Spiritual Experiences from the Brain

A Physician Greater than I

I had just finished operating for the day and I had a meeting to attend but I told my wife before the meeting, I would join her and the children for a quick picnic, and if I didn’t leave soon I would be late. To say I was rushed was a bit of an understatement, but first I had to run up to the ICU and quickly see Nora Horace who I was scheduled to operate on the next day for metastatic breast cancer to the brain.

Nora had been diagnosed with breast cancer several years ago and had undergone treatment, including chemotherapy, but a recent PET scan was clear. So it was quite a shock when the emergency room physician told her she might have a brain tumor.

Nora had been having some imbalance and unsteadiness walking but she thought it might have been side effects from the chemo, but when it got worse, she and her close friend Diane felt it best to have it checked out further.

She actually had been admitted the evening before and I had been called during the afternoon and was told of her case. So when I reviewed the CT scan, I ordered an MRI to be done the following morning and told the nurse I would be by to see Nora the next day after I finished operating.

The MRI indeed revealed a large tumor in her left cerebellum which is the area of the brain responsible for coordination; in addition the pressure it exerted on the brain around it, caused compression and partial obstruction of the flow of cerebrospinal fluid within the brain. This was even more critical because if the flow became completely blocked off, the pressure within the brain would reach a life threatening level.

So it was clear I had to operate to remove this tumor. Unfortunately, Nora also had three ‘pea-sized’ tumors elsewhere in her brain which indicated her metastatic disease was more widespread.

As I walked into her room, she greeted me in a warm way similar to what I had experienced at a resort in the Bahamas many years before. This was her nature because she, in fact, was from one of the islands in the Caribbean.

I brought up the images of her MRI on the portable computer to show her and her friend the nature of the problem. After I finished describing the findings on the MRI and explaining the surgery I had planned, I fully expected her to be like most patients, a bit shocked, a bit depressed but resigned to what needs to be done. At that point most patients say ‘ok, whatever you say doc’. My reply is often a bit curt as I nod and tell them I will see them in the morning, as I turn to leave.

And this day I had planned on it playing out that way, so I could be on my way to where I had to be.

But what she said, stopped me… dead… in my tracks.

Nora then replied, ‘I am not afraid doctor… I know the Great Physician… do you know Him?  I said ‘Yes I do…very well.’ She said ‘that is good because sometimes when I ask people, do you know Jesus Christ? They tell me he was just some guy.’ I continued, ‘No, He is way more than just a guy’.

She then asked if I prayed to Him to guide me before I operate and I replied, ‘all the time’. Nora then asked, ‘Well tomorrow before you operate on me’, as she pointed to the sky, ‘I want you to call Him… collect!’ Practically with tears in my eyes, I promised I would.

I shook her hand with both of mine and told her I would see her in the morning, as I slowly turned, to walk out of her room.

Going into the surgery I anticipated that removing the tumor would be fairly easy, since most tumors of this type are not adherent to the surrounding brain. As it turned out removing the tumor was extremely difficult and I spent no less than six hours micro-surgically teasing the tumor out.

The amazing thing to me was that throughout the procedure, ‘ideas’ would pop into my head on how to proceed, which were not necessarily techniques that I usually employ. As a result I was able to completely remove the tumor without any complication whatsoever.

As I was finishing up, I thought about this, realizing that God had been with me and by my side guiding me every step of the way.

The following morning, I examined Nora and found her to be completely normal neurologically. Though the pain of the incision caused her to wince, she said ‘I am grateful to God, grateful that you are a Christian, and grateful that He worked through your hands to help me’.

for she said to herself, “If I only touch his garment,

I shall be made well.” Jesus turned, and seeing her he said,

“Take heart daughter; your faith has made you well.”

And instantly the woman was made well.

Matthew 9:21-22

Quality of Life

Quality of life. This seems to be very important to most people when making decisions about a lot of things. Whether it is renovating a kitchen, taking a dream vacation or deciding whether to pursue various therapies for a medical condition that may or may not be curable.

In general, I operate on patients because their quality of life has been impacted negatively. Perhaps they experience pain from a ruptured disc in their neck or lower back. Perhaps they have developed severe weakness due to a brain or spinal cord tumor.

Sometimes, however, instead of improving a patient’s quality of life, surgery itself, may have an adverse impact leaving the patient worse off than before.

In particular, when I am removing a brain tumor, the dilemma I often find myself in is balancing this quality of life issue with my own ego.

You may find such a thought absurd, because of course a patient’s quality of life would always come first. But what you must understand is that it is because of my ego that I am able to do what I do. As such it is my ego that makes it possible for me to be focused and aggressively treat these life threatening tumors which would otherwise destroy the quality of my patient’s life anyway, and in the worst case scenario take it from them.

However if I go too far, the patient’s quality of life can be made worse, not better. Unfortunately, knowing where that cut-off point is… is not always clear.

