Spiritual Experiences from the Brain

Perspective and What Matters Most

Perspective... ‘The occurrence of such a tragic event put everything in perspective’.

 I think for every one of us there has been one time or another that has put the everyday frustrations, disappointments, and stressful situations of our lives, ‘in perspective’. Maybe it was an encounter with a terminal cancer patient that made you realize that the chronic lower back pain you experience daily really wasn’t that bad. Or maybe when you found out your neighbor just lost his job and the home that protected his family that you realized your ‘dated’ kitchen really didn’t need that remodel you were planning.

Two weeks ago while at Sunday morning Mass, I received a call that would help me ‘put things in perspective’. A hospital in Brooksville, Florida had a patient in their emergency room, Harold Thurman who was brought in by his wife because he was acting strange and he seemed to have some difficulty ‘getting his words out’. A CT scan revealed he had four hemorrhages in his brain, one of which by report, sounded to me like it was big enough that it might cause him some problems without urgent treatment.

Because that hospital did not have a neurosurgeon on call they requested that Harold be transferred to my hospital so I could take care of him. I told them to transfer him right away. Of course I knew with the distance between our two hospitals and the difficulty getting emergency transport from the ‘field’ to make an inter-hospital transport, it would be hours before he arrived.

Later that afternoon, about 4, I called the CCU to check on the status of the transfer. Jackie answered and told me Harold had just arrived but what she said became worrisome to me. Earlier in the day when I spoke to the doctor at the Brooksville hospital, he told me that Harold had been awake when he arrived there and now Jackie was informing me that he was very lethargic. This suggested to me that Harold was lapsing into a coma. Clearly something would have to be done; I told Jackie I would be in immediately to evaluate him myself.

When I arrived I introduced myself to his wife Elaine, their son David and Elaine’s sister.  When I examined Harold I discovered he would open his eyes slightly and move his arms and legs but he could not speak and as soon as I stopped stimulating him, he would then immediately become unresponsive. To be certain his condition had indeed deteriorated, I turned to his wife Elaine, and asked her if his present level of consciousness was different from when she initially brought him to the hospital;  she nodded and said ‘Oh yes, definitely’.

I reviewed the CT scan from the other hospital and decided that because many hours had transpired since that one was done I would repeat it to see if any additional bleeding had occurred. Fortunately there was not, although the four hemorrhages together had increased the pressure within Harold’s brain dramatically.

The largest one was in the center of Harold’s speech area on the left side. I knew if I removed this hematoma it would reduce the pressure by the greatest amount but I also knew it was highly likely I would permanently damage any functioning part of his speech area that surrounded the hemorrhage.   

The best course of action was to let this hemorrhage resolve on its own which it would do if I waited several weeks. The problem of course was that Harold’s condition was such that if I didn’t do something to reduce the pressure within his brain he wouldn’t survive the two or three weeks to allow this hemorrhage to dissolve.

On the other hand there was a second hemorrhage that was located in the right frontal lobe and this was an area I could safely operate in without causing any appreciable damage to Harold’s brain function. This hematoma was moderate in size and was definitely putting pressure on the surrounding brain and causing it to shift from right to left, but I was not certain that removing it would help Harold.

I probably went back and forth from Harold’s bedside to the CT scan display no less than five times, agonizing over the decision I had to make. Logic told me that I should remove the large hemorrhage, but ‘something’ in the back of my mind told me the best thing for Harold’s survival and recovery was to perform a right frontal craniotomy instead.

I sat at the monitor one last time and prayed the Our Father asking for guidance. In an instant, the answer became clear. I told Chad, my physician’s assistant that we would go ahead with the right frontal surgery and at the same time I would place a ventriculostomy or catheter in the ventricle on the left side so we could monitor Harold’s intracranial pressure after the surgery. This would allow the nurses to drain some (cerebrospinal) fluid if his pressure got too high.

I went in to Harold’s CCU room and told Elaine of my decision and that I would be performing surgery immediately. She was hopeful that I would save Harold’s life, but I cautioned her that because we had no idea why the hemorrhages occurred in the first place there was no way to be sure that even if surgery was successful, that it wouldn’t happen again. She nodded affirmatively and thanked me nonetheless.

As I walked towards the elevator, I turned to Chad and said, ‘Man, a case like this certainly puts things in perspective’. What I didn’t say was how stressed out I had been over finances as of late, worrying over how I was going to pay the mounting bills when collections had slowed down to a bare trickle.

But here and now Harold was fighting for his life; and the decision I struggled over was truly a life or death one. This was a situation that truly deserved of a little anxiety; not worrying about something as trivial as bills. After all as long as I had my health and I could work, everything else would take care of itself.

So we walked off to the OR to get ready for surgery.

