Spiritual Experiences from the Brain

Respect, Responsibility, and the Right Thing to do

Respecting another person’s wishes can be a difficult thing to do, especially when I don’t agree with their choice. In the situation of a patient, if he or she has made known the conditions under which they wish me to withhold ‘extraordinary’ measures such as surgery or even ventilator support I am not at all troubled.

However when these wishes have not been made known and family members take it upon themselves to make this decision, on occasion I will find those decisions troubling.

If there is no hope for survival or more importantly functional survival, then it is a decision I myself would probably make. However, recently I have been confronted with situations that have caused me to be a bit unsettled.

One of course was the patient I spoke of in my story titled, ‘An Unusual Way to Die’. Then, there were two others; one was a patient of mine and the other a family member.

Alice Stram was an 87-year-old woman who had fallen at home. Because she was on the blood thinner Coumadin she developed a sizable hematoma compressing the right side of her brain. When I arrived at the hospital that Sunday morning to perform her surgery I was told her son would not sign the consent for surgery.

When I spoke with him he appeared somewhat angry that I was suggesting that he even consider allowing his mother to undergo surgery. I was somewhat confused and so I asked him, ‘As of a week ago your mother was independent, living at home, was she not?’ He replied and somewhat emphatically, ‘She was independent as of three days ago!’

So I asked him why he did not want me to perform surgery, but he just glared at me and said nothing. A woman, I assumed to be the daughter-in-law, sitting by the bed to Alice’s left, looked up and said to me, ‘But she’s too weak to have surgery’, which made absolutely no sense to me as I replied, ‘Excuse me? She is going to die without surgery’. But she said nothing in reply.

The husband sat by the bed to Alice’s right holding her hand silently, looking to his son for anything that was to be said.

What troubled me was that Alice walked into the hospital and then had lapsed into a coma over the last eighteen hours or so while the son thought about what should or should not be done. It was conceivable that with surgery Alice could have walked out of the hospital, but her son would not give his permission for me to do what I could to see if that would happen.

The third instance is family member who shall remain anonymous. Because of various events in her life she has made choices that not only have I disagreed with but have angered me as well. But as I contemplated my feelings I had to acknowledge how much that person had a positive and truly inspirational effect on my life.

In fact you could say that God used her to be an angel in my life. So, in reply, my thoughts to that person were that we are placed on this earth for a reason. And though our lives may have physical (and emotional) limitations God wants us to know we can still enjoy the life He has given us. More importantly though, is that more times than not our joy doesn’t come from within but from the happiness we bring to others.

Last night as I meditated, I was very tired but Jesus used that fatigue to truly open my heart to several words in the Prayer of St. Francis… ‘that where there is wrong, that I may bring the spirit of forgiveness; … Lord, grant that I may seek to comfort than to be comforted; … For it is giving that we receive. …’

As a physician, the Hippocratic Oath dictates that I must always respect the wishes of my patients, but it is also my responsibility to help that patient, to the best of my abilities.

I’m not sure what motivated Alice’s, son’s staunch opposition to surgery but since she could not speak for herself there really wasn’t much else I could do. Perhaps I could have brought her case to the attention of the ethics committee, but these things take time and I doubt any judge would overrule the wishes of the family of an 87-year-old woman.

On the other hand, with my family member, while I may not agree with choices made or things said I must still respect her decisions. The only thing I really can do is to try to lovingly instill in her a desire for life, the life God blessed us with, if not for herself, than for her family who loves her.

One might argue that it is her life and it is up to her to decide what is best and right for her. But I would argue our lives are not solitary but interwoven with the lives of others and that we have a responsibility to them just as they do to us.

‘For the body does not consist of one member but of many…

that there may be no discord in the body, but that the

members may have the same care for one another.

If one member suffers, all suffer together; if one member

is honored, all rejoice together.

1 Corinthians 12:14, 25-26

A Test of My Feelings, Fortitude and Faith

Hector Gomez fell at home and was found on the floor by his family so he was brought to the hospital and he was admitted for further tests. Because he also complained of numbness and tingling in his arms and legs, an MRI of the cervical and thoracic spine was ordered.

The results of the thoracic spine MRI prompted a call to me for transfer to Mease Dunedin Hospital. The radiologist said Hector had a tear in the tissue layer that enclosed the spinal cord. As a result the spinal cord itself had herniated through this opening and was trapped causing the numbness in Hector’s legs. This report startled the doctors taking care of Hector and so they wanted him transferred ASAP, figuring he would need surgery right away!

Personally, I thought the abnormality was actually a cyst of spinal fluid which surrounded the spinal cord compressing and it pushing forward, but either way it looked like Hector would require surgery. Unfortunately because Hector was obese and had numerous medical problems surgery would be technically difficult and risky. Nonetheless I instructed the transfer center to arrange transport of Hector to Dunedin.

When Hector arrived, not only did he have numbness and tingling in his legs, they were weak as well, although his right leg was slightly weaker than his left. But before I could consider operating I needed an additional scan. But because of Hector’s size we had to transport him off campus to another facility because he could not fit in the MRI scanner at the hospital.