Recently I took care of two patients where this was apparent in very different ways. Tom Davis had a large benign brain tumor that technically was so difficult it took me all day to remove it; and Paul Kinsey had an equally large but malignant tumor that extended so deep into the brain it took me nearly as long as Tom’s surgery.

After my initial surgical exposure of Tom’s 2 ½ inch diameter tumor, it quickly became apparent that the tumor was literally stuck to the brain. Not only that but it was densely adherent to the blood vessels that were responsible for providing circulation to the motor area that controlled the left side of Tom’s body.

So I knew I would be spending many hours with my eyes glued to the oculars of the surgical microscope tediously removing the tumor from theses vital structures.

It was perhaps half way through Tom’s surgery that I was becoming discouraged as I began to realize I might not be able to completely remove his tumor. This weighed heavily on my heart since he was only 36 and if I was not successful in doing so, the tumor would recur and very likely prevent him from being the father that his young children needed.

I was also becoming fatigued and as I had learned all too well when you become tired it is very easy to make mistakes that could have profound consequences. So, I stopped momentarily, closed my eyes and prayed to God that He would give me the strength and perseverance I would need to remove Tom’s tumor without causing any injury to the critical areas of his brain.

Roughly, ten hours after I began my attempt to remove Tom’s tumor I had successfully removed 98% of it with only a small amount of tumor adherent to two large blood vessels.

In fact when I zoomed out the microscope to get an overall view of the operative field, I was astounded. It appeared as though the tumor had simply rolled off the brain surface without any damage or discoloration of the brain cortex. I smiled as I shook my head, realizing I had just participated in a small miracle.

Tom did great following surgery and was discharged from the hospital four days later feeling better than he had in a while.

Two days later I operated on Paul and the difficulty I had was no less than I encountered with Tom’s surgery. The difference of course was that Paul’s tumor was a malignant astrocytoma and as such I knew there was no possibility that I could remove it completely. In addition, Paul was 66 and not 36.

So, at face value it would appear that the complete removal of Paul’s tumor was neither possible nor imperative. However, I also knew that Paul’s overall survival would be directly related to how much of the tumor I did remove.

In addition, Paul’s wife knew me and she had requested that I be the one to operate on him rather than my partner or the other neurosurgeon on call who was initially consulted to take care of him. So in reality I felt more than the usual amount of pressure to remove as much of the tumor as I could… safely.

And that is the ‘operative’ word here, safely.

In general the appearance of this type of tumor is distinctive compared to the normal surrounding brain tissue. The problem is it is not always easy to determine when ‘enough’ tumor removal is actually, ‘too much’.

So as I was operating three inches deep into Paul’s brain I contemplated how much more of his tumor I should remove. To a great degree my decision is based upon visual and tactile cues I get, but there is also a ‘sixth sense’. And this is when I pray to God to help me ‘know’ when enough is enough.

Postoperatively, I am not always satisfied with the extent of my resection based on the follow-up MRI. Nevertheless, I have to trust that I did my best. Although more importantly, however, I have to trust that I did what was best for the patient and for the quality of the life of that patient that remains.

In Paul’s case his postoperative MRI looked quite good and in fact he was playing a round of golf two weeks after his surgery. That knowledge made me feel good, as I smiled once again, realizing that I was part of another small miracle for the second time in the same week.

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

 

Guilt, Gratitude and a Good Laugh

‘Then our mouth was filled with laughter,

and our tongue with shouts of joy;

then they said among the nations,

“The Lord has done great things for them.”

The Lord has done great things for us;

we are glad’

                                 Psalms:126:2-3

 

I pray for many things. The thing of it is that what I pray for isn’t always what I need’s God’s help for. Fortunately He is merciful enough to help me anyways…and my realization of this shows me He has sense of humor too!

 

Quite a while back I operated on a gentleman, Grant Lisset, who had a brain tumor. Unfortunately the surgery did not go as I had planned. At the time of surgery I encountered an unexpected degree of brain swelling which prevented me from removing the tumor completely. Not only that but postoperatively, Grant, my patient, who entrusted his life in my hands developed paralysis on his right side and an inability to speak.

 

After his initial recovery he gained back his ability to speak and a significant amount of strength in his arms and legs to the point where he was able to walk with assistance.

 

Ultimately, a second surgery resulted in removal of the remainder of his tumor, although I had felt guilty…no, remorseful that I wasn’t able to completely remove his tumor the first time without complication. What had transpired during his first surgery likely would have happened to anyone else who might have operated on him but I, still, felt personally responsible.

 

The thing of it is that my approach to a difficult case is directly influenced by my experience with the one that preceded it. So, when Barbara Nelson came to my office with a similar tumor to what Grant had, I hesitated, initially, to even do the case. However, the tumor had increased by 40% over a year and a half period so despite her age of 81 years, it had to be removed.

 

What made the decision somewhat easier was because of her advanced age I knew I didn’t have to achieve a complete resection. This was because radiation could be administered following surgery and would, in all likelihood prevent it from recurring during her remaining lifetime.

