Spiritual Experiences from the Brain

A Godly Man Does Not Belittle His Talents

 

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

 

 

If Healthcare is a God-given Right, How Can We Possibly Consider Rationing It?

 

It was Thursday night and I was just getting ready to go to bed. It was 11 pm and I turned my phone on to see if I had missed any messages. I wasn’t on call for emergencies so I had my phone set to vibrate. When I looked at the phone I saw that I missed a message at 9:11. Actually no one was on call for neurosurgical emergencies that particular evening.

So, when David Osgood arrived at the ER with an abnormal brain MRI scan which was done as an outpatient earlier that day, Kelly the ER nursing director sent out a text to see if any of the staff neurosurgeons were available to take care of him. I tried texting her back but got no answer so I called the ER directly and spoke with Dr. Feusner who was on duty. She told me that arrangements had been made to transfer David to another hospital but that he was still there at Mease.

I told her it wasn’t necessary to transfer David and that I would be available to see him first thing in the morning. So she cancelled the transfer and arranged to have him admitted to Mease Hospital.

David was 67 years of age, married with three children, two daughters and a son. He had recently developed a facial droop on the right side of his face and also was having some difficulty speaking. It wasn’t that he couldn’t speak; it was just that he had trouble getting some of his words out. He also had weakness of his right arm which began at the same time as his speech problem. Initially his doctor thought he had a stroke, but when the MRI scan was performed it was clear his symptoms were not due to a lack of blood flow to his brain but a tumor located right in the center of his frontal speech area, on the left side of his brain. Dr. Feusner told me David had a tumor; I just didn’t know the tumor likely was inoperable until I walked into David’s room the next morning.

As I entered his room, David was lying in bed and his wife Marjorie was at his side. They only had a vague idea of what the MRI showed and were certainly hopeful that despite what was in his brain, there would be a treatment for it, even if it required surgery. I picked up the MRI folder and turned to the window as I began pulling out the films one by one, holding them up to the sunlight to see what kind of tumor David had and where it was located. I too, was hopeful that there was something I could do for David, but as I looked at the scans, my heart sank. Because of where the tumor was located, surgery would almost certainly worsen David’s problem speaking, or aphasia. In other words, he would be able to understand what was said and perhaps even know in his mind what he wanted to say but wouldn’t be able to verbalize a single word.

And to make matters worse, this tumor was most likely a malignant astrocytoma. Given this diagnosis and the inability to aggressively remove the tumor made it likely that David would have 6, perhaps 12 months to live.

Knowing all this, I now had to turn away from the window and face David and Marjorie. Times like this are probably the second most difficult conversations I will have with a patient and their family. I have to be honest, yet at the same time I must give the patient hope. And as I stood there, during the first few seconds while I contemplated what I was about to say, I thought how can I possibly project a hopeful outlook?

That’s the thing about these conversations…patients listen to what I say but more than anything they study my facial expressions and how I deliver the message to determine if there is something I am not saying.

I explained to them what kind of tumor I thought it was, and the fact that even with an aggressive surgical resection, tentacles of the tumor would likely be left behind. The problem was, I told them, that because of where the tumor was located, it might not be possible to safely remove any of the tumor. I asked if I could have some more time to study the films further and that I would return later in the day to speak with them again. ‘Of course’, they said in unison. So I took the MRI scan and walked back to my office.

I told Chad my PA about David and what his MRI scan showed and asked what he thought I should do. I knew I was the only one that could make that call; he merely shrugged his shoulders and said, ‘well you could debulk it ‘, although he and I knew too well the possible implications of that.

I returned to David’s room later that afternoon to speak with him and Marjorie although at this point I still had not completely decided what I would do. In part, this is because the phrase’ ‘Do no harm’ is more than just a cliché to me. By this time his children had arrived and surrounded his bed. I began by repeating most of what I said earlier in the day since David’s children had not been there. At one point David asked, ‘How much time do I have?’, only because of his aphasia it came out more like, ‘How much light is there?’ Not wanting to take away all hope and yet at that moment realizing what I needed to do, I told him if we did nothing he might have 6 months. If I operated and removed as much of the tumor as I could safely, inserted some chemotherapy wafers in the brain and post-operatively he received radiation and additional chemotherapy, he might have 12 – 18 months or possibly longer. Through the tears he and his daughters were shedding, he said ‘OK, do it’!

