Spiritual Experiences from the Brain

Faith, Medicine and Miracles

 

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.

An Unexpected Death

 

I have been in practice more than twenty years and I can count on one hand the number of times a patient of mine has died unexpectedly. Each time it has happened the one thought in the forefront of my mind has been, “I wonder if I’ll get sued!” Sure, I had concern for the patient’s family and the pain they were now experiencing but, immediately I would begin to think about all the things I had done for and to the patient… did I forget anything?, did I do anything wrong? When I perform elective surgery I expect all the patients to do well and leave the hospital within a day or two. So when the unexpected occurs, and everyone is in a state of shock, me included, everybody wants to know, “what happened?” That’s when I would begin to wonder if the patient’s family will ask questions and when the answers are unclear, if they will hire a lawyer because now the feelings of grief turn into anger.

Just the other day, Theresa Marsden, a patient that I had operated on less than a week before had a massive heart attack and died. But this time I felt different…

Theresa was a very pleasant woman, a retired nurse who had already survived one cancer, a melanoma as well as several other ‘brushes with death’. So when I told her she had a brain tumor she was upset and initially cried but she summoned up the strength to look forward, determined to fight it and win as she had in the past. Her husband of thirty years, Ed, was a character. After I had reviewed her brain MRI with them in her hospital room, he looked at me and said, “I’m gonna ask you a question that I have asked her surgeons in the past, and it always seemed to throw them off”, “I ask it because it tells me a lot about your character”… “Are you as good as you think you are?” Most times I get asked how long have I been in practice, or how many times have I done this surgery and most of the times when I get asked the question at all, what is my success rate? But never quite like Ed put it. He did throw me off a bit! So, I looked off a second or two, thought about it and then looked at him the eye and in front of Theresa’s nurse and Chad my physician assistant I said, “I am blessed to have the skill that I do”. As I looked at Ed, his face screwed up, somewhat surprised by my answer, and he nodded and stammered, “Well that’s why I asked it because I wanted to know what kind a person you were”. Now it was Ed’s turn to be thrown off! He then continued, “so when are we doin this?”

I explained to them we would have to transfer her to Morton Plant Mease hospital in Dunedin because that is where we perform all of the neurosurgery and that likely it would be Friday afternoon.

The tumor was located in Theresa’s occipital lobe on the left. She was an avid reader, reading three books a week but recently had suddenly stopped. When Ed asked her what was wrong she told him she couldn’t understand what she was reading anymore. As it turned out not only did the tumor damage her ability to see anything off to her right (the occipital lobes decode the signals from the eyes and creates the image we ‘see’), but the tumor had extended towards her ‘speech area’ (which decodes the words we see into meaningful speech) as well. And by the looks of the tumor on the MRI it was not only large but very likely a highly malignant brain tumor, an astrocytoma.

The surgery went well, though initially when I cut into the tumor, I discovered it had so many abnormal blood vessels I thought for a second it wasn’t a tumor but a congenital abnormality of blood vessels called an arteriovenous malformation. But as soon as the pathologist reported that it was indeed a malignant astrocytoma, I settled in and began the systematic removal of the tumor. After I was satisfied with my resection of the tumor, I inserted the chemotherapy wafers in the brain and then closed.

After surgery, Theresa was unchanged. She still could not see off to the right, and her ability to read still was mildly impaired. She recovered well, was transferred out of the intensive care unit on post-op day number two, and was up and walking in the hall on the second floor feeling quite good. In fact I remember seeing her on Wednesday as she had just finished eating dinner. I asked her how she was feeling and all she could do was remark how hard the broccoli was and that she couldn’t eat it like that. I then remarked “well, I guess if you are able to complain then you must be doing OK”. I promised I would speak with the administrator about the broccoli and walked out figuring she would be ready for discharge in day, or two at the most.

