.  But not always.

A few years ago I was already driving home at the end of a long day when I got a call from the ER.  A thirty-something year-old mother of two had been driving home from work when her car was struck broadside from someone running a red light. She had been briefly unconscious at the scene, but was alert and able to give a coherent history on arrival at the ER. Then she unexpectedly lapsed into a coma, the right pupil dilating.

By the time I arrived, a CT scan had confirmed my suspicions of an intracranial hemorrhage, specifically an acute subdural hematoma.  If the clot could be removed before she suffered permanent damage to the critical life-support and consciousness areas of her brainstem, she could live.  But the window of opportunity was narrow.  She had less than two hours.

An emergency OR team was called and the patient resuscitated with assisted breathing through a mechanical airway and medications to minimize brain swelling.  Blood for transfusion was reserved, labs were processed.  The clock continued to tick.  I shaved her hair in the ER while waiting for the OR to be ready.

Finally, she got to surgery.  I made a big incision and cut a big window in her skull to allow room to evacuate the blood clot and find the source of bleeding.  A large surface vein had been torn due to the accident, but the brain itself looked normal.  Once the clot was out and the bleeding controlled, the tension level in the OR dropped and the surgery finished without any problems.  I bandaged her head in a classic turban dressing.

Her post-op scan showed complete resolution of the intracranial bleed, and she quickly regained consciousness.  Early in the morning of the second post-op day I visited her in her ICU room surrounded by her celebrating family.  She had made a full neurologic recovery and, other than a black eye and a bandage, looked perfectly normal.

I needed to change her bandage.  Although it looked pristine on the outside, undoubtably the inner layers of gauze had blood and serum from the incision, and I wanted it clean there, too.  I cut away the old bandage and reached for the new gauze wraps when she quickly put her hand to her head and grabbed a mirror.

“My hair,” she wailed. “What happened to my hair?”  Tears welled up.

I re-bandaged her head and assured her that her hair would grow back.  Her family comforted her and told her how glad they were to have her alive and how little they cared about her hair.  But she was inconsolable.

I was disappointed.  She had a perfect medical result.  Yet, she would need many months of psychiatric treatment for post traumatic stress disorder (PTSD).  She had been cured by her surgery, but not healed.

A few months later I received a consult to see a patient that I knew I couldn’t help.  This patient had suffered paralysis due to a gunshot wound to the thoracic spine several weeks before and had been treated at another hospital before transfer to the rehabilitation facility in my neighborhood.  The question on the consult was whether or not she needed to continue to wear a brace (she did not).

All I had to do was talk to the patient, do a brief exam to confirm my findings and write a note explaining what I already knew from looking at her hospital records and x-rays.

“Can you tell me what happened?” I said.

“The best thing in my whole life,” she replied.

I stared at her, a thirty-something year-old woman who looked older than her stated age.  Her hair was prematurely gray, disheveled and greasy from too many weeks in the hospital.  She must have misunderstood me.

“No, no,” I said.  “I meant about the spinal cord injury, the gunshot wound.”

“Yes, of course,” she said. “It was the best thing that ever happened to me.”

I realized that I was not going to have a normal conversation with this new paraplegic.  “Okay, I’ll bite,” I said. “I’ve seen lots of people with spinal cord injuries. Some adjust better than others, some adjust quicker, but I have never heard anybody say it was the best thing that ever happened to them.”

“I was an addict working as a prostitute to support my habit,” she said.  “A family of Christians lived in my neighborhood.  They knew what I was doing.  Every day I would walk by their house, and these little children would say something like, ‘Miss JoAnn, won’t you come in?’ or ‘Miss JoAnn, Jesus loves you.’  The last time it was the little boy. He said, ‘Miss JoAnn, Jesus loves you and we are praying for you.’

“I remember thinking I’d come and visit the next day, after one more high.  But that’s what I told myself every day.  A couple hours later I got shot in a drug deal gone bad.  I woke up three days later in the hospital unable to move my legs.”

She paused, collecting her thoughts and trying to form an explanation.

“But three great things happened to me that day.  The first–I was delivered from 20 years of addiction to crack cocaine. The second–I was delivered from 18 years of prostitution. The third–I found Jesus Christ as my Lord and Savior.  I have joy in my heart for the first time since I was a child.  So if never walk again, which is what they are telling me, it’s a pretty good trade.”

I couldn’t offer her a cure.  But then, she didn’t need it.  She had already been healed.

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The Hard Place

It was a Sunday of August 1991. I was lying/sitting in the hospital bed. The doctors had come and explained what they were going to do. My parents had gone to the hotel. I was sixteen, looking at the prospect of brain surgery. Earlier that day my mother tearfully told me that she didn’t know if I would live two days, two weeks, two months or twenty years. She did say that God had something for me to do and that he would give me the time to do it. There was a lot riding on the next morning’s procedure. If the biopsy came back badly, I would likely be dead by Christmas. If they didn’t put the shunt in I wouldn’t live long enough to care about the biopsy.