The additional scan was unremarkable. I spoke with Dr. Lopez, the neuroradiologist who reviewed all of Hector’s studies and agreed the problem causing Hector’s numbness and weakness was a cyst compressing the spinal cord. With this confirmation I took Hector to surgery the following week. Micro-surgically I was able to remove the cyst and take the pressure off of Hector’s spinal cord. Immediately after surgery the strength in his legs was stronger than pre-operatively although it was not yet normal.

Since the hospital was full to capacity, Hector was kept in the Recovery Room instead of being transferred to the ICU following his surgery. This arrangement actually turned out to be a blessing in disguise.

The following day I happened to be performing a spinal fusion and Allen, Hector’s nurse came into my room about 3 pm with some disconcerting news. Suddenly, Hector began complaining of numbness from his chest down and now he was saying he could not move his legs at all.

I was somewhat unsure of whether to believe Hector was truly worse since the numbness he had before surgery had persisted even after the operation; and his strength was still not normal, having examined him earlier that morning. But Allen was insistent that there was a real change, for the worse.

I asked Chad who was scrubbed in with me to go examine Hector while I finished operating and let me know what he thought. He returned to tell me that Hector indeed was worse neurologically. Unfortunately we didn’t have time to get an MRI off campus because if Hector had a post-operative hematoma compressing his spinal cord we needed to act fast.

I instructed Chad to see if there was any way he could be scanned in the MRI scanner at Dunedin. Randy, the MRI technologist seemed to think we could try. Unfortunately, as soon as Hector saw they were going to try to scan him here he became fearful he would get stuck and had a panic attack.

When I arrived, Hector was in a full-fledged panic, screaming to the top of his lungs that he wanted to get out of there, while everyone stood around not knowing what to do.

I went to his side and tried to calm him down and impress upon him the importance of getting the test so we could help him. But nothing I could say seemed to quiet him.

He then began rambling and at first I wasn’t sure what he was saying but then it became clear…he said, ‘If I cannot move my legs, I cannot work, so I want to die’. I told him ‘no’, that I was going to help him walk again, although at the time that was the thing I was least sure about.

‘No, I want to die’, he kept repeating. As I held his hand I closed my eyes and prayed, ‘Dear God give me the wisdom to know what to say’. So I said, ‘Hector, Jesus loves you’ figuring this would get his attention and hopefully focus him on the importance of getting the tests we needed to determine if I had to take him back to surgery.

Instead of quieting him, he said, ‘No, He does not, He has forgotten me!’ I replied ‘No, He has not’, but that did nothing to get Hector off the ledge he had crawled out on to.

He then started saying, ‘I want to be with my mother’, to which I replied, ‘where is your mother?’, although I was certain I didn’t want to know the answer. ‘In heaven’, he replied. ‘I want to be with my mother in heaven’ and he said it over and over.

At this point I did not know what to do. I had failed miserably to calm Hector and I still needed to know what was going on with Hector’s spinal cord. I was very close to giving up but the thought of Hector being permanently paralyzed forced me to do what I had to do to help him, in spite of himself.

So I decided since we could not get an MRI scan I would order a myelogram. For this test the radiologist would inject dye into Hector’s spine. If there was compression of his spinal cord the normal flow of the dye around the spinal cord would be cut off. Fortunately, Dr. Lopez just happened to be at the hospital to see another patient and he was kind enough to agree to perform the procedure, even though he was not on call.

As I walked into the myelogram suite with some paperwork that had to be filled out, Hector looked at me and said, ‘Are you my friend?’ and I replied ‘yes’. He then grabbed my right hand and placed my index finger against his temple and said, ‘then you kill me.’ I took a deep sigh, said ‘No’ and turned to leave as Patrick, the anesthesiologist started the sedative infusion and Hector drifted off to sleep.

The myelogram test indeed revealed Hector had a blood clot pressing on his spinal cord, and at the time of surgery at the bottom of the very large hematoma I found a small artery vigorously pumping blood. With the hematoma removed and the pressure relieved, I coagulated the artery and closed, praying and hoping Hector would recover.

The following day the strength in Hector’s left leg was close to normal but he had no movement in his right leg. Both he and I were somewhat discouraged but I told him to keep trying to move it and I would continue to pray.

The next day, still no improvement but on the third day, when Chad walked into his room, Hector said, ‘I am so happy!’ Chad was slightly confused as he walked toward Hector’s bed with a quizzical look on his face. At that moment Hector lifted his right leg off the bed. When Chad told me, I said ‘man, now that’s a miracle!’

Within a week, Hector was walking with a walker with some assistance and was discharged to a rehab center where he continued to make progress and was then discharged home after about a week of intensive physical therapy.

For me, the most difficult part of taking care of Hector was not the stress of worrying about whether he would ever walk again; it was not knowing what to say to him when he wanted to give up. Granted at the time he was in such a state of high anxiety he probably wasn’t even aware of some of the things that he said. Nevertheless I wasn’t very inspiring either.

What I did do well however was knowing to listen to the angel tapping me on the shoulder telling me ‘Forget about trying to minister to Hector’s soul, and do what you do best. After all, God is depending upon you to take care of the sick for Him.’

‘But when he heard it, he said, “Those who are well have no

need of a physician, but those who are sick”’

Matthew 9:12