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Broken

 

The patient had just murdered his wife.  A single shot from his handgun had sent her straight to the morgue.  Then, with a sudden loss of basic marksmanship, he failed to kill himself.  He placed the gun in his mouth, allowed an awkward angle, fired, and the bullet lodged in the right temporal lobe of his brain, narrowly missing the structures that would have led to his immediate death.

Frankly, I lacked enthusiasm for treating him.  He wanted to die.  He deserved to die.  I wanted him judged by the standard of an eye for an eye, a tooth for a tooth, and a life for a life.  But the discipline of medicine allows no such judgements, and I found myself in the operating room removing the bullet, debriding damaged brain, and sealing the cranial cavity from potential contamination from the tract through the mouth and sinuses.  Miraculously, and somewhat to my disappointment, he survived.

And he survived well.  On day one, I changed his bandage.  On day three, he regained consciousness with no loss of vision or paralysis.  On day five, I removed his stitches.  He suffered no complications despite the high risk of infection.  Physical therapy supervised his return to normal balance and ambulation.  For two weeks he wore a patch over his right eye because he saw double, but then that symptom also went away.  By the third week he could read again.

His discharge was delayed, however, because he had no place to go except jail, and he couldn’t go there until he reached sufficient physical and mental capacity to be competent and self-reliant.  For several weeks he lingered in the hospital with a sheriff’s deputy stationed at his door.

Each day I would come to see him.  Always he was courteous and cooperative with myself and the staff, and in my mind I tried to reconcile the gentle person before me with the raging lunatic who had killed his young wife.

I asked what would happen to my patient after he was transferred to jail.  The deputy shrugged.  “It’ll be up to the judge,” he said.  “But I think probably nothing.”

“But he murdered his wife,” I said.

“Yeah, but the judge is going to see that scar on his head and send him to a psychiatrist who will say he’s not competent to stand trial, and maybe he’ll go to a state mental hospital, or maybe he’ll just go home.”

I stared at him.  He shrugged again as if to say What are ya gonna do?

The next day I found the patient reading his Bible.  I wondered if he even remembered what he had done.  So I asked.

A cloud passed over his face.  “I killed my wife,” he said.

“Do you remember why?” I asked.

“I was angry.”

His memory was intact, but sometimes patients with temporal and frontal lobe damage will be incapable of remorse.  “How do you feel about that now?” I asked.

The cloud came back.  “I feel bad,” he said.  “I loved her.”  He paused for a moment,  then continued, “I’m not that person anymore.”

In his last statement, he was entirely correct.  Due to his self-inflicted wound, his temporal lobe and frontal lobe were significantly damaged, and changes to his emotional responses and intellectual capabilities were undeniable.  He may be incapable of anger.  In a way, he was broken.  Yet the changes left no outward signs.  Even the scar became hidden as his hair grew back.

I once watched a man in Wyoming break a horse.  The horse was dangerous and useless, but expensive with good breeding and therefore worth saving if at all possible.  As a last resort the horse had been sent to the trainer from New Mexico.  Unless the horse could become trainable and safe, it would be euthanized.

The horse bucked and snorted in his stall before being released to a circular corral about forty feet in diameter.  The man stood in the middle of the corral with only a light six-foot flexible rod and let the horse run around him, seemingly oblivious to the threat of crashing hooves and sharp teeth.  He then described his own life, full of passion and rage and despair, and stated he and the horse were alike until, on the eve of his own self-destruction, he was broken and began a redeemed life.  Over the next hour he talked to us about redemption as he let the horse run, made himself vulnerable to the horse, thereby building trust, and then gave the horse the opportunity to submit.  He never touched the horse with his rod or his hand until near the end of the hour when he faced the now calm animal, stroked his muzzle, and placed a halter on his head.  Then he mounted and rode around the ring.  The horse was no longer the dangerous bucking bronco that had entered the ring.  The changes left no outward sign, but the horse was “broken.”

I know that within myself is a streak that is wild and self-serving and ultimately destructive.  It is the voice that tells me that only I know what is best for myself, that life is short and I need to get what I want now, that I need to free myself from the people and the rules that restrain me.  This voice echoes the wild spirit of the stallion, the spirit that would have led to its destruction, and I expect that it echoes the demon voices that drove my patient to murder.

We all needed that spirit to be broken before we could become whole–at least whole in the sense of fulfilling our best destiny.  In other words, we needed to be broken to be healed.

