Spiritual Experiences from the Brain

The Price of Friendship

“Every one who comes to me and hears my words and does them, I will show you what he is like: he is like a man building a house, who dug down deep, and laid the foundation upon rock; and when the flood arose, the stream broke against that house, and could not shake it, because it had been well built. But he who hears and does not do them is like a man who built a house on the ground without a foundation; against which the stream broke, and immediately it fell, and the ruin of that house was great.”

                     Luke 6:47-49

 

Just the other day I was thinking about the friendships I have had. There have been some rock solid ones that have stood the test of time, although these are few indeed. Many of them have been built on shifting sand as it were, rarely surviving the first storm that served to wash it away. Then it occurred to me that I have not always been the friend I should have been, standing behind the very people who had stood by me in times of trouble.

Unfortunately over the years I have encountered people who seem to have an ulterior motive in being my friend. In most cases it was when they desired a friendship in order to establish a business relationship, and in these situations, this has made me feel at the very least uncomfortable and many times, sad.

When I order CT and MRI scans and other x-ray tests I can choose from many different facilities to perform these studies, and I usually do so depending upon where the patient lives. Predictably the physicians and other ‘health care providers’ affiliated with these free standing businesses do whatever they can to entice me to refer my patients to their ‘center’.

I have, for the most part, refused these inducements on principle and utilize the facilities based on the quality of the services they provide.

However, many years ago I became friends with the owner of one of these MRI centers. His name was Steven Wright (No, not the comedian). But he was a funny guy and he was an enjoyable person to be around; and I had many interesting and intellectually stimulating conversations with him. I would even admit at the time, if all things are equal, you might as well do business with a ‘good guy’ (and as it turned out the quality of the scans his center produced was just what I needed to make my clinical decisions).

In many ways we were very good friends and I probably bought dinner and drinks as much for him, if not more, than he did for me! We even spent holidays and vacationed together a few times. But I always had this feeling in the back of my mind; if I stopped referring patients to his scanner would we still be friends...?

Over the years I have been in practice I would see patients referred to me from chiropractors. Generally, these patients were no longer benefiting from chiropractic care. In many cases they had a ruptured disc in their neck that was compressing their spinal cord and so chiropractic would not help and even could be dangerous.

Although more often than not they were accident cases and the motor vehicle insurance was exhausted so then they would refer me the patient. The difficult and often uncomfortable issue with this was, while I was grateful for their referrals, I was often made to feel that I had to send them patients, less they ‘lose confidence’ in my skills as a surgeon.

The reality of my practice is that by the time patients are referred to me for possible surgery they have already treated with a physical therapist or chiropractor or both and so there was little need for me to prescribe such care.

Nevertheless, I would, on occasion have reason to refer a patient for conservative treatment. Sal Marino was one of the chiropractors I would send patients from time to time. Interestingly, as long as I continued to send patients to Sal he would send patients that required surgery to me, and we were great friends. But as soon as the referrals to Sal’s practice dropped off, seemingly his confidence in my ability and our friendship dropped out of sight as well….

Then there was Tim Perry. Tim worked for a company that sold spinal hardware - surgical screws, rods and plates that I would use to correct spinal deformities which were caused by trauma, cancer or degenerative disease. Since the company was on the leading edge of technology and the fact that Tim provided outstanding service I worked with him exclusively for many years. Understandably we became friends, although to be honest I kept that friendship at ‘arm’s length’ because I doubted his sincerity.

I often wondered how Tim would (re)act if I started to use another company to provide the surgical instrumentation that I used frequently. And for a period of time I did just that. Not to test the friendship, but I thought that just from a business standpoint it would encourage him to continue to provide a high level of service, and that the hospital might benefit from better pricing.

Tim actually handled it very well and in the end I came to respect him more for his maturity. Actually, distributing the cases fairly equally between the companies became a nightmare logistically and most of the time I felt uncomfortable being around Tim if that particular day I was using the instrumentation from the competing company. So, one day I just shifted all the business back to Tim. And I allowed myself to become better friends with him as well….

Somewhat ironically I recently found myself assessing a friendship based upon how it benefited me from a business standpoint. Although it would be more accurate to say I turned my back on that friendship because of the feeling, ‘there was nothing in it for me’.

For several years Lance Durso and I have worked closely together and over that period of time had become good friends. Not too long ago because the strategic plan for the hospital had changed, Lance found himself making critical decisions that could possibly affect me professionally, and from my perspective, negatively.

Instead of understanding those decisions had nothing to do with our friendship, I lashed out. Not only did I disrespect Lance, I as much insinuated that he was no friend of mine for taking that action. Unfortunately I am not always the most diplomatic when my feelings are strong and I said things I didn’t mean.

The reality of the situation was that there was no way Lance could avoid taking this course of action since it was for the greater good of the hospital and if he refused, his job would be in jeopardy; but I was too immature to accept it.

And so here I was attaching a price to my friendship with Lance, in the same way I that I thought others had done with me. Why? Because the way I had practiced medicine for almost twenty years was about to change and this frightened me. Of course fear is not what I felt; it was anger! I even convinced myself Lance was making these decisions without even considering how it would affect me.

But as I thought more and more about how I allowed my feelings to get out of control I realized that not only was it totally un-Christian of me, I was allowing  Satan to take advantage of my insecurities and harness that anger to blacken my soul and to inflict pain on someone else. Sad to say it was not first time I’ve committed this sin of jealousy and mistrust.