‘Why are you cast down, O my soul,

and why are you disquieted within me?

Hope in God; for I shall again praise him,

my help and my God.

Psalm 43:5

Immediately following surgery, David’s ability to speak had worsened somewhat although it slowly improved during his stay in the hospital and when Francy, my nurse saw him for an incision check 10 days later his speech was back to where it was when I first met him.

Only time will tell whether I appreciably lengthened David’s life here on earth. Which brings me to a thought? With all the concern over curbing the rising cost of medical care, if we know that, statistically, a patient’s survival from a malignant astrocytoma will not be long, do we withhold treatment? Personally I think this would be wrong…dangerous…and evil. Because then we would be playing God, essentially determining the worth of a human life. It is one thing for a patient or the family, if the patient is unable to make that decision, to decide enough is enough, but the only other one to make that decision should be God, not us.

As I have pointed out before, extending one’s life even 3 months can be a miracle if allows a human hurt to healed or gives family the opportunity to say goodbye, at least for now.

Unquestioned Trust in God

 

Just the other day, I was in an exceptionally good mood, and found myself whistling at work, as I was running up the stairs heading towards the OR to begin my surgical cases for the day. Immediately I found myself transported back 36 years to Botany class during my freshman year at Fairfield University. My professor at the time, spoke out somewhat rhetorically (as he had a difficult time looking me or anyone else in the eye) that whistling was not allowed. He said ‘whistling did not promote a professional atmosphere in the scientific laboratory and was prohibited’.

I actually had to agree with him at the time. Scientific inquiry had to be precise, rigid, and devoid of all emotion. And whistling was certainly an emotional act of happiness, contentment and glee…and certainly there was no place for these sentiments in a scientific laboratory…right?   

Even at 18 years of age, I guess I was still juvenile and naïve. And so began my official desensitization that would be advanced during medical school and then ramped up into overdrive in my neurosurgical residency.

Children, of course are without any prejudice or barriers, just innocence. They accept without question what they are taught. Their belief in things that are seen and unseen is true and unwavering. As we mature we become responsible and conscientious and as we advance our intellectual curiosity we begin to question and doubt. After all that is the scientific method, is it not? The unfortunate thing is that we also question and doubt the truthfulness and honesty of those around us. And as we become skeptical we may even become cynical. We may even question the very existence of God.

Of course, for me, I must be analytical and critical and there is certainly no place for being childish in the operating room…. I remember a particular case well. It was 1992 and I had just begun my practice of neurosurgery in Palm Harbor, Florida. I was on call for neurosurgical emergencies at Mease Hospital in Dunedin when Alex Goodman was brought in to the emergency room by EMS. Alex was 32 and had been working out in the gym when he had the sensation that a bomb had just gone off in his head as he was bench pressing 225 pounds.

Shortly after his arrival a CT scan of his brain revealed a massive hemorrhage from a ruptured brain aneurysm. I ordered a cerebral angiogram which showed me the location of the aneurysm. I had to operate immediately and place a clip across the aneurysm to prevent it from rupturing a second time which almost certainly would be fatal.

The surgery had been textbook right up until I was getting ready to ‘fire the clip’ across the neck of the aneurysm. As I was reaching for the titanium clip, the most improbable chain of events occurred. The aneurysm ruptured and the light bulb on the operating microscope I was using burnt out at the same time.

At a time like this there is no room for a temper tantrum, and I couldn’t lose my composure simply because Alex’s life was slowly slipping from my hands as arterial blood poured out of the opening I made in his skull. I calmly told Liz, the circulating nurse to pull the microscope away from the operative field and replace the light bulb. I inserted a large-bore suction into the operative field to remove the blood that Alex’s heart was pumping through the tear in the aneurysm wall and I instructed the anesthesiologist to use his finger tips to compress the carotid artery in his neck to slow down the flow of blood. Simultaneously a second anesthesiologist began administering two pints of blood intravenously to replace what blood Alex was losing through the ruptured aneurysm in his brain.