But I don’t think we can break ourselves.  My patient may have come close by trying to destroy himself.  But the horse needed a gentle trainer.  And I also have a gentle trainer; His name is Jesus.

When we are broken, we can be redeemed from the wild and self-serving spirit that leads to rage and lust and alcohol and drugs and despair, the things that hold us in back from our best selves.  The best of us are broken.

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Another New Heart

Dean

I raced to the hospital, crossing the Buckman bridge after midnight well over the speed limit while making arrangements with the operating room on my cell.  I was afraid of being too late, of another exercise in futility, of another sleepless and fruitless night.  I was afraid of the need to give another end-of-life speech to a family.

The case was not hopeless.  That would not have required speed.  Or fear.  I already knew the patient’s diagnosis:  an epidural hematoma.  If his head could be opened, the clot removed and the bleeding stopped within four hours of injury, he would live.  With any delay, he would die.

As I raced to the hospital, I sought to calm my frayed nerves and slow my pounding heart.  As a person of faith, I should be able to have peace.  So I prayed.

I thought about how easy it seemed to have been for Jesus.  He never rushed, he never appeared anxious.  Lay on hands, command the demons, maybe a little mud in the eyes, and poof!  Cured.  All without time constraints.  Your servant is in the next village a day’s travel away?  No problem; go on home, he’s fine.  He’s been dead for three days?  No problem; show me the grave.  Never racing through the middle of the night uncertain of the outcome.

To be fair, I will never know what it cost Jesus to heal and give hope.  But still, even if Jesus bestowed upon me His powers at that moment, I remained certain that an epidural hematoma would need an operation.

So I prayed I would not be too late.  Because I trust neurosurgery and I don’t trust faith.  Not for this, not tonight.  I finished with something like, So, show me how a prayer for this guy does any good.

The case went well–at least for an emergency in the middle of the night.  Two hours later, the hematoma had been removed and the major bleeding stopped.  Another hour or more of surgery remained, taking care of the important but less urgent tasks: preventing re-bleeding, replacing the skull flap and closing the scalp.  This is the time when I can stop working by reflex and start thinking about what I’m doing.  And why, and to whom.

The back story filtered into the operating room.  The patient, whom I will call Zach, was a thirty-year-old cook at local restaurant who had come in by ambulance after an epileptic seizure.  Over the previous several months Zach had been in the ER three times for seizures.  Each time his anticonvulsant levels were low and his toxicology screen was positive for cocaine.  Each time, the ER staff treated him with anticonvulsants, gave him a new prescription, cautioned him against recreational drug use and sent him home.  Tonight was no different.  His labs confirmed what the staff expected: a toxicology screen positive for cocaine and low anticonvulsant levels.  A CT scan was normal.

They treated him with anti-convulsant drugs, cautioned him to re-start his prescription, avoid drugs, then sent him home with a friend.  Getting only as far as his friend’s car, Zach had another seizure, this time striking his head on the pavement.  He was carried back to the ER, but this time a CT scan showed an acute epidural hematoma.

One of the great disillusionments in medicine comes with the realization that guys like Zach care less about their life than the people charged with taking care of them.  It is easy to become bitter at two AM.  I want to ask him why the whole health care team is working, resources are being poured out, and he doesn’t care enough to take his medications and stay clean.  I want to shake him and point out to him other people who are suffering with incurable diseases while doing their best to stay alive, and would give anything to have what he is so willing to give up.

But duty and diligence take over.  We treat because we believe in the right to second chances.  And third and fourth and fifth chances–as many chances as it takes when they come in on your shift.  And I know, when I get past the bitterness, that there is a reason for the self-destruction.

Addiction.

I’ve seen lots of patients like Zach over the years.  A life-threatening illness or injury as a consequence to addictions to drugs, alcohol, nicotine, would bring them to the hospital.  A complex and expensive treatment would “save” their life, and they would be discharged only to return a few days, a few weeks, or a few months later, still addicted and now dying all over again.

Zach was dying not simply because he had bled in his head, but because his actions were beyond his control.  One mother called her son’s addiction a terminal illness.  In religious terms, he was possessed by a demon, dying of sin.

The operation saved Zach’s life.

Or did it?  Preventing death and healing are not the same thing.  If he was going to really live again, his healing needed to go way beyond the sutures in his scalp or the screws in his skull; it needed to reach all the way to his heart.

