Spiritual Experiences from the Brain

A Miracle of Words

Charlene Charles had always been a woman with a tough personality, never mincing words, and often times having ‘choice ones’ for people or situations that irritated her.

 

In many ways this demeanor served her well, since she had a difficult life to say the least. She survived the diagnosis and treatment for breast cancer almost twenty years ago and more recently had to undergo chemotherapy for a second cancer, lymphoma and was currently in remission.

 

Though she had periods of time when she saw the glass more empty than full, she managed to fight through it all.

 

Given this history one might feel she had been through enough, but unfortunately she had one more trial to endure.

 

This time, however, things progressed more rapidly and the outlook was darker than it had ever been before. One day she had been fine, and the next day, the words that came from her mouth were a jumbled mess. Speaking with her you could tell by the look in her eyes that her brain knew what it wanted to say but she just couldn’t get the words out so they made any sense.

 

As a result she visibly became frustrated and because of her personality she became extremely angry as well.

 

At times like these I kind of feel like an interpreter attempting to translate a foreign language. Because I have seen so many people with aphasia, or difficulty speaking I can almost tell what the patient wants to say just by listening to their fragmented speech even when the actual words are completely wrong.

 

Shortly after she was admitted an MRI scan was performed and revealed what she and her family had dreaded and I suspected...she had a brain tumor. Only it was not a metastasis from her breast cancer or the lymphoma but she had developed a third type of cancer, a malignant astrocytoma.

 

The following Monday I took Charlene to surgery to remove the tumor. That morning before the nurse took her back to the operating room I went and ‘spoke’ with her. Since she had been receiving a steroid medication for the brain swelling caused by the tumor, her speech was actually more clear, though still not normal. Unfortunately, because of the tumor’s location (left temporal lobe) I realized her speech might not get any better and could even be much worse.

 

She knew that too.

 

Surgery went well. 

 

Though I knew I could not completely removed this type of cancer, I hoped that removing as much as I did would decrease the pressure on the surrounding brain enough that her speech would improve, and that her prognosis would be better as well.

 

I was crushed to discover that following surgery, Charlene could not speak at all. At first I believed this was probably due to my manipulation of her brain as well as the anesthesia and once these effects wore off after two or three days, she would be better. Unfortunately she still was unable to speak, and in fact she seemed to regress to the point where she would not even open her eyes or respond.

 

Two days after surgery I ordered an MRI scan to be performed. When I reviewed it, I had indeed removed a majority of the tumor but I clearly avoided her speech area so I was even more puzzled as to why her condition was so much worse than before surgery.

 

I quickly became concerned that now, she might not even make it out of the hospital alive, let alone survive for 12 - 18 months.

 

Her sister had arrived a few days after surgery and when I spoke to her she revealed how Charlene had on more than one occasion expressed her desire to give up fighting and just join her husband who had long since passed away. 

 

I continued to treat her for whatever brain swelling might still be present in the hopes she would recover but after 5 days, there was no change. When I spoke with her sons later in the day, I expressed my concerns that her recovery was in doubt, as I too, began to accept the inevitable.

 

At the suggestion of the neurologist who had seen her I started mannitol, which is a diuretic of sorts for the brain. Surprisingly, Charlene began to awaken and become more responsive. This didn’t make sense to me from either a medical or scientific standpoint because this medication shouldn’t have had any significant effect this far out from her surgery.

 

What is more is that we only administered this medication for a couple of days, then stopped it, yet her improvement continued.

 

When I saw Charlene 9 days out from her surgery, I was dumbfounded. She was sitting up in bed speaking clearly! Not only was her speech better than before surgery, it was perfectly normal.

 

She then began to relate to me the ‘dreams’ she was having in the days following her surgery. The images she described sounded more like demons and monsters that were out to get her and in that moment I was reminded of a child hiding under the covers in her bedroom to escape them.

 

Looking back, it seemed like, to her, just a bad nightmare.

 

Now, how much of this was the due to the short-circuiting of the complex wiring of her brain caused by the tumor and the surgery, and how much was due to something more inexplicable, I can’t be sure.

 

But what is clearly miraculous is the degree to which her speech completely normalized... and I this is exactly what I told her. 

 

At this point I am unable predict her prognosis since the post-operative MRI revealed there was residual tumor and the diagnosis was that of the worst possible primary brain tumor, a Glioblastoma Multiforme. But what is clear, is that at least for now, she has been blessed with more time to enjoy her family, and they both have the opportunity, perhaps, to say and understand the things they have been meaning to say to one another for quite some time.