Initially I drilled a small hole in the skull on the left side and inserted a soft rubber catheter into the ventricle and the cerebrospinal fluid literally shot out. The actual intracranial pressure was near 300, with normal being around 95. When I removed the piece of the skull on the right to remove the hemorrhage, the brain was visibly swollen. I was actually relieved to see this because I wasn’t certain I would encounter much pressure since the large hemorrhage was on the opposite side of the brain.

After I evacuated the hematoma, the brain was relaxed and the pressure was normal.

When the surgery was complete I told the anesthesiologist to keep Harold on the ventilator and deeply sedated. Though the surgery went well I still was not particularly optimistic for Harold’s recovery because of the extent of the other hemorrhages, but we would find out once we allowed the sedation to wear off in a couple of days and allow Harold to, hopefully, wake up.

On Wednesday afternoon I went by Harold’s CCU room and ‘amazement’ would describe my feelings. I had discontinued the sedation early that morning, and because Harold became so alert, the pulmonologist had removed the ventilator that had been breathing for Harold while he was on the anesthetic drip. Not only was he sitting up slightly in his bed but when I asked him how he was doing he said ‘OK, how are you?’, and when I asked him what his name was, he told me without hesitation.

What you must realize is that when Harold initially was brought to the emergency room he was globally aphasic which means he could neither understand what was spoken to him nor could he speak himself. This of course was not surprising to me because the large hemorrhage was right in the middle of his speech area. But this was not the hematoma that I removed!

As I finished writing my daily progress note in Harold’s chart I looked up to see Dr. Raja, the pulmonologist walking down the hall. As he walked toward me he remarked, ‘Well, he seemed to be awake enough so I extubated him’ as he gestured in the direction of Harold’s room. ‘Yeah’ I replied, ‘but the fact he is speaking is a miracle!’ He nodded somewhat quizzically and continued walking past me toward his next ventilator patient.

I was somewhat disappointed that he did not appear to acknowledge God’s hand in Harold’s recovery but, as long as I did then at least I could keep things ‘in perspective’.

Charity and the Price of Eternal Salvation

‘And Jesus looking upon him loved him, and said to him,

“You lack one thing; go, sell what you have, and give to the

poor, and you will have treasure in heaven; and come, follow me.”

At that saying his countenance fell, and he went away

sorrowful; for he had great possessions.’

Mark 10:21-22

How difficult is this request for us to follow?  I suspect for most of us, myself included, if we are to be honest, it is practically impossible! And not only does Jesus want us to give up our material possessions, he also wants us to follow Him, relying not on the life that allowed us to accumulate those things in the first place. And I believe, in these words also is the inference that Jesus wants us to be happy with the choice.

This command not only pertains to material possessions, but our time and talent as well. And it is with these gifts that I am not always such a ‘cheerful giver’.

In the course of my practice I am on call for emergencies and not every patient that is brought to the emergency room has insurance. And for many of these patients this is the reason they stay away from the doctor in the first place.

Granted, many of these patients are there because of self-destructive behaviors, such as abuse of alcohol and drugs. But, there are some who find themselves incapacitated, frightened and without a choice. It is these patients that remind me that God has given me a gift that I must give freely to others.

Darnell Benjamin is a patient that reminded me of this recently.

In April, Darnell decided he would get back in shape since he was about to begin a construction job he was lucky enough to have landed. During one of his workouts he felt a pop in his neck followed by some pain but he figured it was a muscle strain so he just took some Tylenol and ignored it.

Over the next few months he developed some weakness in his hands and actually noticed some of the muscles had atrophied but since he could still lift and haul the lumbar that his construction job required he quietly went about his work. His daughter tried to convince him he should see a doctor but since he did not have health insurance he told her ‘no’. In late October, Darnell began to notice his legs were a bit sore and weak but he just figured it was due to all the hard work he had been doing.

About 3 weeks ago he awoke one morning and his legs were so weak could barely get out of bed. And when he tried to stand up his legs gave out from under him and he fell to his bedroom floor. It was at this moment he also noticed he could barely pull himself back up because his hands and arms had gotten much weaker as well.

Unable to ignore his problem any longer he allowed his daughter to call 911. Shortly after he was brought to the Emergency Room by the EMTs, he was examined by the ER physician on duty who then ordered an MRI scan of his neck and lower back. As soon as the radiologist interpreted the scans and informed the ER doc of the results, I was called.

Darnell was actually in a hospital 20 miles to the north of Mease Hospital where I practice and because the emergency room doctor there believed a neurosurgical emergency existed, she wanted Darnell transferred because they did not have a neurosurgeon to take care of the problem there. After reviewing the MRI scan I agreed Darnell would need surgery.

Darnell had ruptured a disk in his neck and because there also was injury to the ligaments of his spine it created additional weakness that resulted in damage to his spinal cord. Not only would I have to operate on his cervical spine through an incision in the front of his neck and remove the disc and fuse the vertebra together; I would also have to operate on his spine a second time through an incision in the back of his neck and insert screws and rods into his spine to prevent further damage.

