Diana Baxter was a 76 year old woman who one day developed weakness in her left arm and leg. Her family took her to the nearby emergency room where she was diagnosed as having a stroke. Since it had been a very short time since the onset of her symptoms (weakness) the Emergency Room doctors decided she was a candidate for a specialized form of treatment, called intravenous tPA, which is short for tissue plasminogen activator. Essentially, this medication is injected into the blood stream and it dissolves the blood clot occluding or blocking off the blood vessel in her brain that caused the stroke in the first place. Within minutes of receiving the drug, Diana's paralysis reversed. She no longer was weak on her left side. A 'miracle'. Unfortunately, this medication is so effective it often thins a patient's blood too much. Shortly after her weakness disappeared, she began to complain of a headache. The nurses taking care of her became concerned and asked Diana how bad was her headache. She told them it was getting bad and before she could say anything further, she became comatose. The doctor was notified and he immediately intubated her or put a tube down her mouth and into her trachea, hooking her up to a ventilator since she could no longer breathe for herself. A emergent CAT scan was obtained and this clearly revealed the reason for her coma. In the area of her stroke on the right side of her brain Diana had developed a hemorrhage or blood clot within the brain. Because of the effects of the tPA it had ruptured out from the brain and into the space surrounding the brain called the subdural space. Since the bleeding would not stop, it began to accumulate and put pressure on the brain and the vital areas of her brain stem. By the time I was called to evaluate her, there was already damage to her brain. Nevertheless, in attempt to save her life and in the hope this damage could be reversed I took her emergently to the operating room to remove the blood clot. Although Diana could feel no pain, the anesthesiologist administered general anesthesia and I quickly positioned her on the operating room table. I shaved the entire right side of her head and scored a giant reverse question mark in her scalp with the back of a scalpel to indicate where I would make my incision for real. The scalp was then then prepped as I scrubbed my hands in the sink just outside operating room #4. After the operative field was draped out, I made my incision in Diana's scalp and as I did so I applied bright blue plastic semicircular cylindrical (Raney) clips to the edge of the scalp to control bleeding. Prior to the surgery, Diana had been given numerous medications as well as plasma to reverse the effects of the tPA and help thicken her blood so it would clot normally. At this point in the procedure there was very little excessive bleeding so I was somewhat encouraged. This reassurance would be short lived, however. As soon as I drilled a hole in Diana's skull, the underlying dural layer between the skull and the brain beneath was penetrated, and dark venous blood burst forth as if I had cut into the carotid artery. I quickly took the bone saw and cut out an 8 inch piece of Diana's skull. Normally when I perform surgery such as this to remove a blood clot pressing on a patient's brain the source or site of bleeding is easily identified. Once the bleeding is stopped which usually can be achieved very quickly using a cautery forceps the remainder of the surgical procedure is no longer like a 'Chinese fire drill' but a calm, systematic process of irrigating or washing out of the rest of the blood, reapplying the bone and suturing the scalp. On this particular evening I was afforded no such respite. In fact no matter what I did, the bleeding continued unabated; not only that but the bleeding came from everywhere. I inspected every area around the brain, gently retracting it to visualize all of the major blood vessels that I thought could be responsible for this torrential pouring of blood from Diana's brain. I even resected a portion of the temporal lobe where the bleeding began but still the bleeding persisted. Despite calling upon my 20 years of experience I could not stop the hemorrhage. At one point, I gently packed a soft spongy material called gelfoam which was soaked with thrombin (which helps promote the clotting of blood) peripherally around the brain and this seemed to control the bleeding but then the brain began to swell uncontrollably and the surface of the brain began to spontaneously bleed itself. I finally had to concede there was nothing further I could do. After years of mending and saving lives I was confronted, head on, by the realization that I was no longer in control, Despite thinking I could save Diana's life, I had to accept that I could not and that it was not in God's plan to do so. This did not however, assuage the feeling in my gut that I had failed. I replaced the bone flap, securing it with plates and screws and sutured the scalp, knowing that Diana already was brain dead.
The walk to the waiting room that night was a long one, knowing I had to give the worst news possible to her family. What happened however was not only unexpected but even given the circumstances, somewhat uplifting. I finished explaining to her son and daughter what had transpired and how I had done all I could but I still could not save their mother's life. As I was getting up to leave her daughter turned to me and said "thank you for helping people and God bless you".
How do you respond to kindness like that? Despite being exhausted and feeling utterly dejected at that point I immediately felt comforted. I turned to her, thanked her and gave her a hug.
This experience has taught me that God is always there to comfort us, no matter how bad the situation is and that he will often use others to extend that comfort and so we too must be ready to be instruments of that comfort ourselves.
"who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God. For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too." 2 Corinthians 1:4-5
The walk to the waiting room that night was a long one, knowing I had to give the worst news possible to her family. What happened however was not only unexpected but even given the circumstances, somewhat uplifting. I finished explaining to her son and daughter what had transpired and how I had done all I could but I still could not save their mother's life. As I was getting up to leave her daughter turned to me and said "thank you for helping people and God bless you".
How do you respond to kindness like that? Despite being exhausted and feeling utterly dejected at that point I immediately felt comforted. I turned to her, thanked her and gave her a hug.
This experience has taught me that God is always there to comfort us, no matter how bad the situation is and that he will often use others to extend that comfort and so we too must be ready to be instruments of that comfort ourselves.
"who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God. For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too." 2 Corinthians 1:4-5