Zach went home from the hospital a few days after his operation.  I waited to see if he would show up for his post op visit in three weeks.  Surprisingly, he did.  His wound had healed nicely.  He had no more seizures while taking his anticonvulsants.  He was drug free.  We talked about addiction as the root cause of his near-death experience.  He made another appointment, and I waited.  Six weeks later, he remained seizure free, drug free, active in rehabilitation.

That night I raced to the ER, he needed an operation that I could do.  But he needed something more, something that only God could do.  Maybe He gave Zach a new heart.  I hope so.

But I know He showed me some things.  I could do an operation, but I couldn’t save Zach.  Only Jesus could do that.

And how many operations for epidural hematoma had I done by then?  Fifty?  A hundred, maybe?  How many of those patients had I prayed for?  Only one.  Jesus kept coming back to give me a second chance, and a third, and a fourth, and a fifth, as many as it took.  Because it’s always His shift.

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God in our Fear

Adam

Having cancer is fear: like having a gun put to one’s head. The day before the diagnosis, one could go where he or she wanted. When the diagnosis comes down, the patient’s autonomy boils down to a single question. Will I accept or refuse treatment?

As they were prepping me for surgery they screwed metal bolts into my skull. It was like something out of a horror movie, and I just lay there acting like it was normal while they tightened the metal halo, and my head felt like a grape being squeezed. A few minutes later they had me lie down on the gurney. I was encased in a metal cubic framework screwed into my skull.

Then, a month later I could actually smell my skin burning during radiation therapy.

During cancer treatment there dozens of atrocities visited upon a patient’s body. I had to have my blood drawn every week. My veins weren’t so good so it took a lot of sticks. I can remember telling myself that if I got better I would never let anyone stick me again.

Then there was morning when I came in for a CT scan. They gave me a “Big Gulp” sized cup of contrast. I drank a little less than half and couldn’t get any more down. My mom urged me to keep drinking; I did my best. Then I started throwing up.

I feared not only dying or discomfort. I also feared of my utter lack of autonomy. They could have told me that they were going to have to cut off my leg or my nose or blind me and I would have had to say yes. In this way being a cancer patient is like being in a concentration camp, except that a concentration camp seeks to kill while cancer treatment seeks to give a long, arduous road to life.

Where is God in the midst of this journey? He carried me when I wasn’t strong enough or brave enough to walk. I wasn’t particularly pious or spiritual. I just had a feeling, a spiritual feeling, that I was going to be ok.

During my cancer treatment I suppressed my fears and thoughts of trauma. Later, when God put me down I had to deal with them. God carried me through a horrific wasteland, like a battlefield inundated with explosions, shrapnel, barbed wire and terror. When he put me down I had to look back over that wasteland and examine the scars on my body, my spirit and my soul.

 

“As the sun was setting, Abram fell into a deep sleep, and a thick and dreadful darkness came over him. Then the Lord said to him, “Know for certain that your descendants will be strangers in a country not their own, and they will be enslaved and mistreated four hundred years. But I will punish the nations they serve as slaves, and afterward they will come out with great possessions”(Gen 15: 12-14).

 

The Israelites did not come out of Egypt without scars. There were the literal scars from the whips of the Egyptians and the overseers. There were the memories of the babies killed by the soldiers or eaten by crocodiles in the Nile. Bodies were broken by decades of slave labor. More than all of these, they lived with constant anxiety. They had lived for four hundred years in a setting where one simple change, like not gathering enough straw, could bring utter ruin.

My biggest anxiety was the MRI machine. To me, going into an MRI was like being buried alive. Less than six inches separated my eyes from the top of the tunnel. The sides of the tunnel pressed my arms to my side, and it was always cold, around sixty degrees. The mechanical voice on the intercom told me time after time not to move. Even swallowing my saliva worried me. A typical MRI takes about 50 minutes. Of course, in the machine I had no way of sensing of time. All I had was my thin, cotton gown. About halfway through the scan they would move me partially out of the tunnel, stick me, and add contrast to my veins.

Above all the unpleasantness hovered the fact that one MRI in August of 1991 had changed my life forever. One bad MRI took me into the wasteland of cancer. Any MRI after that could return me to the same wasteland.

It was the summer of 1992. I was going for my first annual MRI scan. By that time I’d started to rebuild my life. I was driving again, taking tennis lessons. I had enough hair to brush, and I looked forward to my senior year of high school. I walked into the imaging center determined to put on an optimistic face.

In reality, I was absolutely terrified.

God must have laughed at my phoniness.