 

In addition the tumor was right on the surface of her brain and from a technical standpoint would be (relatively) easy to approach surgically and remove. Nonetheless, I prayed hard for God to guide my mind and hands that I might successfully remove Barbara’s tumor.

 

The tumor was located essentially in the back of her head on the left side, just above the occipital part of her brain which is responsible for her vision. The only difficult part of the surgery would be exposing the tumor because it was right up against the superior sagittal (venous) sinus which runs in between the two hemispheres of the brain.

 

Essentially, the arterial blood which carries oxygen and nutrients is transported to the brain by the carotid arteries. After the arterial blood passes through the brain it becomes venous blood and drains into the superior sagittal sinus on its way back to the heart. Should any damage occur to this venous sinus the build-up of arterial pressure in the brain can cause a major hemorrhage or worse, death.

 

So it was critical for me not damage the superior sagittal sinus as I removed the skull overlying it to expose Barbara’s tumor.

 

As it turned out the surgery was ‘textbook’. I completely removed Barbara’s benign tumor and she was on her way to the recovery room less than four hours after I started the procedure.

 

The irony of my day in the OR, however, lay with my next case, where I would need every bit of God’s answer to my prayers!

 

It was by every indication a routine case. On Wednesday, the week before Deborah Grant had come to my office complaining of severe pain that started in her neck and radiated down her right arm into her hand. She described the pain as ‘a searing type pain that felt as though it was deep within the bones of her arm’ and nothing she did, not the medication, the therapist nor the chiropractor had lessened the pain a bit.

 

In addition her index and middle fingers were completely numb and when I examined her, the muscles of her right arm were severely weak as well. When I looked at her MRI the reason for her signs and symptoms was clear. She had a ruptured disc between the 6^th and 7^th vertebra that was literally squashing the nerve up against the bony opening through which it normally passed easily.

 

Having successfully removed Barbara Nelson’s tumor earlier in the day, I was feeling quite confident (perhaps even a bit prideful) so I figured correcting Deborah’s cervical disc problem would be a ‘walk in the park’ by comparison. In fact what happened couldn’t have been further from the truth!

 

I had just finished removing the majority of Barbara’s disc and with the use of the operating microscope I was closely inspecting the back part of the disc for a small tear in the ligament that separated the disc itself and the nerve root. Ninety-nine percent of the time I would have expected to find a fragment of the disc that had torn and ruptured through this ligament to put such excruciating pressure on the nerve traveling into Barbara’s right arm…but I found nothing.

 

Immediately I had a sense of dread come over me…I must be at the wrong level! Quickly I looked at the x-ray I had just taken…1, 2, 3, 4, 5… 6 and 7. No, I was at the correct level. But where was the herniated disc! I turned to review the MRI scan. Yes there was the fragment on the scan but why couldn’t I find it surgically?

 

In most cases a cervical disc will herniated more towards the central part of the spinal canal but in Barbara’s case it was far out to the side. Just beyond this was the vertebral artery which is similar to the carotid artery but it travels close to the spinal column to the base of the brain. Once, many years ago while performing a cervical disc surgery I punctured the vertebral artery and I had never witnessed such extensive hemorrhage before or since.

 

And I didn’t want to ever see that kind of bleeding again.

 

But I really had no choice at this point in Barbara’s surgery. I had to make a cut in the ligament to see if the fragment of disc was hiding beyond my surgical view. So I took a deep breath, said a quick prayer and then taking a micro-surgical instrument I separated the fibers of the ligament until I punctured through….

 

Fortunately there was no bleeding but what I did see created a sigh of relief…the fragment of disc I had agonized over not finding for the past 20 minutes! In fact as I probed out along the nerve root I found several large fragments.

 

As I stood there peering through the oculars of the surgical microscope it occurred to me I needed God’s help on this case a whole lot more than I did with Barbara’s brain tumor. And it was that case that I was way more fearful of doing in the first place. I really had to laugh at myself over that one.

 

God really does have a way of getting our attention. And I guess this day He reminded me that even the most ordinary, every-day, run-of the-mill events of our individual lives can be the most important or possibly the most treacherous if we take them for granted.

Perspective and What Matters Most

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blind Faith and Praying For a Cure

As humans we are slaves to our senses. If we can not see it, or touch it, it doesn’t exist. And that is why faith is so hard for many. It requires believing without seeing. But when we are able to believe at the very depths of our soul, our faith can change lives.

Quite a few years ago, shortly after I had finished my active duty service as a neurosurgeon in the US Navy I began my private practice of neurosurgery in Palm Harbor, Florida. One of the first patients I took care of was Shelly Birch. Shelly had a brain tumor and one that I told her would have to be removed surgically. After I explained this to her as well as the details of the surgical procedure and its associated risks, she politely thanked me and got up to leave. When I asked her if she was going to schedule her surgery, she proceeded to informed me she would be having the members of her church pray over her so God could perform the miracle of removing her tumor without surgery.

