Spiritual Experiences from the Brain

Hearing a Voice in the Wind

I had just finished my second case of the day, a cervical fusion, when Chad, my PA got a consult to see a patient at Countryside Hospital.

Aaron Cook, 81 had been diagnosed with multiple myeloma, which is cancer of cells in the blood that accumulate in and weaken the bones of the body.

Chad had spoken to the nurse and was told, Mr. Cook was paralyzed in his legs.

An MRI of his spine revealed that the cancer had replaced most of the bones of his spine. In his mid back, the cancer had weakened so much of one of the vertebra that it crushed upon itself. As a result the bone and cancer cells were pushed back into Mr. Cook’s spinal cord causing his paralysis.

Given Mr. Cook’s age, his paralysis, and the appearance of his MRI my initial reaction was that there wasn’t much that could be done. I spoke to his physician, Dr. Reynolds, who told me Mr. Cook had initially presented with severe back pain.

But because the cancer was so widespread it was concluded by the oncologist and radiation specialist that any treatment would be palliative, which basically meant the cancer could perhaps be slowed down but not cured.

Dr. Reynolds informed me Mr. Cook had been in the hospital about ten days receiving radiation treatments to his spine. ‘The excruciating back pain that he had on admission had subsided’, he continued, ‘but now he was unable to get out of bed because his legs were paralyzed’.

I told Dr. Reynolds that it was unlikely anything could be done surgically to help Mr. Cook but that I would go by and evaluate him if he wished. He said that would not be necessary. He just wanted me to look at the films and let him know if there was anything that should be done.

As soon as I hung up I was called back to OR room #4 for my next surgical case of the day. I finished up operating at about 6pm, and after I dictated my surgical note and checked on my post-ops I thought about Mr. Cook. I knew I wasn’t expected to see him but I felt compelled to drive over to Countryside Hospital and see him nonetheless.

As it turned out I had performed surgery on Mr. Cook’s wife many years earlier so he knew me, and in fact, he was expecting me. As I talked to him about how he wound up in the hospital he told me that up until about 4 weeks ago he was just fine. He and his wife had gone over to the Florida east coast but because he ‘just didn’t feel right’ he told his wife they needed to cut their trip short and return home.

When I was given his history earlier in the day I just assumed he had been diagnosed with multiple myeloma several years ago and that now his MRI revealed the end stages of the disease. But he had just been diagnosed 10 days ago.

When I examined him, I discovered he was ‘paralyzed’ in his right leg but that the strength in his left leg was only mildly weak. I then discussed with him options and prognosis. ‘In most circumstances such as yours I would remove the crushed vertebra and replace it with a metal or plastic cage filled with bone’, I told him. ‘Then I would place screws and rods in the spine above and below the fractured vertebra to stabilize it’, I continued.

‘But because the cancer had affected so much of your spine, I can’t do any of that. And because of your age, I’m not sure you would survive such an extensive surgery anyway’, I concluded.

‘So, what does that mean’, he asked. ‘Well’, I said hesitantly, ‘I’m not sure you will ever walk again’.

Choked up, Mr. Cook said, ‘Oh my God, my wife is too ill to take care of me…’ Looking down at him lying in his bed, still in pain and unable to get up and walk, I was sorrowful, wishing there was something I could do, yet realizing surgery was too risky.

I told him I was sorry and that perhaps with continued radiation treatments, he still might get better, although I knew this was not likely.

As I stood at the nurse’s station writing my progress note in Mr. Cook’s chart, I felt compelled to look at his MRI scan again. As I flipped through the images I thought to myself, ‘there’s got to be something I could do that might help’.

I called Chris, one of my colleagues to discuss his case. He too, agreed that Mr. Cook at 81 years-of-age would never survive a major surgery. But perhaps if I removed some of the bone from the back part of the spine, he suggested, this would free up enough of the pressure on the spinal cord so that his strength might improve to the point where he could walk again.

I thanked him, hung up the phone and walked back into Mr. Cook’s room.

I told Mr. Cook that I had given his problem more thought and there was something I could do surgically that might help him. ‘However, while I cannot promise you it will be successful, I think it may be worth the risk’. Not surprisingly he was willing to take that chance.

I spoke to Dr. Reynolds and explained my plan who then agreed to have Mr. Cook transferred to the hospital where I would perform surgery in the morning.

Surgery went well and though the cancer had destroyed most of that particular vertebra I was able to relieve the pressure on Mr. Cook’s spinal cord. Over the ensuing weeks following surgery Mr. Cook gradually regained strength in his leg and began to walk using a walker and some assistance.

For me, Mr. Cook’s case reinforced to me the importance of several things. The first is that nothing replaces talking to and examining the patient myself.

Not only does this allow me to get a real sense of the patient’s problem but also helps me to understand the true impact of the illness on the patient and his (or her) life.