So, when Chad called me Friday morning to tell me Theresa just had a cardiac arrest and the code team was trying to bring her back, I was stunned! I told him I would be right there. As I drove in my thoughts drifted to Ed and how he must be feeling. He was losing his lifelong partner and friend, and not over the course of months as we thought it might be, but, right now. I didn’t think at all about what I might have done wrong.

I stood at the foot of her bed as the nurse performed chest compressions and the intensivist ordered more drugs to be given, and Ed paced back and forth in the hall outside the room. But to no avail. After 30 minutes of this, the intensivist looked at me and shook his head. Ed came in, asked how long we had been ‘coding’ her, and then asked everyone to stop as he said “you’re not going to bring her back”. He went immediately to her side, bent over, put his arms around Theresa and cried.

As he walked away from her bedside, I looked at him and told him I was sorry as he grabbed me, hugged me and thanked me for everything I had done.

I am indeed blessed to have the skill I do, and having asked for God’s guidance before her surgery, I knew I did everything that was in my power to do.

…but to set the mind on the Spirit is life and peace. Romans 8:6

 

 

A Malignant Tumor, and Support for the Caregiver

Carol Edwards was 67 years old. When I first met her she appeared socially proper and refined, and she was dressed impeccably. Her husband, Thomas had been diagnosed with a brain tumor a year previously, and had undergone surgery at the Henry Ford Hospital in Detroit, Michigan. The surgeon was able to remove most of the tumor visible on the MRI scan and not surprisingly, Thomas recovered without any neurologic deficits. Unfortunately the diagnosis was that of a glioblastoma multiforme, which is the most malignant form of brain cancers. He received radiation and was started on chemotherapy and because he had done well and his follow up MRI did not show any tumor recurrence, he and Carol decided to come to Florida for the winter.

Shortly after arriving in Dunedin however, he began experiencing some neck pain. His doctor figured that he probably had some arthritis in his neck since he was 69 and suggested he see a chiropractor. Within a few weeks he also began experiencing some numbness and tingling in his arms and legs and began having difficulty walking. His doctor then ordered an MRI scan of his cervical spine and this revealed the presence of a tumor within the center of his spinal cord extending from just below his brainstem to the level of the sixth cervical vertebra. This most certainly represented a rare but not unheard of spread of the glioblastoma from his brain. He was sent immediately to my hospital for neurosurgical evaluation.

After I finished operating for the day I went to the emergency room that evening to evaluate Thomas and it was there I met his wife Carol and their daughter Audrey. I explained the location of this tumor was perhaps too risky for surgery and that most  neurosurgeons in private practice, myself included only rarely see patients with tumors in this location let alone one that had spread from a glioblastoma in the brain. I prescribed a steroid medication to control the swelling in the spinal cord that likely would occur as a result of the tumor.  I then offered to call his neuro-oncologist in Detroit first thing in the morning to inform him of the latest developments in Thomas’ condition and ask what he would recommend, since they were contemplating returning to Michigan for any additional surgery or treatment.

After speaking with the neuro-oncologist and explaining the location of the tumor he merely said palliative radiation would be the only course of action which Thomas could just as easily receive in Dunedin, Florida as he could in Detroit, Michigan. He thanked me and told me he would communicate that to Carol by email right away.

I stopped by Thomas’ room that evening and Carol told me they had decided to remain in Florida for the radiation treatment. I assumed that Thomas would be discharged the following day to carry out the radiation as an outpatient, so I was surprised to see he was still in the hospital two days later. I learned that the radiation oncologist was reluctant to begin radiation without a biopsy and so was arranging to have him seen by another neurosurgeon at the university teaching hospital in Tampa for the biopsy.

Two days later I printed up my patient rounding list and was surprised once again to see that Thomas was still in the hospital. I figured a course of treatment was in place and my assistance was no longer needed so I deleted his name of my list. I went about my rounds seeing my post-op patients and then proceeded to leave the hospital. As I was getting ready to walk out the door, I heard a voice in my head saying, “go back and see him”. I thought to myself, “why?” “Perhaps” I thought, “no one would do the biopsy so if it needed to be done I certainly could do it”. So I turned around and went back to the hospital ward on the second floor.