 

 

P90X and 'Spiritual' Reps

Years ago, a big part of my life was lifting weights. I was obsessed, you might say. I worked out at least three days a week for 2 – 3 hours at a time.

One day as I was moving from the bench press to the dumbbell rack I thought, ‘I spend so much time chiseling my physical self, if I only spent half as much time on my spiritual life how much better a person I might be!’ But, the thought vanished as quickly as it came to me and I went about with my ‘bicep curls’.

It has taken me many years to get to the point where my spiritual health has taken on a more important role than my physical appearance. Although with my responsibilities at work and the time I devote to my family, helping out with homework assignments and shuttling here and there after school, exercise had been pushed way down on the list of priorities anyway.

Of course as a result my overall health has suffered. Hypertension is something I have had since medical school but diabetes is something I have acquired within the last five years or so and it has gotten worse. So clearly, my health is something I must refocus my efforts on.

But balance is the key. It is important to take care of our bodies and to be the healthiest physical version we can be, but it is equally important to be the healthiest spiritual version of ourselves as well.

 

Do you not know that you are God’s temple and

that God’s spirit dwells in you? If any one

destroys God’s temple, God will destroy him.

For God’s temple is holy, and that temple you are.

1 Corinthians 3:16-17

 

Unfortunately, it is not because we inherently want to be the healthiest version of ourselves although that may be in part, or perhaps completely, the excuse; but because we have a narcissistic desire to look better than the next guy, or girl and to be sure the world knows it.

The irony is that to be the best spiritual self we can be is more difficult to achieve. It takes a tremendous amount of humility and ‘strength’ of character; and when we become prime physical specimens it often brings out in us an attitude that is the exact opposite. After-all being in a state of perfection requires us to crush the opposition, does it not?

In reality, I believe we can be both spiritually and physically strong at the same time as long as we keep things in perspective, but it takes work… and more than bench pressing 275 lbs!

Recently I read in the book, The Measure of a Man, the importance of being meek without being weak! How is this possible?

This is an interesting concept because it would imply that our faith can be strong and when necessary forceful but without being puffed up with pride. After all Jesus warned us about showing off how ‘holy’ we are to others but rather we should keep it to ourselves so that only God knows. (Matthew 6:1-6)

Of course we are human and by our nature we often fail.

Recently, a friend of mine mentioned the workout routine P90X and how it was really effective but that the workouts were intense and that the diet was something you had to stick to. So I decided I would try it out. Besides you could do the workout as intensely with resistance bands instead of weights, which appealed to me because I had injured myself in the past with weights.

I admit the food is not always a gastronomic delight but I have lost weight and in fact my diabetes has been impacted tremendously. And at this point in time, practically speaking, I am not taking any diabetes medication at all! So this has been the greatest motivator for me and my appearance becomes a by-product of my health, and not the other way around.

However…just the other day as I left my Friday morning men’s group I was focused on getting home and performing my workout for the day. But the parish school where my children attended was about to go to morning mass and in the back of my mind I thought I should go too. But that workout loomed large over me.

That’s when I stopped and began to listen to ‘God’s’ voice in my head… ‘Here you are being somewhat critical of those who are obsessed with THEIR workouts and now you are becoming the same way about YOURS!’

I knew He was right, and besides I had nowhere special to be that morning and I could exercise afterwards… so I turned my truck around and returned to the church parking lot. Of course it was a wonderful mass and I was so glad I went. To think I could have lost that important moment in my life and that of my children.

The other day I joked with my wife Stacy that not only was I doing the P90X workout but also one that was more important, the Alpha and Omega X workout! She looked at me a bit perplexed, as I reminded her…

 

“I am the Alpha and the Omega,”

says the Lord God, who is and who was

and who is to come, the Almighty.

Revelations 1:8

 

For me, making Christ, a part of my daily ‘workout’ is what helps me achieve this balance… although as with anything that is worth having, it takes hard work.

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

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

The Love of a Mother

Understandably, with the passing of my mother-in-law, my wife Stacy has undergone a life altering experience. And as much as I might try to comfort her and tell her I understand, the reality is… I don’t. It is more honest to say that I am trying (to understand).

On the other hand, my mother is quite elderly, 89 to be exact and though she has lived a full life and I might think I will be able to accept her passing when it is time, until it happens I really won’t know. What I have come to realize however, from witnessing my wife’s experience and speaking with others, is that losing a mother seems to be a greater loss than when a father dies.

I can’t speak for everyone but while I love and have a great appreciation for my father, I would have to say that the bond between my mother and I is stronger.  In part it is because our personalities are so much more alike, but somewhere in the recesses of my brain I feel it goes deeper than that.

A father loves and provides for his children, as I have done and I would have to say without hesitation that I would lay my life down for my children.