In Mr. Cook’s case I initially dismissed ‘out of hand’ that anything could or should be done surgically in someone who had widespread cancer. However after speaking to him I realized he was living a normal life just 2 weeks earlier. Not only that but his wife was very ill herself and there was no way she could take care of him.

So as I stood there leaning up against the counter at the nurse’s station, I felt a change of heart. Was it merely my sense of compassion… or was it an angel, or the Holy Spirit that inspired me, reminding me I was given my gift to help others.

And so, grateful once again for be able to hear that voice in my head, I did what I could to help Mr. Cook, and his wife.

“The wind blows where it will, and you hear the sound

of it, but you do not know whence it comes or whither

it goes; so it is with every one who is born of the Spirit.”

John 3:8

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

 

Mental Telepathy and a Miracle in OR #4, continued

 

As I moved the tumor away from the spinal cord I saw what appeared to be nerves within the wall of the tumor… and they were cut. ‘That’s impossible…it couldn’t be’, I thought. ‘It just didn’t make sense’. Immediately I thought the pathologist’s interpretation had to have been wrong. It must be a tumor that arose from the nerves themselves and not a meningioma. So I took a biopsy from another area of the tumor and sent it to him for reexamination. Several moments later the pathologist called back into the room and said it was indeed a meningioma.

So I inspected the area between the tumor and the spinal cord again. Perhaps, I thought, the tumor arose from the dura laterally and as it grew slowly toward the spinal cord it displaced not only the spinal cord but the sensory and motors nerves along with it. The thing of it was, I couldn’t trace these ‘nerves’ back to the spinal cord where the motor nerves exit en route to the biceps muscle in Annie’s right arm.

Perhaps these ‘nerves’ were actually sensory nerves that were pushed down by the growing tumor toward the motor nerves and then looped backed on themselves to join the other sensory nerves. Regardless, I thought, because they were so adherent to the tumor wall, they were very likely permanently damaged anyway and not functional.

To be sure, I stimulated them with a nerve stimulator but there was no response.

It is at times like this during a case that I stop what I am doing and reassess the goal of my surgery…the purpose for subjecting this lovely elderly woman to a major operation. Sure it would have been nice to be able to completely remove the tumor, but to do so would have been, at least in part, to gratify my ego as the ‘best neurosurgeon on the planet’! No, my reason for operating in the first place was to decompress the spinal cord or to remove that pressure that was threatening to permanently damage Annie’s spinal cord and paralyze her from the neck down. And I had already accomplished that.

Besides this was a slow-growing tumor and Annie was 84-years-old, so the likelihood this tumor would grow back and cause any significant problems in the time that Annie had left was remote. Not to mention to extend the length of time Annie was under general anesthesia at her age would only increase the risk of post-operative complications.

And so it was at this point I decided that ‘the enemy of good is better’!

This is a truism that I have learned pertains not only to surgery but life as well. Often times we attain an acceptable outcome in whatever we may have set out to do and any attempt to attain ‘perfection’ only serves to undo all the good we have already accomplished. And so at times like this we should be happy with the ‘good’ we have done and we must bury our pride when our ego wants to be ‘better’.

As a safety measure, instead of merely suturing the dural tube closed, I inserted and sutured in place a tissue graft to enlarge the diameter of the dura. In this way, if the tumor did grow it would have twice as much space and thereby lessen the likelihood it would ever cause undue pressure on Annie’s spinal cord.

Immediately after the surgery, when Annie awoke from the effects of general anesthesia, I went into the Recovery Room to examine her. To my grateful surprise, the strength in her right arm and hand was completely normal! There was no abnormality or deficit of sensation or motor function. It actually was not the first time I have expected a neurologic problem post-operatively only to discover there was none.

Perhaps, those nerves were not working to begin with or that they were redundant and not needed, or perhaps it was just miraculous. Regardless, the way in which the events of Annie’s surgical procedure transpired certainly affected what I did surgically. And I am convinced that was the true miracle…that Annie came through the surgery fine, without any complications.

Soon after I checked on Annie, I went out to the surgical waiting room to speak with Jill. I sat down and began to describe to her the events of surgery. Half way through she interrupted me and said ‘you know, it seemed to me that the surgery was taking a long time so I said to myself, I wish he would just remove the part of the tumor that was compressing the spinal cord and not worry about trying to get the entire tumor out’. To which I replied, ‘well, that is exactly what I did’. Jill promptly smiled and thanked me for everything I had done. I reassured her that her mom was resting comfortably in the recovery room and was doing fine, her strength was normal and that she would be up and about in no time.

And so I left to make rounds feeling blessed that I listened to my conscience and the angels that always whisper in my ear, hoping I will listen.