I arrived at Thomas’ room to see Carol sitting by his bed. She appeared a bit flustered and was hurriedly straightening out folder full of papers that undoubtedly she accumulated during this recent hospitalization. Thomas was sound asleep as he had been most of the other times I had stopped by. When she saw me, she relaxed. I asked her what was happening and she told me the doctors had performed a spinal tap and because cancer cells were identified, the radiation oncologist decided a biopsy would not be necessary and that Thomas had received his first chemotherapy infusion that day and would begin his radiation tomorrow.

I said, “OK, I just wanted to stop by and check in, to make sure everything was progressing, as far as Thomas’ care”. I merely expected her to say, “oh yes, thank you”, but instead she reached out for my hand, with tears in her eyes and said, “thank you so much for stopping by”. Taking care of a loved one who is terminally ill is such an enormous task and can be completely draining emotionally even for a normally strong-willed individual, such as Carol. It is at times like these that caregivers need as much care and support as the patients they look after.

As I left Thomas’ room and walked down the hall on Hospital 2, I realized how important those few minutes that I spent with Carol were. And once again I became convinced that voice inside my head was one of my ‘angels’ keeping me on the path that God put me on.

Remembering what is best for the patient.

I was in the office seeing patients the other day and as I looked at my patient list for the day I saw one of my patients was listed as having a brain tumor. As a private practicing neurosurgeon most of what I do in the operating room is treating patients with either disc problems or bone spurs in the cervical and lumbar spine. I enjoy helping these people, but the reason I became a neurosurgeon was to operate on the brain.

So when I saw the David Albright had a brain tumor, I was actually excited. What David reminded me of however, was that I must always temper my surgical judgment with what is truly best for the patient.

In my eagerness to see David, I only glanced at his chart and failed to review the attached documents from his doctor. So, as I asked how long David had the symptoms of headache and dizziness, he began by telling me since shortly after he the IV port placed for his chemotherapy. Immediately I realized his problem was far more serious than I had initially thought.

As it turned out David was diagnosed with a cancer of his kidney, several years before. After surgery and chemotherapy, it appeared his cancer was in remission. Within the last year, however he was found to have metastatic disease or spread of his cancer to his bones and his lung, and the oncologist told him it probably wouldn't be long before it went to his liver and brain. So he was placed on another regimen of chemotherapy in the hopes it would shrink the tumors that had already spread and prevent the possibility of further metastasis. That was when he developed the headaches and dizziness which was causing him to stumble a bit to his left when he walked.

So, David had a brain MRI which revealed an abnormality in his brain on the right side. Initially looking at the scan the radiologist believed this represented a relatively benign, abnormal collection of blood vessels, but looking at it myself, I was not so sure. Given David's history and the fact that there was some swelling in the brain I believed this represented a tumor, and not a benign one, but one that spread from his original cancer.

So I sat down with David and his wife Christine to discuss options about what to do. Surgery, I told them would be risky given the tumor's location, which was close to the area of the brain that controlled the left side of his body. Also, I told them with the presence of some abnormal blood vessels in the area, the risk of a brain hemorrhage would be fairly high. That is when David interrupted me. He told me, 'Doc, at this point I am more interested in the quality of life I have left, not to see how many operations I can survive'. I could hardly agree with him more. So, I stopped talking and merely sat there, looking at he and Christine and listened as they recounted the events of the last several months. After they were done he looked at me and said, 'Doc what would you do if I were your father?' Immediately, and without hesitation I said, 'I wouldn't operate on you, Dad'.

As they got up to leave, I apologized, saying I was sorry there wasn't anything I could do, but then I said, 'if it is OK with you, I would like to keep you in my prayers'. David immediately turned around, looked me in the eyes, as he grasped my hand and said, 'Absolutely, thank you'.