Somewhat surprisingly a light bulb was readily available and I was peering through the oculars of the operating microscope less than five minutes later. The hemorrhage was profuse and I was unable to completely suction the blood from the operative field. Fortunately I had an image of the carotid artery and the aneurysm indelibly burnt in my brain so I inserted the clip through the pool of blood towards the spot where I thought the neck of the aneurysm was and released the clip. Immediately the hemorrhage stopped and as I quickly inspected the carotid artery, its branches and the aneurysm, I discovered the clip was in perfect position. Post-operatively, Alex was fine and completely unaware how close he had been to dying.

During my residency, our mantra was ‘just deal with it’! No excuses, no whining, you just had to be able to take care of the situation at hand, no matter what.

So, be it scientifically or surgically there is a necessity for the lack of emotional involvement. Over time however, as my religious faith has deepened and as I have become closer to God, through Jesus Christ, I have come to realize that spiritually, not only it is difficult to separate human feelings from what I do, it is imperative that I remember my patients are human beings not merely surgical cases!

However during a time of crisis I almost have to forget that I am operating on a person. I have to look at it as a problem that must be solved…quickly. But when it is over and I am done I must once again have empathy for my patients and their families, regardless of the outcome. I have to embrace the innocence inside of me and them.

‘And they were bringing children to him, that he might touch them; and the disciples rebuked them. But when Jesus saw it he was indignant, and said to them, “Let the children come to me, do not hinder them; for to such belongs the kingdom of God. Truly I say to you, whoever does not does not receive the kingdom of God like a child shall not enter it”’. Mark 10:13-15

So, as I was whistling, I was on my way to operate on David Osgood who had a malignant brain tumor located in his speech area. It was a risky surgery but I was confident in what I had to do and feeling blessed I was certain that God would guide my mind and hands, to do what was needed.

The Good Samaritan

 

David Arnold was a sick man. He had every reason to be depressed and perhaps even a bit angry. He had coronary artery disease having had a heart attack a year ago. He had high blood pressure, diabetes and peripheral arterial disease, the combination of which resulted in kidney damage which would soon require dialysis. In addition he also developed blockage in the circulation to his right foot and then his left leg which in turn resulted in gangrene. Because of this he required amputation of the toes of his right foot and amputation of his leg just below the knee on the left. Initially he had a prosthesis made for his left leg but because he had difficulties with this he was unable to walk and was confined to a motorized wheelchair to get around.

And if this wasn’t bad enough, he had fallen transferring from his wheelchair two days prior to his admission to the hospital and upon arrival to the ER, a CT scan revealed he also had a developed a small blood clot on the surface of his brain on the left side. That’s when I was called to see him. When I walked into his room in the ICU for the first time he was lying in bed with his eyes closed. In cases such as this it is critically important for me to be sure the patient is just sleeping and not comatose. If David was in a coma this would be indicative of significantly increased pressure on the brain, which would require emergency surgery to remove the blood clot or hematoma.

Lying there, looking at him, it appeared as though he hadn’t shaved in more than several days, and probably had not bathed either. Immediately, I began to assume he probably was an alcoholic as well. I shook him and called out his name. He promptly opened his eyes, but only half way and shot a piercing glance at me as if to say ‘what the hell do you want?’ I told him who I was and why I was there. He said nothing. I asked him, ‘where do you live’? He muttered, ‘In a house’. Despite several more questions, he said nothing further. I ordered a follow-up CT scan to be sure the hematoma had not enlarged and was causing more pressure on his brain. It was unchanged.

 As it turned out, he was not an alcoholic; he was just ornery by nature, a curmudgeon.

I followed him daily in the hospital for about a week, ordering additional scans to be the sure the hematoma was not enlarging. It did not and so I signed off his case.

About a week later, Chad, my physician’s assistant called me to let me know a repeat CT scan had been obtained on David because he had some increasing headaches. The blood clot had enlarged and now was causing significant pressure on his brain. In fact it caused a slight shifting of the left side of his brain into the space normally occupied by only the right side. He needed surgery. Fortunately David remained alert and displayed no stroke like symptoms, so while surgery needed to be done it was not an emergency. I took him to the operating room the following day and performed a craniotomy to remove the hematoma. The surgery was straightforward and was without complication.