“Do nothing from selfishness or conceit, but in humility count others better than yourselves. Let each of you look not only to his own interests, but also to the interests of others” Philippians 2:3-4

Mental Telepathy and a Miracle in OR #4

Annie Carter is a very pleasant, spry 84-year-old woman who had been quite healthy all her life. So she was a little surprised when her doctor, Dr. Thomas sent her to the Emergency Room because she thought Annie was having a heart attack. For several days she had been experiencing some pain in her upper back, across her shoulder blades. She didn’t have chest pain or left arm pain radiating up into her jaw, the typical signs of a heart attack. And she certainly didn’t have the sensation that an elephant was sitting on her chest! If anything it felt like a horse kicked her in the back. She had an EKG performed, blood drawn for tests and was admitted to the intensive care unit. The cardiologist examined her and reviewed the results of all her tests and concluded she did not have a heart attack. In fact her heart was healthier than someone half her age! Of course none of that surprised Annie. She was then discharged home.

Nevertheless, she continued to have these pains and in fact they worsened in severity becoming burning in quality as well. She also developed some tingling in her right arm, oh and by the way she had been experiencing some numbness in her right foot as well, which she had forgotten to tell her doctor initially. Because of this Dr. Thomas ordered an MRI of her cervical spine, thinking Annie had to have a pinched nerve or two in her neck. Well she had more than a pinched nerve. When Dr. Thomas called with the results of her scan, Annie was more than a bit surprised when she was told she would need to see a neurosurgeon…she had a spinal cord tumor that could paralyze her at any time!

When I saw Annie in my office she was accompanied by her daughter Jill, who was a carbon copy of Annie, just younger. They both appeared young and vibrant, and Annie certainly seemed much younger than her 84 years. When I examined her it was clear to me she had something compressing her spinal cord, as there were early signs of spinal cord damage.

I then brought up the images of her cervical spine MRI on the computer in the examination room and began to review the findings with Annie and Jill.

The cervical spine is made up of 7 roughly block shaped bones (or vertebrae) that sit on top of one another. (The first and second vertebra, however, have a slightly different shape, but nonetheless sit in line with the others.) Separating these blocks are the discs, or spongy-like shock absorbers that also allow the spine to bend forward, backward, side to side and also twist or rotate. Each spinal block has two small bones that protrude backward from each side, kind of like the walls of a house. Every house, of course needs a roof, so on the back side of these small bones is a gable-like roof that encloses the space called the spinal canal. It is here that the spinal cord is protected, enclosed within a sheath of tissue called the dura, which is shaped like a tube. Within this tube is also the cerebro-spinal fluid which bathes and cushions the spinal cord. Within this spinal canal the spinal cord travels from the brain down to the rest of the body.

The bony spinal canal in Annie’s neck was approximately 1 inch in its widest diameter. The spinal cord occupied about half of this space. The tumor was located at the level between the fifth and sixth vertebrae within the dural tube, on the right side, and was twice the size of the spinal cord. Because of it size it deformed her spinal cord and pushed it to the left. In spite of her age I had to do something to lessen this pressure before the tumor caused significant paralysis of her arms and legs.

Fortunately, based on its appearance on the MRI scan the tumor was benign and not cancer.

I spoke with Annie and Jill about the surgical procedure and the risks involved, and though I told them the risk of paralysis was small, it was always a possibility. They understood and wished to proceed with the operation.

At the time of surgery, I cut away the roof of the house of the spinal canal at the fifth and sixth level. Having peeled away the tissue layer enclosing Annie’s spinal cord, the spinal fluid flooded my surgical field. After I suctioned this fluid away, I could easily see the tumor squashing Annie’s spinal cord. At this point I moved the operating microscope into position in order to be as precise as I could be removing the tumor. Protecting the spinal cord with tiny cotton sponges, I biopsied the tumor. Shortly afterward, the pathologist confirmed the diagnosis; it was a benign tumor, a meningioma.

On the surface of the tumor were the small nerves coming from the spinal cord, which supplied sensation to Annie’s right arm. On the bottom side of the tumor, I knew had to be the nerves supplying the electrical signal to the muscles in Annie’s right arm that would allow her to grasp her coffee cup in the morning and bring it to her mouth so she could drink it.  Damage to these nerves would have devastating consequences, especially since Annie was right-handed.

I then proceeded to remove the tumor using an ultrasonic probe, similar to what a dentist uses to clean your teeth, but this one not only disrupts the tumor tissue, it sucks up the tumor cells essentially shrinking the tumor from the inside. In this way the walls of the tumor can be collapsed and thereby dissected, or moved away, from the spinal cord and its nerves.

Some spinal tumors which arise from the nerves of the spinal cord invade and encompass these nerves, which prevents removal of the tumor without cutting or sacrificing them. Meningiomas, in general push away the spinal cord and its nerves and while it may be difficult to dissect those nerves away, using the surgical microscope, it is possible.

When I had removed a majority of the tumor and could push the wall of the tumor away from the spinal cord I was able to see on the other side of the tumor, expecting to see the motor or muscle nerves passing along the back side of the tumor and out through their opening in the spinal canal traveling to Annie’s right arm. When I did so, however, I was quite literally shocked at what I saw….

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.