But a mother will sacrifice everything, including herself, every day of her life if necessary, for her child. After all her child is flesh from her flesh.

Recently this occurred to me as I was making rounds in the ICU.

When Jesus saw his mother, and the disciple whom he loved

standing near, he said to his mother, “Woman behold your son!”

John 19:26

Bobby Waters is a 24-year-old ‘boy’ who had been complaining of a headache after having sustained what he thought was only a minor head injury. He then began having some difficulty speaking, but because he did not have insurance he avoided going to see a doctor. However when he became lethargic and his girlfriend found him lying on the floor of his apartment, she called 911.

Bobby was a tall, well-built, good-looking boy who had an equally good-looking girlfriend. Unfortunately, during his hospitalization a lot of that would change, all except one thing.

On arrival to the hospital, a CT scan was done which showed that Bobby had a large hemorrhage deep within his brain on the right side. The size and location couldn’t have been worse for this young, previous healthy boy. It extended into the top part of his brainstem resulting in paralysis of the left side of his body.

And there was nothing that could be done surgically to safely remove the hemorrhage and reverse the damage that had occurred.

The hemorrhage also blocked off the normal flow of cerebrospinal fluid within the brain causing it to back up and resulted in an elevation of the pressure within his brain to critical levels and as a result, Bobby was in a coma.

The neurosurgeon on call emergently performed a ventriculostomy, which is basically drilling a small hole in Bobby’s skull and passing a thin, soft catheter through the brain into the fluid filled ventricles within the brain to drain off the cerebrospinal fluid and thus relieving the elevated pressure.

Unfortunately this only prevented other problems from developing, because Bobby still remained paralyzed and in a coma, and on the ventilator.

Over the next several weeks, Bobby would develop a collapsed lung, pneumonia, an infection in his blood stream and a suspected infection in his brain. And though he survived it all he remained dependent upon the ventilator to breathe for him. And while his brain condition improved to the point where he would open his eyes, if you were to look at him you would hardly consider him ‘awake and responsive’.

Ultimately the CT scan revealed that the hemorrhage resolved although whether Bobby would recover was uncertain at best. The catheter which stuck out from the top of his head that drained into a bag on the side of his bed was removed. In its place was an internalized shunt with a valve that would regulate the pressure within Bobby’s brain so that it would be normal.

He also became less dependent on the ventilator but nonetheless the tube coming from his mouth was converted to a tracheostomy coming from the front of his neck.

Through it all, Bobby became a shell of the vibrant young man he was going from almost 170 to 115 lbs.

One day after about 4 weeks into his hospitalization, as I happened to walk by his room in the ICU I looked on to see a solitary person sitting by his bedside, as she had from morning till night each and every day since his admission a month ago…his mother.

Gone was his brother. Gone were the friends. Gone was his father who as near as I could tell only came to town briefly mid-way through Bobby’s stay in the hospital. Now, she was the only person there, as if keeping a vigil awaiting her baby boy’s first words.

He still has not spoken though he has shown some movement on his paralyzed side. He does know when his mother comes into the room and he tracks her with his eyes as she moves from the door to her usual chair by his bedside.

To me, this epitomizes the devotion and complete self sacrifice of a mother, which as I think about it mirrors the depth of love that Jesus has for each and every one of us.

So, as a child when you lose this person, your mother, there can be no loss that equals the pain that you must feel. I suppose the only consolation is to know that one day you will once again be reunited with her, although the pain persists nonetheless, taking time to lessen. Of course, we still have the ever present person of Jesus Christ who is always there to console us.

Peace I leave with you; my peace I give to you; not as the

world gives do I give to you. Let not your hearts be troubled,

neither let them be afraid.

John 14:27

Walking with Jesus

Jesus said to him, “Rise, take up your pallet and walk.”

And at once the man was healed, and

he took up his pallet and walked.

 

Afterward Jesus found him in the temple, and said to him,

“See you are well! Sin no more, that nothing worse befall you.”

John 5:8-9, 14

 

In my last post I included a passage from Luke’s gospel that told the story about Jesus giving sight to a blind man. The key statement by Jesus was: “Receive your sight; your faith has made you well”. Here, Jesus heals a paralytic but the implication, to me, is not just that the man was able to physically walk, which certainly was a miracle, but that he should also walk in the footsteps of Jesus. And just to be sure the man ‘got it’; Jesus finds him later and clarifies what is really important in his new life by saying, “Sin no more, that nothing worse befall you”.

Recently, my wife’s mother Janice, who had been ill, past way. Because we had been on Cape Cod at the time we had a funeral service there. She was then cremated and when we returned to Florida we had a funeral mass here.