When I registered, a new Christian manned the desk. We talked about the cancer and my fear that it would come back, and I received the gift of peace. God knows and ministers to our fears, even the ones we are afraid to admit to ourselves.

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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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When God Lays Us Down

 

When astronauts and cosmonauts return from the space station there is a rush to get them out of the return vehicle. They are then plopped into lawn chairs so their bodies can have some time to adjust to full gravity. It is the first step of restoring their bodies from the atrophy they experience without gravity.

Like space vehicles that carry astronauts through the freezing vacuum of space and the fiery tempest of reentry, God carries us through the hell of cancer and other crises. Then the survivors often go into a deep depression even as their bodies start getting better. During the crisis, patients and their families pour every bit of their physical, spiritual and emotional assets into the eclipsing task of survival. When the question of survival is no longer central, they are in deep emotional and spiritual deficit. That deficit has to be paid back.

It was February of 1992. I was going to live. Eventually, I would grow my hair back. The muscles, though never as toned and defined as they had been when I was a gymnast, would return so that when I jumped my toes might leave the ground.

But my spiritual self was lost and confused. I’d just had a very intense experience with God. I’d felt the Holy Spirit inside of me. It made me hungry for more. I didn’t know anyone who had the same experiences. When God stopped carrying me, I felt like he’d dumped me in a wasteland. In reality he was teaching me to exercise my spiritual muscles. Just as my leg and arm muscles needed to be rebuilt my spiritual muscles needed to be rebuilt.

As a pharisaical Christian I tried the things that I’d tried before: Bible studies, my church’s youth group, service projects, and even making plans to become a minister. Talk about the blind seeking to lead the blind! I was in a desperate search for the love that God showered upon me during my sickness. I felt that I had something special to share because God had saved me during the darkest part of my life. It took me years and years of seeking, searching and stumbling to get connected to mature Christian communities.

After more than twenty years I’m still working on being a good servant. By now I’ve identified some of the reasons why my journey was so long, arduous and frustrating. First of all, I wasn’t ready for a community of mature Christians. I could no more survive in and tolerate such a community than I could wake up one day and run a marathon without any training. I needed a steady diet of prayer and Christian fellowship.

The second biggest hurdle in my Christian journey was that I completely misunderstood the nature of being a servant of God. I thought that I was going to do great things for God, and He was going to reward me with money, power and prestige. It took me years and years and years to understand that what I did was not important. Only what God did was important. The best feeling in the universe is to be a tool in God’s hand when He is working. Too often I’ve been the hammer thinking I had a better idea than hitting the nail. A true servant of God is forged over years and decades to perfectly welcome and facilitate His will. I still have a long way to go.

My most challenging hurdle was that I didn’t start with fellow travelers, guides or mentors to lead me through the process. This was 80 to 90% my fault. I’d always taken myself too seriously. I’d was obsessively independent. That’s how I ended up with such an atrocious plan for salvation. As one of my former professors was fond of saying, “When you get singled out, you get picked off.” The Christian journey is not meant to be walked alone. It is meant to be walked with Christian brothers, sisters, fathers and mothers.

If I could go back 25 years to being the skeletal, baldheaded, traumatized boy that I was, these are the things that I very much wish that I’d done sooner:

  1. I would actively solicit a prayer partner, someone that I could meet with weekly. We would talk, share our challenges and pray for each other during the week.
  2. I would seek a mentor, an older, mature Christian who could build between my independent, egotistical self and a more selfless Christian community.
  3. I would find an area of service that would remind me of God’s work, and my humble place in that work.

When God lays us down, and stops carrying us through our crises, He is priming us to actively seek Him and learn to serve Him. It isn’t an easy process. It’s a long journey during which we build our spiritual muscles and become disciplined in our journey toward being at the heart of his will.

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Ray of Hope

Dean

I drove home from the emergency room at 4AM feeling tired, frustrated, and depressed.  As I angled off Beach Boulevard onto Hogan Road I passed a low, triangular-shaped black building topped with a cross formed by lighted letters.  Horizontal letters read Jesus Saves; Vertical letters proclaimed Jesus Heals.  Nobody believes that, I thought.  Otherwise the ambulance would have come here instead of the ER.  And I wouldn’t have blood on my shoes.

The victim that night was a twenty-one year-old man named Ray.  He had been in a single-car accident after midnight and looked brain dead on arrival.  He had been intubated in the field, was now on a respirator without motor tone or reflexes, and his pupils were fixed and dilated.  But he was drunk and hypothermic, so an official diagnosis of brain death could not be made.  Resuscitation continued.