Postoperatively, I called into the recovery room to check on David. The nurse told me he was fine neurologically. He was awake, talking, actually screaming at the nurses, and he was moving his arms and legs well, actually thrashing about and throwing some punches at the nurses, as he yelled for them to leave him alone. I reassured her that was his usual behavior.

The next day, I went to see him in the ICU. As I stood at the entrance to his room, he looked identical to the first day I saw him. Still unshaven and disheveled with that angry look on his face. I asked him how he was. He said, ‘OK’. I figured I would try to inject some levity into the situation so I asked him, ‘Did the surgery change your disposition any?’ He replied bluntly, ‘No’. I told him his post-op CT scan looked good and I turned and walked away.

As a human being, the tendency is to want to walk away from the difficult situations, the difficult patients. And at times I am no different than anyone else. But it is specifically at these times we must force ourselves to face them, not with a stern, confrontational attitude but with both our mind and arms open, even if figuratively, with loving acceptance. Angela, David’s nurse reminded me of this.

On Friday of that week I was on my way to my satellite office in Spring Hill when it occurred to me I really should stop by and see David when I returned from seeing my patients that day. Not just to check on him but to sit down by his bedside and talk to him. Truly I had not treated him the way he deserved, as a patient who was very ill and in need of more than what my surgical hands could deliver.

As I walked into his room that afternoon, there was something distinctly different about him. At first I wasn’t sure what is was, but as I sat down I realized he actually was almost smiling. Angela asked if I noticed anything different about him. Immediately it occurred to me she had helped him shave and she had bathed him. She walked over to the opposite side of his bed and picked up his right hand with both of hers and proceeded to speak aloud, almost rhetorically.  ‘You know he has some trust issues’ she said as David nodded in agreement. ‘But we understand each other now and he knows the importance of being respectful and kind and not being overly demanding’, she continued.

I sat there in silence…and amazement at the transformation that had come over David. All because Angela had been kind to him first. At first she was turned off by his attitude too, but she realized that his apparent anger was probably a manifestation of some emotional hurt or insecurity deep down. She was right.

All it took was for her to set aside her feelings and ‘turn the other cheek’ as it were. As soon as David realized she was not there to confront him but to comfort him, he began to trust her. Thus, she reminded me how much more we can help others by thinking of them first, rather than ourselves. (This of course does not pertain only to patients but our family and friends too).

Luke 6:27-31

We cannot hear if we don't listen.

How well do we listen?

I speak for many reasons. Sometimes I have an idea to share, often because I have command to delegate, occasionally I’ll speak up so as to not be the only person in that meeting who hasn’t said anything, and perhaps not infrequently because I like to hear myself talk.

To be sure, speaking is an essential part of communication but listening is probably more important. Listening allows us to fully appreciate another’s point of view and it allows us time to formulate our ideas more carefully. But, in some cases if we don’t listen closely enough, we may miss an important message.

It was September of 2004. Darius Hall had just returned home from evening church service and was opening the door to his home when someone called out to him from the house next door. A man on the porch asked Darius if he could come over and help him move a piece of furniture. Being the kind and considerate person that he was, Darius said ‘of course’. As Darius walked through the front door, the other young man directed him towards a room at the end of a long hall. Little did Darius know there was another man in that room with a metal pipe ready to beat Darius so the two strangers could rob him of his possessions.

I wasn’t on call that night, but as I sat at my computer, something prompted me to go online and check the CT scans that had been that evening. I reviewed Darius’ brain CT and saw a large blood clot pressing on the left side of his brain. I called the ER and told them I would take care of him. The ER doc was extremely grateful because he was having a difficult time finding another hospital to transfer Darius to, for emergency neurosurgery.

As I was operating on Darius that night I became conscious of the thought that I was supposed to be there that night saving his life. That Darius had some important purpose to fulfill in his life which would have been impossible if I had not checked the brain CTs earlier, ‘for the heck of it’. A few days later I felt compelled to share this with him. Though he seemed to have a look of doubt on his face, I knew in my heart this was true, that it was not just a coincidence.

