Spiritual Experiences from the Brain

Rock and Roll, and a Prayer

 

‘You can’t always get what you want,

But if you try sometime you just might find,

You get what you need’

Mick Jagger, 1968

 

I can’t recall how many times I have heard this song, but these words are forever embedded in my brain, coming to forefront of my thoughts from time to time.

There was the time about 10 years ago, when my neurosurgical practice was in disarray and I was facing many obstacles. I actually had seriously considered quitting practicing altogether. Through the course of many events I found myself at a men’s retreat at my parish church. Early in the morning of the first day I sat, somewhat nervously, at a table with about 7 or 8 others. Joe, our group leader quickly made me feel at ease, as he was the embodiment of love and acceptance, seeing the good in everyone. We started out the morning reading a scripture from the bible, one I should remember but I cannot. Joe asked us what we thought Jesus was saying to us in that particular passage. Almost immediately and without thinking, I said, ‘You can’t always get what you want, you get what you need’.

As it turned out, by the end of the weekend I discovered that what I did for a living was not merely a job it was a vocation.  I had been given the talents to help and heal others and this was truly a gift from God. And even when my hands could not heal my patient’s bodies I was in a unique position to help them emotionally or spiritually. And while I had ‘wanted’ to quit doing it I realized what I ‘needed’ to do was to fight through whatever adversity I had because in relative terms they were minor in comparison to the problems of the patients I was asked to treat.

For many years I thought of neurosurgery as a means to inflate my ego and to monetarily provide me with the lifestyle I wanted. But now, I came to the realization of my true purpose as a brain surgeon; that there were a great many more things I was not only capable of but had a responsibility to integrate into my practice and my life.

Many of us, me included think we know what we want even to the point of praying for it. We certainly don’t want to get sick or get a brain tumor but it happens anyway…

On Wednesday I saw a woman in the office, Kathy Poster who is 62 and is a diabetic. “A brittle diabetic’ she told me. By this she meant that her diabetes was extremely hard to control…that her blood sugar could be over 600 or less than 50, before she would even know it. She told me that she frequently would wind up in the hospital for days on end when her diabetes got out of control which happened regularly. Though she had been diagnosed about 10 years ago she is considered a Type I diabetic.

To look at her you wouldn’t think she had diabetes. She is thin and without any other medical problems. In fact when her doctor in Massachusetts sat down with her to tell her she had diabetes, she said, ‘you’re full of s___, no one in my family has diabetes so how could I have it.’ I told her while I had Type II diabetes I had the same reaction, only I didn’t use the ‘s’ word.

But with being repeatedly sick and in the hospital with diabetes Kathy had become angry and depressed. ‘Why couldn’t this one or that one (in my family) have gotten it instead of me’, pointing her finger back and forth as if those family members were sitting in front of her.

But as of late, with help, she had learned to let go of her anger and in fact she had me smiling and laughing the entire time she sat in my office.

So how is it that any good can come from Kathy Post having diabetes or Tom Tremain (March 8, 2010) (or any of the other patients I take care of)  having a malignant brain tumor and how is it that any of this can be can possibly be what we need. I guess it just depends upon our perspective. As I have mentioned before, we often hang on to our life here on earth with clenched fists and anything that diverts us from our ‘wants’, be it sickness or family turmoil often times causes us to become angry and to grip tighter.

‘We know that in everything God works for

good with those who love him, who are

called according to his purpose’

(The letter of Saint Paul to the) Romans 8:28

 

Yesterday I had a talk with my son because he had disobeyed his mother. I explained to him that his mother and I were placed here on earth by God to take care of him and to guide him until he was able to take care of himself (or until our guidance was no longer needed, though I did not tell him this). I went on to tell him that when he disrespected his parents he was also making Jesus unhappy too, because God was the one who picked his mother and I to take care of him. He seemed to understand and appreciate what I had said and then went about swimming in the pool.

I know that when God’s use of me as a neurosurgeon is done then something likely will happen that will prevent me from continuing to practice. And I know that when God’s use of me here on earth is done He will take me. When that time comes it may be a sad time for those I leave behind or it may be a time that was anticipated and embraced by those that remain. Either way I have to believe that it will be for the ‘good’ and ‘according to his purpose’  

I’m not certain if Mick Jagger and Keith Richards were trying to be philosophical or even spiritual, or whether the verse just sounded right but I don’t think many rock lyrics have ever been as close to something Jesus might have said than these.

In fact, He did… '"And in praying do not heap up empty phrases as the Gentiles do; for they think that they will be heard for their many words. Do not be like them, for your Father in heaven knows what you need before you ask him. Pray then like this:

Our Father who art in heaven

Hallowed be thy name.

Thy kingdom come,

Thy will be done, On earth as it is in heaven.

Give us our daily bread;

And forgive us our trespasses, as we have forgiven those who trespass against us;

And lead us not into temptation,

But deliver us from evil"'

Matthew 6: 7-13

For Love of Family

 

When I first met Michael Dubois, I found him to be a truly gregarious man, which was surprising given his diagnosis. He was 63. Our paths crossed because he had fallen at home. He didn’t injure himself but went to his doctor anyway. In reality it was his wife, Anna who insisted he go to get checked out. It wasn’t that he disliked going to the doctor but he just always figured whatever problem he had was nothing serious and that it would resolve on its own. On most every other occasion he was right…but not this time.