A CT scan showed a diffusely swollen brain and multiple facial fractures.  He was placed on a respirator, given heating blankets, IV fluids, anticonvulsants, steroids, antibiotics, a room in the ICU, and little hope.  Blood dripped onto my shoes when I drilled a small hole through his skull to place a tube to monitor the pressure inside his head (the ICP).

I left him in the ICU after giving his nurse instruction on his care then looked for family or friends.  No one.

Driving home I felt like I’d performed a great exercise in futility.  Ray’s prognosis was dismal.  If he survived (an unlikely event in my estimation), he would likely be left with severe brain injuries and exist (at best) for a few years institutionalized in a neuro-vegative state.  I wished the ambulance had taken him to the faith healers; the outcome was likely to have been the same.

After a few hours of sleep I returned.  Ray’s temperature had been restored to normal and his alcohol level had fallen below the legally drunk range.  His ICP was controlled with minimal intervention, but his pupils were fixed and he still had no muscle tone or reflexes.

Again, he looked brain dead.  But since he was sedated for the respirator, an official diagnosis could not yet be made.  I felt as if I was not so much treating Ray as I was keeping his organs viable as a possible transplant donor.

This morning Ray’s parents were in the ICU waiting room.  I went to meet them and steeled myself to deliver bad news.

The first thing I noticed was they were surprisingly well dressed–he in a coat and tie, she in stockings and heels.  The second thing I noticed were the little gold crosses–one on his lapel, another on her necklace.

I told them what I must while their eyes searched me, listening carefully for the words I knew they wanted to hear–okay, recovery, rehabilitation–words I did not speak.  I said coma, paralysis, brain damage, blindness and, yes, even death.

Then we faced each other, silent for a moment.  Her face begged for better news; tears welled up and overflowed, creating fall lines in her makeup.  He studied me and asked about chances, searching for the thin comfort of statistics.  “I know you can’t say for certain,” he said.

“Less than fifty-fifty,” I replied.  It was worse than that, but I was unwilling to lie but didn’t want to hurt them more than necessary.  It was the best I could do.

“When will you know?” he asked.

“A day, a week, a month,” I said.  “I don’t know.  Everyday he lives, he’s beaten the odds.”

“There’s hope?”

I pause.  I am careful dispensing hope.  Too much is a lie called false hope.  Too little is another kind of lie.

“His response to the treatments we started last night gives us some hope,” I said cautiously.  Some hope.

His shoulders dropped a fraction, perhaps shrugging off the worst, but his eyes narrowed as he continued to fix his gaze on me.  She breathed now without sobbing.

“If he continues to get better there will be room for more hope,” I say, dispensing the possibility of more hope.  “But if he gets worse…”

“Yes?”

“If there is no hope, I will tell you.”  The possibility of no hope.

He nodded.  She sniffed.  “We will pray for him,” she said.

“And for you, too, Doctor,” he said.

“Thank you,” I said.  I wished without much faith that the prayers would help.

I’d like to report that I went back to the ICU and witnessed a miracle healing.  But it was not so simple.  Ray had a rocky course, fighting for his life for the next month.  His ICPs gradually came under control and he was weaned from the respirator and sedative medications.  He woke from his coma and, although his vision was impaired from bruised optic nerves caused by the skull base fractures, he was otherwise neurologically intact.  Then, a few days later, he had an attack of meningitis–a complication from his basilar skull fracture.  After a course of antibiotics, he required an operation to seal the cerebrospinal fluid spaces and prevent another bout of meningitis.

But he exceeded my expectations.  He recovered and was discharged home walking and talking.  Eventually, he made a near complete recovery and has led a normal life, left with only a moderate visual impairment and a well-controlled seizure disorder.

As I look back, this was when I started to wonder if the prayers helped.  At the time, I thought he got better because of good neurosurgical care.  But he looked dead, I thought his care was futile, and, in spite of my expectations, he lived.

Later, when he came in for office appointments, Ray always wore a little gold cross somewhere, usually a pin on the collar of his shirt.  It made me remember the night I had no hope and the lighted cross I saw.  Jesus Saves, Jesus Heals

Could the faith healers at that little black triangular-shaped building have done better?  Almost certainly not.  But I know now that there is room for both kinds of healers.  Some are called to don latex gloves and get blood on their shoes; others are called to fold their hands and fall on their knees.  Ray needed both.

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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?