 

Humility and a Malignant Brain Tumor

    As a surgeon, I am relatively aggressive in my thinking. Confronted with a problem I decide whether surgery is possible and if it is likely to be beneficial, I do it. I rarely waste time thinking too much. Having done this for more than 20 years, I make a decision quickly. Years ago, a professor of surgery told my medical school class, “A good surgeon is not always right but never in doubt”. A truer thought was never professed. Uncertainty leads to a paralysis of thought and action which leads to an inability to deal with the problem at hand…often in the operating room with the patient’s life on the line. Before an operation I may contemplate the best way to approach a tumor, or the path I will take through the skull but otherwise I have long since decided whether or not to do the surgery in the first place.

    Taking care of Jennifer Blake, however reminded me of the value of careful thought and that my surgical skill is not always the only answer.  In other words, that I need to trust in what I am able to accomplish safely in the first place and that other physicians have an ability to help too.

    Primary malignant brain tumors or those that arise from the brain itself, the so called astrocytomas in most cases recur even after a successful removal. The reason for this is that, arising from brain cells, they send out tentacles into the surrounding brain that are invisible even to the surgical microscope.

    I always try to remove all of the tumor that I can see, but invariably this kind of tumor comes back, often like an angry bear on which I inflicted merely a flesh wound. If the patient is young enough, otherwise healthy enough and the recurrent tumor is accessible I will once again charge into battle with this beast!

    So, when I reviewed Jennifer’s post op MRI after my initial surgery and realized I left some of the tumor behind, I contemplated re-operating immediately, but knowing I could not get it all anyway, I decided to hold off. I told Jennifer the radiation and chemo would take care of what remained, although I was fairly certain the tumor would be back and then I would have another chance to cut out the part of the tumor that eluded me the first time around.

    Jennifer returned to see me 6 weeks after her surgery. She and her husband Rick told me 4 weeks or so earlier she had developed significant paralysis on her left side. An MRI had been performed and revealed what I would have expected…the tumor had grown back. What was worse was brain swelling filled the entire right side of her brain. She had been receiving radiation and chemotherapy so this sudden deterioration in her condition was worrisome to say the least. Her oncologist decided to increase the dexamethasone, a steroid medication which would control and hopefully reverse the brain swelling, and she added another chemotherapy drug hoping this would shrink the regrowth of the tumor. Somewhat surprisingly, her weakness completely reversed. When I saw her I merely assumed the steroid had worked but that the tumor likely remained and the only thing that would help now was my surgical skill.

    To be sure, I ordered a follow-up MRI. When I looked at the scan, I was shocked. The swelling was completely gone and the tumor had shrunk to a size that was no different than the scan I got immediately after her surgery. In fact I double checked to be sure I wasn’t looking at THAT scan, but no, it was the MRI that I had just ordered. I had never seen this before. It was truly miraculous.

    After her surgery, I asked Jennifer if she was religious. She told me ‘no, not really’; although another girl whom I didn’t recognize who was sitting next to her bed, shook her affirmatively and said ‘I am’. I looked at Jennifer and told her that I was too and that I felt God was with me while I operated on her and had guided me.

    When I had looked at her post op scan and realized I had left some tumor behind I felt I had let Jennifer down. And besides how could God have let me down like that, letting me stop without getting a more complete resection. As I think about it, two things are possible. One, that I didn’t listen closely enough or more likely, if I had removed that additional amount of tumor I would have irreparably damaged those brain fibers traveling towards the left side of her brain.

    Trust. That is what I must have. Trust in my skill to do what is right and not harm my patients. Trust in others to help take care of the problem that may be beyond my reach to cure. And most of all, to be humble enough to trust in God to lead me in what I do.

Make me to know thy ways, O Lord;

teach me thy paths.

Lead me in thy truth, and teach me,

for thou art the God of my salvation;

for thee I wait all the day long.