At sixteen I had a plan for salvation. I was going to become more and more holy and eventually become perfect as my father in heaven is perfect.

How could I have come up with such a doomed plan?

Hurt, pride and determination–they were what moved me from being a failing dyslexic in the 4th Grade to a thriving dyslexic at one of the best schools in the state by the10th grade. The lesson I had learned was that any problem could be overcome with hard work and uncompromising determination. Why should salvation be any different?

The problem I had lying in that hospital bed was that I’d run out of time. I could no more become spiritually perfect than I could write a book in a single night. I didn’t know if I would wake up from the surgery with brain damage. I didn’t know if the biopsy would come out malignant. I was in a hard place. I didn’t have any more wiggle room. I was scared and I needed a savior.

“Dear Lord, I always planned to become more holy and a better Christian. I’ve run out of time. Could you please just take me as I am?”

As far as salvation prayers go it was pretty pathetic. I didn’t even mention Jesus or even ask for my sins to be forgiven, but the Lord reckoned even my pathetic prayer as righteousness and I could feel the warmth of the Holy Spirit flowing into me. It hadn’t taken surgery or brain damage to change me. The Holy Spirit made me a new person. Since that day I’ve worried about many things: pain, incapacitation, isolation, and what would happen to my wife and children if I died. But I’ve never worried about death.

Everyone comes to hard places. Sometimes they are dramatic, like the night before brain surgery. Sometimes they are in the middle of sustained challenges, like depression or addiction. Other times they are awakenings to the fact that our salvation plans, like most human plans, are wholly insufficient. What are the hard places you have experienced in your life? What spiritual fruit has grown out of those experiences?

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Resurrection

Healing is the great intersection of faith and science, the eternal and the incarnate, where hope and truth are inextricably entwined.  Names and identifying details have been changed to protect patient confidentiality, but the stories are true and deserve to be shared.  Here’s the first:

I stood at the bedside in the ICU of a patient I’ll call Sandra.  I had run out of options, knowing the battle was lost and wondering why.  I wondered who would mourn her death, why a capable, attractive young woman would disappear, a death notice in the local paper, a vacancy to fill at work, an abandoned apartment somewhere.  I wanted to weep for a life lost before it appeared to have been lived.  I wanted to shout in frustration over the operation that had seemed perfect yet turned out to be lethal.

I had met her two weeks before.  She was thirty-seven, single, without children, and worked as a manager at a dental office in a nearby city.  Recently she had a severe headache at work followed by collapse and evacuation to the nearest emergency room.  A CT scan and subsequent MRI confirmed a colloid cyst of the third ventricle.  She appeared in my office the next day with the scans and a world of questions.

A colloid cyst is uncommon but benign in terms of malignancy.  Yet for some, like her, the cyst causes a potentially lethal obstruction to cerebrospinal fluid (CSF) circulation, leading to headache, loss of conciousness, and frequently sudden death.  As we talked she described headaches that were becoming increasingly frequent with two other episodes involving a brief collapse and loss of consciousness.

I recommended surgery.

A few days later she underwent an operation that seemed to go smoothly.  She awoke with minimal headache and transferred to the ICU with a ventricular drainage tube to monitor her intracranial pressure (ICP) and drain CSF if necessary, a common post-op precaution.

Eight hours later her, ICPs went up.  Initial treatment with CSF drainage brought the pressure back to normal for a few hours.  Then the ICP rose again to dangerous levels.  Post-op CT scans showed an inexplicably swollen brain.

The swollen brain caused a severe headache, then confusion.  Without dramatic treatment she would soon lapse into a coma and die, exactly the thing the operation was expected to prevent.  Anesthetic levels of sedation, control of her breathing, medications to reduce brain swelling were all used with only temporary benefit.  Artificial coma by use of high-dose barbiturates and hypothermia (lowering her body temperature) were used as desperate measures–again with only temporary benefit.

Now, as I stood by her bedside, she was in coma on a respirator and, by the only measurable criteria, brain dead.  Brain death is usually diagnosed by a clinical examination that shows no sign of brain function coupled with an EEG showing no activity.  For the diagnosis to be accurate, the patient must be free of sedative drugs and have a normal body temperature.  Since Sandra was sedated and cooled, the brain death diagnosis could not be made by the usual means.

But neurosurgeons and those who care for patients in coma from increased ICP know that when the ICP is equal to the systemic blood pressure, the blood cannot circulate in the brain and the brain cells die rapidly from lack of oxygen and nutrition.  A clear record of ICP equal to blood pressure for several hours also demonstrates brain death.  This was Sandra’s situation.

In despair, I laid my hand on her bandaged forehead.  I talked to Jesus.  I told Him how I couldn’t see this death as a good thing, how that even if He has a bigger plan, her life now couldn’t exactly be a bad thing.  I confessed that I lack any proximity to perfection and may have messed up my life, and may even have messed up the operation.  But as far as I can tell, I did the best operation I knew how to do without a known error and gave her the best post-op care available.  Why take out divine retribution on this innocent woman?

