Michael Santini was first diagnosed with a malignant astrocytoma in 2004. His surgery was successful and a post-op brain scan revealed that the surgeon had removed all of the visible tumor seen on the pre-op MRI. Of course, as physicians and surgeons we presume that ‘invisible’ tentacles of this kind of tumor extend out into the surrounding brain. In virtually all of the patients I have treated with this diagnosis, that turns out to be the case and at some point the tumor reappears. So Michael underwent radiation treatments to his brain and had chemotherapy. Perhaps because of his relatively young age at diagnosis (58) and the fact that the tumor was initially small in size (about 1 inch in diameter), he remained in remission for five years. However, in September of 2009 the tumor recurred. Unfortunately this time the tumor came back closer to the motor area of the brain, which was responsible for the movement of Michael’s left arm and leg. The surgeon that operated this time was more limited in his ability to aggressively remove the tumor, and since Michael had already received radiation once before this could not be repeated. Chemotherapy was suggested but this time Michael was less eager than he was the first time. And so three months later, the tumor grew back and Michael developed significant weakness of his left arm and leg, causing him to be bedridden for the first time. This is when I first met him.
Upon initial review of his MRI I was reluctant to operate because I knew any attempts to remove the tumor would in all likelihood completely paralyze Michael’s left side. As I discussed this with Michael he said, “Listen doc, you just can leave me in this bed to die!” I was deeply moved by his pleading, but knew I had to carefully weigh the risks before agreeing to re-operate. Studying his scan I decided it was possible to enter the tumor through the same path that the previous surgeon took and thus minimize the risk of any further paralysis.
As I sat by Michael’s bed and discussed the surgery with him, Michael asked me what the likelihood was that the tumor would come back again. Not wanting to take away any hope but at the same time needing to be honest, I told him that the chances were high although, “you never know when a miracle might happen”. He looked at me and said, “Well I guess it’s a miracle that I’ve lived this long!” I nodded and agreed.
Often we define miracles in human terms. That, unless the cancer was cured, it could not be called a miracle. But Michael’s statement is probably closer to the truth. Every doctor and nurse probably knows of a patient whose outcome of their disease or illness was inexplicable. Many of them would claim it was a miracle while others would decry that to say so was traitorous to laws of nature and the science of modern medicine. But don’t miracles happen every day through the hands of physicians, surgeons and nurses. After all, if life and the universe were initially set in motion by God, the intelligence and skill of those taking care of the sick are truly gifts from God. And even if those patients cannot be cured in the ‘physical sense’ are they not capable of being cured in a ‘spiritual sense’. Which brings me to my thought about faith and medicine. Some people would believe that faith and religion should trump medicine and medical care, but for me I see them as co-existing on the same playing field. Certainly, being spiritual or religious helps patients cope with a life threatening or terminal illness and personally it helps me be that more compassionate. But if your faith is strong enough and your belief in prayer steadfast, I believe one’s spirituality and religious faith can transcend the natural laws of the universe. Matthew 17:20.
On the morning of Michael’s surgery I went to see him in the pre-op holding area. I asked him how he was doing and he said, “OK” and then he went on to say, “I’ve been praying for you”. I thanked him and told him, “I am glad you are”. His surgery went well enough but as I had feared his paralysis had worsened.
Somewhat surprisingly to me when I went to see Michael the day after his surgery he was grateful and said to me, “I want to thank you doc for all that you did for me”. Even the next day he was more blunt with me…”Doc I want to thank you for not making me a quadriplegic and a retard”! Though the latter term made me wince a bit, I certainly appreciated his gratitude. As time went on, however, and Michael realized he wasn’t getting any stronger on his left side, particularly his arm, he became less animated. Perhaps it was the decadron taper or more likely he began to realize he wasn’t going to leave that bed after all. Because of the severity of his weakness he remained in the hospital longer than most. This gave me the opportunity, however to visit with him more than I might have with other patients.
It is difficult to encourage most patients when they are in the condition that Michael was, so most times I just sat by his bedside and talked with him. Always, when I got up to leave he would extend out his strong right arm, look me in the eye, and shake my hand with such force as if to say ‘thanks for spending time with me’. The last day he was there, Michael was despondent. He asked me “Doc, do I really only have less than a year to live?” Before I could answer he said, “I hope so, I really can’t live like this”. Even I could understand why he would say that. All I could say was, “Well, this world we live in is not the be all and end all”. I asked him if I could pray for him. He glanced at me and then motioned with his head towards his left arm and said, ‘for this, yeah, OK”.
Taking care of Michael left me unfulfilled both as a neurosurgeon and a Christian. I still believe it is important to pray for miracles, but it also important to realize that God’s answer to our prayers just may not be what we expect.
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