I was shocked at her suggestion. With an incredulous tone, I told her, ‘that wouldn’t be a good idea’. I continued, ‘if the tumor got even the slightest bit larger it would put you in a coma and you could die’. She smiled and told me resolutely she would be fine.

Several weeks later she returned without any additional neurological problems, actually feeling better than she had in years. She requested that I order I repeat MRI scan so she could see that prayer had cured her. I almost scoffed at the idea, knowing that the tumor would still be there and perhaps even larger. But I agreed, only to show her that she would need me to cure her.

Indeed the tumor was still there, and Shelly consented to having the surgery which I performed without complication. (Interestingly, when I reviewed the follow-up scan with her she didn’t appear all that disappointed. It was as though God’s will was still at work in her life even if the outcome wasn’t as she or her church had been convinced it would be).

Now flash forward almost twenty years. I am more experienced for sure, certainly more mature but without a doubt more religious than I had been when I first met Shelly Birch.

Praying to God for a cure is something that people who are ill should do, but as I have pointed out previously, praying that God would place before us those who can help and possibly cure us is what I believe God would want us to do first. Quite honestly when I treated Shelly Birch, I did not believe God would cure her but I also did not believe God had anything to do with me successfully removing her brain tumor either. At the time I firmly believed that she was cured of her tumor solely because of me. Today, I know that was not the case.

Granted, her story is different from many of the patients I treat with brain tumors because she had a benign meningioma which I was able to completely remove. Not that it wasn’t difficult to do so, it is just that her prognosis happened to be brighter than patients with, for instance, a malignant astrocytoma.

A colleague of mine once said, in reference to malignant astrocytomas and in particular the glioblastoma, ‘we aren’t even treating these patients’ brain tumors (effectively), it’s more like we’re beating them with a stick’. Perhaps from a medical standpoint this may be true, but I think Shelly Birch had more to teach me than I realized at the time.

Actually my experience with Shelly came to mind the other day because of a conversation that I had with the wife of another patient of mine.

Tom Renner is 47 years of age. He had been experiencing symptoms of sinusitis and so he went to his primary care physician. Since he had also been having a low-grade fever and night sweats, his doctor prescribed an antibiotic. After finishing the prescription, his symptoms persisted and so his doctor prescribed a stronger antibiotic. But this didn’t help either and in fact he began to develop some pretty severe headaches. It was at this point his doctor sent him to the emergency room at Mease Hospital.

An MRI revealed Tom had a tumor in the right frontal part of his brain. Because most of the tumor appeared to made up of a cyst and he had been having a fever at night we thought this could represent an infection or a brain abscess. Although deep down I didn’t feel he would be so fortunate.

Indeed it turned out to be a malignant astrocytoma. Surgery went well enough but because the tumor extended to wall of the cerebrospinal fluid ventricle within the brain I purposely did not attempt a more aggressive resection but instead implanted some chemotherapy wafers on the surface of the tumor that visibly remained.

Tom was discharged within five days, with arrangements made for him to begin his radiation treatments in two weeks. Unbeknownst to me, he and his wife Renee had sought out additional opinions at Moffitt Cancer Center in Tampa and then at Duke University in North Carolina. Because of logistical difficulties starting Tom’s treatment nothing was done and two months passed.

Tom then began to experience some increasing headaches and a repeat MRI was done. Because of the findings I called Renee.

‘The tumor has come back’, I told her. ‘In fact’, I continued, ‘it’s probably bigger than it was when I operated on it two months ago’. She was devastated, although she was not that surprised given Tom’s symptoms. She explained the events of the last two months and how frustrated they both were that they could not get the physicians from the different institutions to co-operate with one another.

I told her that additional surgery would probably not be the answer at this point and they should pursue the aggressive chemotherapy and radiation recommended by the local oncologist Tom had just seen. Not having much more to add medically, I told her I would keep Tom and her in my prayers. She thanked me and I hung up.

The next day I remembered Shelly Birch and how I could not believe she was going to walk out of my clinic to pray that her tumor would disappear and now I was praying that would happen for Tom Renner. If only the depth of my faith could be a fraction of what Shelly had, I thought.

As I take care of more and more patients with malignant brain tumors (on occasion, with God’s help, using a ‘very big stick’), I have become convinced that God has a larger role than I could ever have in trying to cure them. In reality, I only treat these patients and it is only God that can cure them… and He’s probably responsible for most of the long-term survivors, too.

‘And Jesus answered them,

“Go and tell John what you hear and see:

the blind receive their sight and the lame walk,

lepers are cleansed and the deaf hear,

and the dead are raised up,

and the poor have the good news preached to them.

And blessed is he who takes no offense at me”.

Matthew 11:4-6

A Colleague, a Friend and a Missed Opportunity

 

Today, a colleague of mine died. We were not close friends but I had known him for almost 20 years. He had been struggling a long time with cancer.