I reminded Him that once He raised the dead, like Lazarus.  Maybe He still did.  I told Him that this one didn’t even have to be a big publicity stunt; I was the only one who knew she was dead.

I stood there for another moment, one hand on her forehead, another on her arm, hoping to hear from heaven, but expecting nothing.  I raised my eyes to the monitors.  They beeped the same lethal numbers.   I turned to leave the room.

Her nurse stood at the door, chart and clipboard in hand.  She tilted her head, curious, as if seeing something she had never seen before.  “Were you praying?” she asks.

I wanted to say no.  Because I’m a doctor, a scientist.  But I said, “Yes.”

I left the ICU and saw hospital patients with more mundane problems, then went to the office to see more patients, all of whom were suffering to one degree or another but were still blessed with the illusion of their own immortality.  For the next several hours I expected to be interrupted at any moment by a call from the ICU telling me that Sandra’s ICP was out of control again.  The ICPs had to be out of control, and the nurse should be calling to ask what else to do.  I had no answers, but I still expected the questions.  Finally, I phoned the ICU to speak to the nurse.

“The ICPs are normal,” she said.

I didn’t believe her.  Prayers don’t reverse brain death.

Not trusting the nurse, I left my office and returned to the ICU to see for myself.  I checked lines and re-calibrated the ICP monitor.  Still normal.  Blood flow to the brain was now restored.  Her pupils were constricted due to the barbiturates, but they were reactive to light, a sign of life.

The lethally uncontrolled ICP was now controlled.  Still, whether the ICP would remain normal as her body temperature returned to normal and the barbiturates were discontinued remained unknown.  More importantly, had irreversible brain damage already occurred?

I left orders to discontinue the cooling measures.  By the following morning, the ICPs had remained normal and I discontinued the barbiturates.  Next, she was weaned from the respirator.  Finally, the ventricular drainage catheter was no longer necessary to monitor the ICP.  I hesitated to remove it, having spent ten days worrying over each pressure reading.

But she had awoken.  Weak and confused, she could speak and move all her extremities purposefully.  Her vision was normal.  Her wounds from the original surgery seemed healed.  I pulled the ventricular catheter.  A few hours later she started out of bed for the first time in two weeks.

In a few days she was transferred to a rehabilitation hospital, and three weeks later she went home, aware of her life, but unaware of her resurrection.

I have a scientific theory on what post-op complication led to the uncontrollable brain swelling.  Possibly a large vein had a thrombus that formed at the time of surgery and resolved spontaneously a week later, the morning I prayed for her.  Perhaps she did not suffer extensive brain damage because of the protection offered by barbiturate coma and body cooling.  Perhaps the important faith was not in God but in the power of medicine.

But then again, if you ask God for a miracle and it occurs at the very moment you ask, can you honestly tell yourself it was a coincidence?

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Shock!

It was a Friday in August of 1991. I was sixteen. I’d been driving alone for six-months. The whole world was in front of me. I could do whatever I wanted, except on the day before I’d had an MRI and been diagnosed with a malignant brain tumor. It was killing me, blocking the water from draining out of my brain, putting pressure on the area that controlled my eyes.

There are times when those who get bad news, really bad news, lack the emotional and cognitive capacity to absorb that news. In other words it’s like trying to eat an entire elephant in one bite. Like a deer in the headlights of a huge truck I had no idea of how to process what was happening or what was about to happen. The doorbell rang and my Mom ushered in the minister from our church. He was new to our church and didn’t know anyone well. In retrospect I think he was as shocked as I was. Ministers were supposed to fix things, to make people feel better, to boldly proclaim that God is good and that he will shepherd us through the valley of the shadow of death. That’s was a tall order when he didn’t even know me. After a few pleasantries he took me into the library and asked “How are you?”

There is a story of a man who jumped off a ten story building at each floor they asked him how he was doing at every floor he said, “So far, so good.” How we are doing in our body, mind, heart, spirit and soul is a complex question. I wasn’t much of a Christian back then. I’d read enough of the Bible, gone to church enough and prayed enough to be a very promising Pharisee. My understanding of grace was sorely lacking. My experience with the Holy Spirit was miniscule. I didn’t want or even know how to be vulnerable in front of the minister. In this moment of crisis I fell back on one of the stories I’d heard in church. It was the familiar story of the footsteps in sand. I man had a dream where he was walking on a beach. As he looked back he saw two pairs of footsteps in the sand. The footsteps represented the journey of his life. When it came to the really difficult times in his life one of the sets of footsteps disappeared. The man asked God, “Why did you abandon me during those difficult times?” God said those were the times I carried you.” In the pressure to respond to the question of “How are you?” I said, “I don’t feel that God has abandoned me.” That was the best I had at that moment.

When we get pressed and shocked beyond our human capacity to respond we fall back on the spiritual tools we’ve learned and absorbed. What are some of the spiritual tools that work best for life’s unexpected and often dreaded surprises?