Human nature being what it is, we will occasionally compare ourselves to others. To a degree this may be a good thing because we can gauge whether we are being a good Christian, for instance. On the other hand if we use others as a barometer of our own personal worth or wealth we may find ourselves drawn to the darker side of jealousy and envy.
A few of weeks ago a friend sent me an email that contained a video story of a young patient with a brain tumor that had undergone surgery at the Johns Hopkins Hospital in Baltimore, Maryland. It was a wonderful and inspiring story about Carlos who had a grade 2 astrocytoma and his surgeon Dr. Henry Brem, the chairman of Neurosurgery.
In the story, Carlos is described as an upbeat, positive and fearless man who had braved the jungles of South America. As a result of the treatment he received at the Johns Hopkins Hospital he was deeply grateful for Dr. Brem saving his life and yet because of his diagnosis he had become a bit more cautious not wanting to venture out too far from Baltimore. Dr. Brem is a brilliant man described by Carlos as ‘one of the best in the world at what he does’ and at the same time one who is compassionate and keenly aware of the importance of treating Carlos as a human being and respecting the dignity of his personality and life.
Arthur Grand is a patient of mine. He is a 62 year old man who had fallen several weeks earlier and developed a subdural hematoma, or a blood clot in between the inside of his skull and the surface of his brain. On Wednesday of the week preceding, my partner had removed the blood clot and Arthur was doing so well he was discharged on Friday. In the early morning hours of Saturday, however, Arthur suddenly became aphasic, or unable to speak. His wife, Ellen immediately called 911. Upon arrival to the emergency room, a CT scan was done and revealed there had been another hemorrhage which resulted in the recurrence of the subdural hematoma which was now putting pressure on Arthur’s speech area. And so I was called. After reviewing the CT, I contacted the nursing supervisor to call in the surgical team.
As I drove into the hospital that Saturday morning to operate on Arthur, contemplating Carlos’ story, I began to feel insignificant. I thought about Dr. Brem and what an incredibly skilled neurosurgeon he was to maneuver through Carlos’ brain removing a tumor that visually, looks very much like his normal brain tissue. And here I was heading into the hospital to perform a surgery that a junior neurosurgical resident could execute flawlessly.
Once I arrived at the hospital, I reviewed Arthur’s scan once again and determined the recurrent blood clot was immediately underneath the previously removed skull flap. So, all I would need to do was to reopen the skin incision, unscrew the bone flap that was secured to the surrounding skull, wash out the blood, control whatever bleeding had caused the recurrent hemorrhage and then replace the skull flap and close.
As I removed the last screw, the bone flap popped off, and indeed there was a blood clot beneath it but there was something wrong. I would have expected that once the blood clot was removed and the pressure released, the brain would become relaxed, but that was not the case. The brain still appeared swollen and under pressure. And if I didn’t do something quickly the brain might continue to swell out through the opening in the skull. Immediately, I realized I would need all 20 years of my experience to figure out what the problem was and what I would need to do to fix it. So much for this ‘simple’ procedure!
First, I had the anesthesiologist raise the head of the bed thereby decreasing somewhat the effect gravity might be having on engorging the brain. Secondly I took a malleable brain blade or ½ inch wide flat metal retractor that I used to gently retract the brain so I could inspect subdural space beyond the limits exposed by my craniotomy. In this way I could determine if there was an additional blood clot beyond what I could immediately see. Indeed there was both clotted blood and fluid that was trapped in this space and upon releasing it the brain began to relax.
However, also located in this space was a membrane or tissue layer that Arthur’s body had formed in response to the presence of the blood clot in an effort to isolate it from the underlying brain. The problem now was there was active bleeding from the edge of this vascularized membrane. And so with the brain blade in my left hand retracting the brain, I first cut away the membrane with a scissors in my right and then took a bipolar forceps, also in my right hand to coagulate the edge of the membrane to stop the bleeding. I then inserted strips of surgical foam soaked in a substance that would assist in clotting the blood and soon the bleeding had stopped and the brain was completely relaxed. I was now able to replace the skull flap and close.
Before surgery, Arthur had difficulty speaking and appeared confused but was wide awake so to look at him you might not think he had a serious, let alone life threatening problem. But, in the recovery room, he awoke speaking fine and said something that made me realize how bad off he really was. When I asked him how he was he said, ‘where am I? …what happened?’ When I saw him in the office 10 days later he was smiling, looking perfectly normal. I asked him how he was. He said, ‘great’, so I jokingly said to him, ‘good, stay that way’ as he laughed and smiled even wider.
The experience of Arthur’s case taught me two things. One, I should never underestimate the impact I might have on someone’s life no matter how ‘insignificant’ that act might seem. And two, I must never disrespect the gifts given to me by God by thinking that the actions of someone else, even a neurosurgeon are more important. Everything in life is relative… There will always be someone that is smarter, or more skilled surgically, or more gifted athletically. But everyone has unique talents that are gifts from God and they are just as remarkable as the abilities of others. So, for me to diminish the importance of my intelligence and skill is not only wrong but an insult to God – a sin. And not surprisingly to me God has a way of periodically reminding me of this by placing before me people and situations that hammers that point home.
‘For as in one body we have many members, and all the members do not have the same function, so we, though many, are one body in Christ, and individually members one of another. Having gifts that differ according to the grace given to us, let us use them: if prophesy, in proportion to our faith;’ Romans 12:4-6
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