He was a neurologist so I had frequent interaction with him when I began my private practice in neurosurgery. He was an extremely bright man, in fact my former partner, Kevin and I used to say that he was so intelligent that he probably had little room for common sense. Nonetheless, we respected him greatly and always knew that if we had a difficult and puzzling case Bryce was one of only two guys we would go to.

Jack was the other neurologist I knew. He was more of a philosopher. Perhaps not as intelligent as Bryce (although I think we would be splitting hairs here!) but he had a ‘sixth sense’ about patients. He would tell me you had to have a gestalt about the brain and neurological problems. He would say ‘if a clinical finding didn’t make sense in the grand scheme of things you had to at least temporarily disregard it, if not throw it out altogether to see if a diagnosis could be made based on the remaining information’. Otherwise you could be ‘stuck in the weeds’ for a long time, so to speak.

When I was in medical school contemplating what area of medicine I would pursue, I gravitated to neurosurgery because it made sense logically (I was fascinated with neuroanatomy and I loved surgery), but probably more importantly I felt ‘at home’ being among other neurosurgeons. For neurologists, I am certain it is the same; it’s just that the cerebral aspects of the brain captivate them more than wanting to be ‘merely a technician who cuts out what we (the neurologist) have already diagnosed’.

In a way it’s a funny thing that our personalities influence our choice of hobbies as much as the medical specialty we are ‘drawn’ to. Many of the neurologists I have met over the years have been avid gardeners, which in a way is ironic. In neurosurgical residency the patients we would operate on who either had a major stroke or brain hemorrhage postoperatively often became unable to communicate or care for themselves. These patients, or the so-called ‘vegetables’ would then be passed on to the neurologists, who would take care of these chronic patients. We would joke that they essentially would ‘water the garden’ since there wasn’t much else they could do.

Of the two, Jack was the gardener although I’m pretty sure he would have turned up his nose at the notion anyone would have considered him an ‘amateur’ at it. In fact his depth of knowledge was so great it would have more appropriate to consider him a botanist. Bryce on the other hand was an avid photographer. So while Jack seemed to revel in the evolving colors of the plants and flowers that he nurtured, Bryce found immense satisfaction in capturing those brilliant moments of nature with his camera.

(By contrast, Jack was also a serious fisherman while I, the neurosurgeon would rather scuba-dive and spear the fish.)

Jack, too, had been sick. He had chronic neck pain and despite several surgeries he required frequent pain medication and occasionally oral prednisone. He also had an aortic valve problem for which he underwent open heart surgery, but apparently his heart had become weak from years of being overworked. And one day about a year ago his heart began failing and despite the heroic efforts of his doctors, he died. When Lora, his wife called me to tell me, I was shocked, saddened and I think, a bit upset. I had just seen and spoken with him on Halloween, several weeks earlier. While not the picture of health he sure didn’t seem like someone whose heart might fail him at any time.

Bryce, fought his disease courageously and at one point it appeared he had won. As of late, however he did not appear well; though because he was a private person and less vocal than Jack I could only make the assumption his cancer was no longer in remission, based on my impression of him. So when I heard he had been hospitalized and was not doing well I was not taken by surprise. Several days later when I heard he had died I almost felt a sense of relief for him.

At first this feeling did not seem strange. For I knew Bryce was finally well and at peace himself; just like he looked in those radiant, healthy, younger photographs of himself. But then I began to wonder why I felt one way with Jack and another with Bryce. I really didn’t socialize with either of them very much outside of work, but I felt more of a kinship to Jack than Bryce. I guess because Jack had ‘taken me under his wing’ when I was starting out, he was more friend than colleague. In a way I sort of had a feeling that he should have been a neurosurgeon rather than a neurologist.

Then I began to think about all the funerals I attended growing up. I came from a large Italian family with many aunts, uncles and cousins. And it seemed like someone was always getting married or dying. So I probably attended as many funerals as I did weddings.

Funerals seemed a bit odd to me. First of all the funeral homes were either Italian (Maiorana) or Irish (Murphy), and depending on your nationality of origin that is who you would call to ‘make the arrangements’. On the night of the wake in the front of the funeral parlor was the family of course but also older matriarchs of the family, usually of distant relation, that held their handkerchiefs in one hand and cried all night. Most of the people sat quietly in the center of the parlor after paying their respects to the family and remarked to one another how good the deceased looked. In the back the men milled around talking to one another as if they were at their favorite bar. The only thing missing was the beer… or was it Dewar’s!

Had I finally become so numb to the dying of patients and family that I was no longer capable of feeling sorrow?

No, that wasn’t it. I knew in the depths of my being that I when I died I would become united with Jesus Christ, my God and for whatever reason I felt that was where Bryce was. I really did not have first-hand knowledge of either Bryce or Jack’s spirituality or faith but I had a strong sense that Jack lacked this in his life.