Ultimately, I realized that this new direction could actually benefit me which of course made me feel even more guilty for doubting Lance’s honest intentions.

I guess I have often had a hard time embracing change but this will have to be a topic for another story. Suffice it to say that acceptance is the key to happiness and a good friendship.

A Patient Who Became 'My Brother'

Most patients in my surgical practice I know for only a short period of time.

Some patients I take care of for a longer duration. Perhaps they did not get well following surgery and so I feel a sense of responsibility to oversee their care, referring them to, say a pain management physician hoping to get them some relief of their persisting symptoms. Occasionally, a patient will develop a surgical complication and I take care of them until the issue at hand is corrected or resolves.

Other patients actually over the course of time develop more than one problem for which they will return to see me.

Of those patients I take care of for an extended period of time I naturally develop a closer relationship with. Rarely, however do I develop a bond with a patient that transcends the usual doctor – patient relationship.

Robert Cross, however, was one of those patients with whom I developed a unique friendship.

Robert turned out to be one of those patients that failed to get better after the initial surgery I performed, requiring additional surgery. But he also developed a surgical complication requiring even more surgery; and then developed an unrelated problem requiring another (sixth) operation. Yet in spite of it all he was always grateful for what I tried to do to help him.

I first met Robert in December of 2002. He was 69 years old. He had previously undergone lower back surgery in April of that year by another surgeon and though his condition had improved he re-injured his back causing one of the discs in his lower back to re-herniate

So, on the 31^st of December I re-operated on Robert to remove the herniated disc that was pressing on his ‘sciatic nerve’ causing unrelenting pain in his left leg.

Following surgery he was certainly better, ‘but not 100%’. I then referred him to a pain management physician who performed periodic injections of cortisone in his lower spine to help alleviate his continued lower back pain.

Robert did reasonably well with this form a treatment for about two years. Ultimately the cortisone injections became less and less effective and then he developed recurring pain in both of his legs. Further tests revealed progressive degenerative changes and arthritis in his lumbar spine.

After reviewing the new MRI scan with Robert, I discussed with him the possibility of fusing his spine as I felt it might give him a degree of stability which I believed he was lacking with the advancing degeneration in his discs. He agreed and so on the 7^th of March 2006 I performed a spinal fusion on Robert Cross.

After he recovered from this surgery he was transferred to a rehabilitation facility but was readmitted one week later with severe left leg pain. Tests revealed it was only inflammation in the sciatic nerve and so I was able to treat it with medication.

Robert did well for about a year until the pain once again reoccurred, for which I performed two more surgeries. Unfortunately his continued complaints of pain finally led me to tell him, ‘Truthfully, there isn’t anything further I can do to help your back pain’. He nodded in agreement and thanked me for my honesty.

Later that year, 2007, Robert began having some difficulty walking but this problem appeared to be unrelated to his lower back. A CT scan of his head revealed that he had hydrocephalus so I inserted a ventricular shunt which improved his ability to walk somewhat. Unfortunately Robert also developed a severe peripheral neuropathy which caused his legs to feel constantly numb. As a result he was unable to appreciate where his legs were, particularly in a dark room, and this would cause him to fall frequently.

One day, not too long after I inserted Robert’s shunt I began to think of him more as a friend, and not a patient. I was in church and was returning from communion when I saw Robert sitting in a pew by the aisle. Without even thinking, I was drawn to him and I reached out my hand to him and extended a greeting of peace.

He was alone and I’m not sure he needed me to acknowledge him but I crossed the aisle shake his hand nonetheless. Actually, that meant a great deal more to him than I could have imagined. Several times after that day when I would see him he would remark about the event prominently, almost with a sense of gratitude, as if I lifted him from a moment of despair.

Actually, Robert had very good reason to be depressed. He was a very sick man, having multiple medical problems which over the ensuing three years caused him to be admitted to the hospital over 15 times; and during those hospital admissions he would undergo six more operations by two other surgeons! In addition, it was becoming increasingly difficult for his wife Joann to take care of him at home.

He wasn’t always admitted to Mease Dunedin, but when he was I would either find out he was there from Francy, my nurse or I would happen to stumble upon him making rounds on my surgical patients. Always I would stop by to at least say hello and to see how he was doing. And always he would turn to the other patient in the room if there was one and say, ‘This guy is a good man’. Slightly embarrassed I would say, ‘You are too kind’ and then reach out my hand to shake his, saying ‘It was good to see you brother’. ‘You too, brother’, he would reply.

Each time I saw him in the hospital he appeared to be getting weaker and weaker. Ultimately, because of his frequent illnesses, the amount of nursing care he required grew exponentially and so he had to move into a nursing home. The last time I saw Robert Cross in the hospital was in December of last year, 2010.

He had developed a pulmonary embolus or blood clots in his lungs. His spirits appeared good although he just seemed tired. I stopped by briefly to say hello, thinking I would stop back later in the week.

I never did see him again. He was discharged only to be readmitted on Christmas day at another hospital with pneumonia. Less than a month later he had a cardiac arrest and died, at 77 years of age.

A week or so later, his wife Joann called the office to let us know, and to ‘especially thank us for taking care of Robert over the years’.

Shortly after I felt compelled to write this story about him because, ‘He was a really good man’ and I wanted to ‘especially thank him for being my friend and ‘brother’ all those years.