Psalms 25:4-5

   

 

Brain death and spiritual inspiration

Diana Baxter was a 76 year old woman who one day developed weakness in her left arm and leg. Her family took her to the nearby emergency room where she was diagnosed as having a stroke. Since it had been a very short time since the onset of her symptoms (weakness) the Emergency Room doctors decided she was a candidate for a specialized form of treatment, called intravenous tPA, which is short for tissue plasminogen activator. Essentially, this medication is injected into the blood stream and it dissolves the blood clot occluding or blocking off the blood vessel in her brain that caused the stroke in the first place. Within minutes of receiving the drug, Diana's paralysis reversed. She no longer was weak on her left side. A 'miracle'. Unfortunately, this medication is so effective it often thins a patient's blood too much. Shortly after her weakness disappeared, she began to complain of a headache. The nurses taking care of her became concerned and asked Diana how bad was her headache. She told them it was getting bad and before she could say anything further, she became comatose. The doctor was notified and he immediately intubated her or put a tube down her mouth and into her trachea, hooking her up to a ventilator since she could no longer breathe for herself. A emergent CAT scan was obtained and this clearly revealed the reason for her coma. In the area of her stroke on the right side of her brain Diana had developed a hemorrhage or blood clot within the brain. Because of the effects of the tPA it had ruptured out from the brain and into the space surrounding the brain called the subdural space. Since the bleeding would not stop, it began to accumulate and put pressure on the brain and the vital areas of her brain stem. By the time I was called to evaluate her, there was already damage to her brain. Nevertheless, in attempt to save her life and in the hope this damage could be reversed I took her emergently to the operating room to remove the blood clot. Although Diana could feel no pain, the anesthesiologist administered general anesthesia and I quickly positioned her on the operating room table. I shaved the entire right side of her head and scored a giant reverse question mark in her scalp with the back of a scalpel to indicate where I would make my incision for real. The scalp was then then prepped as I scrubbed my hands in the sink just outside operating room #4. After the operative field was draped out, I made my incision in Diana's scalp and as I did so I applied bright blue plastic semicircular cylindrical (Raney) clips to the edge of the scalp to control bleeding. Prior to the surgery, Diana had been given numerous medications as well as plasma to reverse the effects of the tPA and help thicken her blood so it would clot normally. At this point in the procedure there was very little excessive bleeding so I was somewhat encouraged. This reassurance would be short lived, however. As soon as I drilled a hole in Diana's skull, the underlying dural layer between the skull and the brain beneath was penetrated, and dark venous blood burst forth as if I had cut into the carotid artery. I quickly took the bone saw and cut out an 8 inch piece of Diana's skull. Normally when I perform surgery such as this to remove a blood clot pressing on a patient's brain the source or site of bleeding is easily identified. Once the bleeding is stopped which usually can be achieved very quickly using a cautery forceps the remainder of the surgical procedure is no longer like a 'Chinese fire drill' but a calm, systematic process of irrigating or washing out of the rest of the blood, reapplying the bone and suturing the scalp. On this particular evening I was afforded no such respite. In fact no matter what I did, the bleeding continued unabated; not only that but the bleeding came from everywhere. I inspected every area around the brain, gently retracting it to visualize all of the major blood vessels that I thought could be responsible for this torrential pouring of blood from Diana's brain. I even resected a portion of the temporal lobe where the bleeding began but still the bleeding persisted. Despite calling upon my 20 years of experience I could not stop the hemorrhage. At one point, I gently packed a soft spongy material called gelfoam which was soaked with thrombin (which helps promote the clotting of blood) peripherally around the brain and this seemed to control the bleeding but then the brain began to swell uncontrollably and the surface of the brain began to spontaneously bleed itself. I finally had to concede there was nothing further I could do. After years of mending and saving lives I was confronted, head on, by the realization that I was no longer in control, Despite thinking I could save Diana's life, I had to accept that I could not and that it was not in God's plan to do so. This did not however, assuage the feeling in my gut that I had failed. I replaced the bone flap, securing it with plates and screws and sutured the scalp, knowing that Diana already was brain dead.
The walk to the waiting room that night was a long one, knowing I had to give the worst news possible to her family. What happened however was not only unexpected but even given the circumstances, somewhat uplifting. I finished explaining to her son and daughter what had transpired and how I had done all I could but I still could not save their mother's life. As I was getting up to leave her daughter turned to me and said "thank you for helping people and God bless you".
How do you respond to kindness like that? Despite being exhausted and feeling utterly dejected at that point I immediately felt comforted. I turned to her, thanked her and gave her a hug.
This experience has taught me that God is always there to comfort us, no matter how bad the situation is and that he will often use others to extend that comfort and so we too must be ready to be instruments of that comfort ourselves.

"who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God. For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too." 2 Corinthians 1:4-5