Sure, I was saddened by his sudden death but I think more so I was upset with myself for not at least speaking with him about my faith and telling him how important it was to me personally and professionally.

Jack was a good, honest and kind person despite his seemingly abrasive exterior so I’m sure eventually he will be in heaven. But for my part I felt should pray for him and his soul that he would get there sooner than later. And so this is what I did for months afterward whenever I would pray the rosary… “O my Jesus, forgive us our sins, save us from the fires of hell, lead all souls to Heaven, especially those most in need of Thy mercy”.

And so, two men, both brilliant and talented neurologists had their lives snuffed out in the apparent prime of their lives. I have to believe there is a reason for this but I firmly believe one day they both will be united together with our Lord in Heaven.

Illness, Prayer and My Summer Vacation

 

This past week we had been on vacation. It was to be a road trip of sorts and one of the stops was to visit with my parents who at 88 years of age were celebrating 56 years of marriage.

 

It didn't turn out the way we planned and in fact we had quite a scare.

 

I have been on the other side of medicine a few times in my life. It always gives me an appreciation of what patients feel when they have to give up total control to someone else, who literally has your health and in some cases your life in their hands. Nothing can prepare you, however for what we as parents went through when our little boy became so sick that he wound up being admitted to the hospital for the first time.

 

During my internship in general surgery and my residency in neurosurgery, I never liked pediatrics. It wasn't that I didn't like children but dealing with anxious parents was ten times, no one hundred times worse than dealing with adult patients or even their families Of course at that time in my life, I could care less about the 'feelings' of my patients or their families. I considered it extraneous to becoming 'the most talented neurosurgeon on the planet'! In retrospect, it is ironic that I have come to realize that allaying the fears and anxieties of my patients and their families, often times, from a spiritual perspective is even more important than what my hands can accomplish.

 

So, I was keenly aware of the difficulty of being a pediatrician but it wasn't until this past week that I came to fully appreciate how important the care they provide truly is. Of course without the nurses and physician assistants that surround them, their job would be next to impossible. I say this because not only did they have to get our boy well, they also had to, and this is the hardest part, calm my wife and me down and convince us that they would do just that.

 

Upon arriving to Connecticut, Michael was feeling fine. That night after dinner, however he developed a fever. I didn't have a thermometer at the time but experience told me his temperature was certainly over 101 degrees. I began administering Tylenol every few hours or so but his fever didn't seem to break. The next day he only seemed to get worse and he began to develop severe gastrointestinal symptoms along with nausea and vomiting. Not only could I not get any Tylenol in him but because he would not drink any fluids, he was becoming dehydrated too. When his temperature hit 105, I knew it was time to go to the hospital.

 

On arrival to St. Mary's Hospital, I told the woman at the desk what the problem was and she immediately rushed us back. The nurse took his temperature and fortunately it was down to 103. They immediately got him a bed in the pediatric section of the Emergency Room and within a short period of time a seasoned nurse came back and effortlessly got an IV in his arm and drew blood for the necessary lab tests. I knew he was sick because he hardly put up a fight even when he saw the nurse coming with the IV needle and tubing in her hands.

 

Soon the pediatric ER doctor came back and told us they suspected he might have appendicitis. The thought of our little boy having surgery began to raise our anxieties and my blood pressure. 'That just couldn't be', I thought. 'His abdomen was so soft without any of the signs of an inflamed appendix'. But after all, I was just the dad who happened to be a neurosurgeon, not the pediatric surgeon. So we waited.

 

Soon, the surgeon, Dr Zarif came in and examined him. He impressed me as experienced and his demeanor was calm and comforting. He looked at us and told us he did not believe Michael had appendicitis but that he would need to be admitted for intravenous hydration and continued observation. We were somewhat relieved but still concerned because our boy was still so sick. Fortunately, it just so happened the pediatric floor of the hospital was actually owned and staffed by Connecticut Children’s Hospital.

 

Our worries however were far from over. I spent the next two nights helping to take care of Michael, getting up every one or two hours helping him get to the bathroom as I navigated his IV pole and then washed him afterwards.  It was a though he was an infant all over again completely dependent on my wife and I for his care .

 

By the following morning as a result of the frequent trips to the bathroom along with the occasional episode of vomiting, he began to experience abdominal pain. Dr. Zarif still did not believe he had appendicitis but rather a severe form of gastroenteritis and colitis. So he consulted a pediatrician, Dr. Jennifer Gannon, who was in contact with the pediatric gastroenterologist in Hartford, Connecticut.

 

Soon we were also told that Michael also had blood present in his urine which could represent a complication of the gastroenteritis, called hemolytic uremic syndrome. Quick research on my part revealed this syndrome could result in kidney failure and in worst cases, heart failure, or coma. And because many of the more effective pain medications could increase the likelihood of this potentially life threatening complication, the doctors and nurses were unable to use anything stronger than Tylenol.