(When I meet patients I try not to be judgmental, but unfortunately since I make assessments and deductions based upon the patients’ history, examination and MRI scans all the time, I too often make conclusions why they have come to see me. Often it is obvious; they are in pain and want to know what their options are to alleviate or eliminate the pain. In other cases it is not so clear; the person may have been in a car accident or had an injury at work and they may only want to collect a monetary settlement or obtain a medical disability so they do not have to return to work.

In some respects it is up to me to try to make this determination so I can decide whether the patient truly is injured and may need surgery or whether they are malingering.

But sometimes I find myself making superficial judgments as to the patient’s appearance. When patients’ such as Darnell are brought in to the Emergency Room and are poorly dressed and without impeccable hygiene, the thought, ‘do they have insurance and will I be paid for the surgery I might have to perform?’ may cross my mind. In those cases I say a prayer to myself and refuse to look at the patient’s face sheet which indicates this information before I have decided what needs to be done and I have done it.)

By the time Darnell arrived at Mease Dunedin it was the following morning. He was then prepped for surgery and brought to the preoperative holding area. As I walked in he looked frightened, which was understandable since he could barely move his legs and could not move his arms much more. I introduced myself, took his hand to shake it and told him what I would be doing. He nodded and thanked me.

The surgery went well and by the next morning he could move his arms and legs quite a bit better. As I walked in to the preoperative holding area this time Darnell was actually smiling. I asked him, ‘Are you ready for round two?’ He said, ‘Yes’.  This operation was more difficult than the first but everything proceeded as planned and there were no complications.

When I rounded on Darnell the following morning he was sitting up in bed eating his breakfast, feeding himself which he was unable to do the previous day. I asked him how he was doing and he said, ‘Very well’. He went on to say, ‘Thank you so much for what you have done. I was so afraid because I could not walk and my hands were so weak. And now I am so much better. Thank you’. I smiled and said, ‘You are very welcome’. As I left his room and walked to my office I felt grateful for being able to help him.

By the end of the week Darnell was walking without any assistance and was discharged home. I figured I would not see him again until his six-week postoperative check in my office. Unfortunately that would not be the case.

Thanksgiving morning, though I was not on the schedule for emergencies, I received a call at 5 am from the ER of another hospital to the north. Apparently something happened to Darnell at home and he became unconscious. When the EMTs arrived his blood pressure was more than fifty points lower than it should have been. By the time he arrived at that hospital he was awake but the ER physician examined him and found him to be almost completely paralyzed in his arms and legs once again. I told the ER physician to transfer Darnell back to Mease Dunedin Hospital.

At this point I thought, ‘Boy, God is really testing me now. Not only did He want to see if I would be cheerful operating on Darnell, gratis, He wanted to see if I would still be smiling now that my Thanksgiving plans might be completely disrupted!’

By the time Darnell arrived in the ICU at Mease Hospital the movement of his arms and legs was almost back to where it had been when he was discharged. After reviewing the scans that were done at the other hospital I concluded Darnell became weak because the blood flow to that damaged area of his spinal cord was compromised when his blood pressure had dropped so low. Fortunately, he would recover completely.

When I returned to see him the following morning, Darnell’s weakness had continued to improve and as we talked about his condition he told me that everyone in the ICU had been great except one nurse who had taken care of him the night before. In fact he told me that nurse was actually mean to him. He then proceeded to tell me in a very articulate way that he had said to the nurse, ‘I want to apologize to you if I had said or did anything that had upset you (‘which I did not’, he said as an aside to me) because I really need your help and I don’t want you to be mad at me and ignore those needs’.

I told him I was sorry that he had that experience and that I would look into it. Darnell then looked at me and said, ‘and I’m sorry if I have inconvenienced you in any way over this Thanksgiving holiday’. I told him not to worry about that and with lump in my throat and a slight feeling of guilt myself I said, ‘that is why I am here, to take care of you’ as I grasped his hand tightly and looked deep into his eyes. Darnell merely said, ‘thank you’ as I turned to leave his room.

Lately, collections have been off a bit and yet the bills continue to pile up and it is hard to ignore when I spend no less than 15 hours operating and taking care of a patient without physical payment. What Darnell reminded me however, was that my time spent was hardly in vain and that God will truly pay me back a hundred fold if I am a ‘cheerful giver’.

 ‘The point is this: he who sows sparingly will also reap sparingly,

and he who sows bountifully will also reap bountifully. Each one

must do as he has made up his mind, not reluctantly

or under compulsion, for God loves a cheerful giver.

And God is able to provide you with every blessing in abundance,

so that you may always have enough of everything

and may provide in abundance for every good work.

2 Corinthians 9:6-8