As it turned out, Michael had been having some difficulty swallowing his food for the preceding month or two, although he wasn’t one to complain, and he thought this was the reason he had lost 20 pounds over that same period of time. His family noticed he looked a bit thinner but neither they nor he thought much of it. Over the last few weeks however, he had also developed some dizziness and began staggering when he walked but once again he brushed off any suggestions that there was something wrong. That was until he fell at home and almost split his head open on the corner of table in the living room.

Oh, and by the way, Michael smoked 2 ½ packs of cigarettes for the last 43 years.

As soon as his doctor saw him in the office he sent him to the emergency room for further tests; since he had the suspicion (although he didn’t tell Michael this) that he would require admission to the hospital. Initially, a chest x-ray was ordered and this showed that Michael had a mass in his chest which likely was a lung cancer. A CT of the chest was then ordered and this confirmed the x-ray findings. Given these findings and in view of Michael’s neurological symptoms, Dr. Nicker ordered a CT scan of the brain. Unfortunately, but not surprisingly, this scan revealed the lung cancer had already spread to several areas in Michael’s brain.

The largest tumor was located in the cerebellum on the right side. The cerebellum is located at the base of the skull, behind the ear. It has the external appearance and color of a walnut shell but twice as big, and the cut surface looks identical to that of a cauliflower floret. The cerebellum is responsible for coordination and so this explained the reason for Michael’s dizziness and unsteadiness walking.

But, Michael had a second tumor located in between the two halves or hemispheres of the cerebellum. It was this tumor that was causing pressure on the fluid space containing cerebrospinal fluid within the cerebellum called the 4^th ventricle (which was connected to the 1^st, 2^nd and 3^rd ventricles located in the brain or cerebral hemispheres above). Because of this pressure, the normal flow of the fluid was impaired causing it to back up leading to enlargement of the other 3 ventricles. This is called hydrocephalus, or what many people know as ‘fluid on the brain’. As a result the hydrocephalus, the increased pressure contributed to Michael’s headache and in reality was potentially more life threatening than the larger tumor.

Looking at his MRI scan I decided to remove the tumors so the pathologist could confirm the diagnosis but also in doing so relieve the pressure that was both causing Michael’s unsteadiness walking and threatening his life. To be sure he would need radiation treatments and probably chemotherapy afterwards but the immediate task at hand was to prevent these cerebellar tumors from taking Michael’s life prematurely.

Armed with all this information I walked into his room in the critical care unit to speak with Michael and Anna. I explained the situation, reviewed the MRI scan findings and then discussed with them my plan.

Anna was tearful as she spoke with me, while Michael could only laugh and joke although his words were a bit slurred because of the tumors’ affect on the coordination of his ability to speak. At first I wasn’t sure whether Michael’s behavior was a coping mechanism but soon it was apparent he was trying to be humorous so Anna wouldn’t cry.

I was wearing my green scrubs at the time and so the cross I wear around my neck was visible through the ‘V’ opening in my scrub top. Anna looked at me and said, ‘I notice you are Catholic’. I nodded my head affirmatively. ‘We are too’ she said as Michael then spoke up…’I go to church and people say I believe in God but I don’t believe in this and I don’t believe in that! I say either you believe or you don’t. I believe so I’m not afraid. If I go to sleep and I wake up, great. But if I don’t, so what…I know where I’m going… So let’s do this thing.’

On Saturday I took Michael to surgery. I removed the large superficial tumor without difficulty. It was when I contemplated removing the second, more deeply placed tumor that I paused. With the distribution of blood vessels on the surface of the cerebellum, there was only a space about 1/3 of an inch that I could operate through and then I would have to go in about an inch and a half just to reach the edge of the tumor.

I thought about the difficulty I might encounter trying to remove this tumor and how I might struggle trying to visualize the tumor well enough to resect it completely. Then there was the bleeding that could occur down in that deep, small hole and if I retracted on the brain tissue too much I might cause more swelling than was already present which would surely obstruct the flow of the cerebrospinal fluid even more. And then of course there was the possibility I could inadvertently go too deep and damage the brain stem which would result in Michael being in a permanent coma.

It was at this point I thought about Michael and his family, and how I would like to spend what time I might have left with my family if I were he. True, Michael was a deeply religious man but I didn’t want my actions to be the reason he wouldn’t wake up. After all I was there to help. No, the length of time Michael would have left would be up to God not me. But I could make sure the quality of his life was something both he and his family could enjoy.

So, I decided not to attempt resection of the smaller deeper situated tumor hoping radiation would shrink it. Instead I decided to remove an additional portion of the right cerebellar hemisphere; knowing I could do so without causing Michael any increased difficulty walking or with his coordination. And in this way, I would provide him additional room for any swelling that might occur during his radiation treatment.

Later, in the recovery room Michael awoke feeling fine and he was walking in the hall two days later and was discharged home five days after surgery. Two weeks after surgery he came in for an incision check with Francy, my nurse and he stopped by my office to say hi and to thank me.

As he stood on the other side of my desk with tears close to welling up in his eyes, I was reminded that every patient I operate on is a person, perhaps a husband or wife, a father or mother, but certainly a son or daughter, and a friend to others. I may not have extended Michael’s life appreciably; but I knew I made the right decision in the operating room that Saturday morning giving back that husband and father to the family that loved him so much. And I thank God for that.