 

It was agonizing for us. There was nothing we could do to make him feel better and it seemed that there was nothing the medical staff could do to either. We just had to wait it out.

 

On the second day of our hospitalization, I picked up a publication of the Connecticut Children’s Medical Center, called ‘Pediatric Matters’. It told a story of a 7-year-old boy who survived an illness much more severe than our son’s. As a result he was selected as a ‘Champion Child’ to represent the medical center as part of the ‘Children’s Miracle Network’ program designed to raise awareness of the specialized health care and research supported by the Children’s Miracle Network and its affiliated hospitals, like the Connecticut Children’s Medical Center.

 

I have to admit I was a bit sleep deprived when I read this but the use of the word ‘miracle’ struck me. The story did not mention faith, religion or prayer but to me the implication was clear. What we could do for our boy was to pray. Not that we would have ever considered not praying, but the urgency of our prayer was never more certain to me in that moment.

 

And not that our prayers would be any less important to God than the next person, but I do believe that the more people who pray for you the more meaningful the prayer is. And that is the interesting thing about Facebook. As a social media it allows people to communicate across the world to friends and strangers alike, though much of the information is often pointless. However, in this situation… in this crisis we found ourselves in, instead, it became a network of people who not only passed along their thoughts and concern but also prayed for us. I have to admit, however, this was not my observation but that of my wife, Stacy, once again reminding me that I don’t know everything.

 

We also found it comforting to be near my mother. She has always been a deeply religious and prayerful person. In fact she initially entered the convent before deciding that her true vocation would be to raise a family. Recently I needed her prayers and she was there for me and now she was there to pray for our son.

 

On the fourth day of our hospitalization, the staff was getting prepared to transfer Michael to the main hospital campus in Hartford for a colonoscopy and biopsy as the diagnosis was in doubt. That afternoon the third and final culture returned positive for Salmonella (the first two were negative) so the transfer would not be necessary. And almost as soon as we were told the results Michael became well. His temperature became normal, his abdominal pain subsided and he wanted to eat. The following day he was discharged and by the looks of him you would never know he had ever been so sick.

 

So our thanks go out to our family and friends for their prayers, and to Dr. Zarif and Dr. Gannon and all the nurses and physician assistants for their part in our little miracle.

 

‘And whatever you ask in prayer, you will receive, if you have faith’

Matthew 21:22

Rock and Roll, and a Prayer

 

‘You can’t always get what you want,

But if you try sometime you just might find,

You get what you need’

Mick Jagger, 1968

 

I can’t recall how many times I have heard this song, but these words are forever embedded in my brain, coming to forefront of my thoughts from time to time.

There was the time about 10 years ago, when my neurosurgical practice was in disarray and I was facing many obstacles. I actually had seriously considered quitting practicing altogether. Through the course of many events I found myself at a men’s retreat at my parish church. Early in the morning of the first day I sat, somewhat nervously, at a table with about 7 or 8 others. Joe, our group leader quickly made me feel at ease, as he was the embodiment of love and acceptance, seeing the good in everyone. We started out the morning reading a scripture from the bible, one I should remember but I cannot. Joe asked us what we thought Jesus was saying to us in that particular passage. Almost immediately and without thinking, I said, ‘You can’t always get what you want, you get what you need’.

As it turned out, by the end of the weekend I discovered that what I did for a living was not merely a job it was a vocation.  I had been given the talents to help and heal others and this was truly a gift from God. And even when my hands could not heal my patient’s bodies I was in a unique position to help them emotionally or spiritually. And while I had ‘wanted’ to quit doing it I realized what I ‘needed’ to do was to fight through whatever adversity I had because in relative terms they were minor in comparison to the problems of the patients I was asked to treat.

For many years I thought of neurosurgery as a means to inflate my ego and to monetarily provide me with the lifestyle I wanted. But now, I came to the realization of my true purpose as a brain surgeon; that there were a great many more things I was not only capable of but had a responsibility to integrate into my practice and my life.

Many of us, me included think we know what we want even to the point of praying for it. We certainly don’t want to get sick or get a brain tumor but it happens anyway…

On Wednesday I saw a woman in the office, Kathy Poster who is 62 and is a diabetic. “A brittle diabetic’ she told me. By this she meant that her diabetes was extremely hard to control…that her blood sugar could be over 600 or less than 50, before she would even know it. She told me that she frequently would wind up in the hospital for days on end when her diabetes got out of control which happened regularly. Though she had been diagnosed about 10 years ago she is considered a Type I diabetic.

To look at her you wouldn’t think she had diabetes. She is thin and without any other medical problems. In fact when her doctor in Massachusetts sat down with her to tell her she had diabetes, she said, ‘you’re full of s___, no one in my family has diabetes so how could I have it.’ I told her while I had Type II diabetes I had the same reaction, only I didn’t use the ‘s’ word.

But with being repeatedly sick and in the hospital with diabetes Kathy had become angry and depressed. ‘Why couldn’t this one or that one (in my family) have gotten it instead of me’, pointing her finger back and forth as if those family members were sitting in front of her.

But as of late, with help, she had learned to let go of her anger and in fact she had me smiling and laughing the entire time she sat in my office.

So how is it that any good can come from Kathy Post having diabetes or Tom Tremain (March 8, 2010) (or any of the other patients I take care of)  having a malignant brain tumor and how is it that any of this can be can possibly be what we need. I guess it just depends upon our perspective. As I have mentioned before, we often hang on to our life here on earth with clenched fists and anything that diverts us from our ‘wants’, be it sickness or family turmoil often times causes us to become angry and to grip tighter.

‘We know that in everything God works for

good with those who love him, who are

called according to his purpose’

(The letter of Saint Paul to the) Romans 8:28

 

Yesterday I had a talk with my son because he had disobeyed his mother. I explained to him that his mother and I were placed here on earth by God to take care of him and to guide him until he was able to take care of himself (or until our guidance was no longer needed, though I did not tell him this). I went on to tell him that when he disrespected his parents he was also making Jesus unhappy too, because God was the one who picked his mother and I to take care of him. He seemed to understand and appreciate what I had said and then went about swimming in the pool.

I know that when God’s use of me as a neurosurgeon is done then something likely will happen that will prevent me from continuing to practice. And I know that when God’s use of me here on earth is done He will take me. When that time comes it may be a sad time for those I leave behind or it may be a time that was anticipated and embraced by those that remain. Either way I have to believe that it will be for the ‘good’ and ‘according to his purpose’  

I’m not certain if Mick Jagger and Keith Richards were trying to be philosophical or even spiritual, or whether the verse just sounded right but I don’t think many rock lyrics have ever been as close to something Jesus might have said than these.

In fact, He did… '"And in praying do not heap up empty phrases as the Gentiles do; for they think that they will be heard for their many words. Do not be like them, for your Father in heaven knows what you need before you ask him. Pray then like this:

Our Father who art in heaven

Hallowed be thy name.

Thy kingdom come,

Thy will be done, On earth as it is in heaven.

Give us our daily bread;

And forgive us our trespasses, as we have forgiven those who trespass against us;

And lead us not into temptation,

But deliver us from evil"'

Matthew 6: 7-13

A Confession

 

I have a confession to make.

In my last post, “Decision, Direction and the Holy Spirit”, I made the following statement: “And having operated my way out of seemingly impossible situations many times before it is easy to understand how I would come to believe that I am indeed the ‘most talented neurosurgeon in the world’”.

The fact of the matter is that for many years I not only believed I this, I considered myself god-like. That all my talents and my skill came from within, and that the illnesses I cured and the lives I saved were entirely because of me. Ironically, as neurosurgical residents we would say, ‘as soon as you would think you were the best, a complication would occur or a patient would die to remind you that you weren’t as good as you thought you were!’ But my memory of these ‘minor setbacks’ was short and in no time I would be convinced they had nothing to do with anything I did or failed to do.

During my training in Atlanta an article appeared  in a magazine pullout of the Sunday paper which referred to neurosurgeons as the ‘High Priests of Medicine’. To me at the time it seemed an accurate portrayal of our supernatural powers.

All this may seem at the very least arrogant, although sacrilegious is probably closer to the truth. Unfortunately I held tight to this view of the world around me for many years.

It would only be years later with the help of my wife that I would place Jesus Christ in the center of my life. Only then would I realize that my talents and skill were gifts from God. Thus becoming more grateful, I also realized my patients deserved not only the work of my hands but to know my ability to treat and heal them was from God not me. That, I no longer ‘walked on water’ as so many of them had said in past.

I am compelled to share this with you because of a CD I was listening to in my truck on Wednesday as I was driving to meet up with the rest of my family for my daughter’s wedding this weekend. It is a talk by a well know theologian, Dr. Scott Hahn who was speaking on Understanding the Lord’s Prayer.

He was speaking about the petition, ‘Lead us not into temptation’, only Dr. Hahn said that the actual meaning of the word ‘temptation’ was a trial or test. He then went on to say that God tests us not to see how much we know, because he already knows that, but to show us how much we don’t know. Dr. Hahn says, ‘He allows us to enter these tests because we tend to overestimate our own strength and that we underestimate how much we need God’s strength; and how often we find ourselves in over our head and yet God is only a prayer away.’

It was at that point a light bulb went on over my head. I certainly had come to appreciate that my abilities were gifts from God, and as I have pointed out previously prayer during surgery has become very important to me as well. But, all those times I found myself in over my head and got out ‘without a scratch’ had falsely convinced me of my own superiority. It was only now that I truly realized God was testing me all along and then delivering me from my trial in the hopes I would come to give glory and thanks to Him. It just took me a while to shift the praise from myself to Him.

‘I am weak yet unafraid because Jesus is my friend.’