At both services I was asked to deliver a eulogy celebrating her life and the person she was. In contemplating what this was, I kept being reminded that the single most important characteristic of her life was the love she had for her children and later in life, her grandchildren.

A passage from John’s gospel clearly spoke of this to me; It was when Jesus gives his apostles a new commandment that they love one another as He loved them. He then tells them, “by this all men will know you are my disciples, if you have love for one another”.

And this is what Janice tried to become in her life… a true disciple of Jesus Christ.

After we got home to Florida, my wife, Stacy found a journal that her mother had kept. In one particular entry from several years ago, she spoke over and over about walking with Jesus. And how she regretted earlier in life not ‘seeing’ that this is what she should have been doing all along. Yet, she was grateful for finally realizing that this was the path she should be on.

I guess I knew she was close to God; after all He used her to touch and change my heart many years ago when cynicism and selfishness threatened to derail me off my path to help others using the gift God gave me.

But, and I am embarrassed to say so, because she wouldn’t come to church with us on Sunday I merely assumed God was not playing a big role in her life. It is ironic that in our efforts to be ‘good Christians’ we allow the evil one to cause us to be judgmental of others when they do not ‘appear’ to be the same ‘God-fearing’ people we perceive ourselves to be.

Of course she had very real health reasons that kept her homebound but I felt she should have made a better effort to be there. Jesus, I suspect would have been more loving and understanding than I. As it turned out she was walking closer to Christ than I was…

When she was 16, she had a vision while she was hospitalized. She recalled that God appeared to her surrounded by the brightest of lights with a child at His feet. She then heard Him say ‘Do not fear, I am here’. At the time it seemed to me she was more confused rather than inspired by what she had ‘seen’.

Later in life as she looked back on this experience, she regretted not allowing it to influence her decisions in life more. I guess we all have our demons that constantly struggle with the good inside of us. Jan worried a lot and as a result became very anxious. Often she found herself being critical and judging others which led to what she called ‘tears of frustration’.

She realized that often she was not always able to forgive others for what they may have done to her. Quite eloquently she wrote that because of this particular failing she had deprived herself of the gift of God’s love and forgiveness.

The one thing that Jan did excel at all her life though, was her love for all her ‘children’. Very much like Jesus, Jan did cherish the innocence and hope that is embodied in every child.

 

And calling to him a child, he put him in the midst of them

and said, “Truly I say to you, unless you turn and become

like children, you will never enter the kingdom of heaven.

Whoever humbles himself like this child, he is the greatest

in the kingdom of heaven.”

Matthew 18:2-3

 

Later in life though, through much prayer Jan reached out to God in the ‘truest form’ and as result came to truly know Him and as a result was able to not only walk in the footsteps of Christ but ‘with’ Him. Of course she realized her first steps had to begin with forgiveness and in this she found such peace and love.

About 10 years ago, Jan’s husband Don or as he was called by his grandchildren, ‘Pa’ was diagnosed with Alzheimer’s. Throughout this time, Jan devoted every waking moment to him right up until his last day three years ago. She missed him dearly but she continued her journey with Christ. Not that it was always easy…

Two years ago she was diagnosed with lung cancer. Initially it was thought because the tumor was so small it could be successfully treated and perhaps cured with a specialized form of radiation. And for a while she did well and continued to live her life to the fullest traveling to Cape Cod with Stacy and with our family to the cabin in North Carolina.

But earlier this year the cancer recurred and so we all were forced to face the reality that she would die, although the end came more quickly than we had anticipated.

As the summer approached she had wanted to make one more trip back to her home on Cape Cod. A repeat PET scan showed the cancer still had not spread so we felt she would be able to make the trip and we fully expected her to make it back to Florida before the end would come.

In fact she was so happy and gleeful to be heading back to Cape Cod that she seemed to have new-found strength that overcame the weakness of her illness. And as she crossed the Sagamore Bridge she had a sparkle in her eye and a smile ‘ear to ear’.

Sadly, as soon as she got home, she weakened quickly and practically before we could realize what had happened, she passed away on the 4^th of July with her family and friends surrounding her, as a final tear rolled down her cheek.

Watching and helping my wife take care of her in the last several months, as she became more and more dependent on Stacy for her care, it seemed as though she became more and more like the child that Christ wanted her to become that day in the hospital 60 years earlier.

Just this past week, Stacy lay to rest the ashes of Jan (or Mimi as the grandchildren called her) and Pa at home in Sandwich, Massachusetts. Together again, they are surrounded by the love of her Lord, Jesus Christ.

 

‘When a woman is in labor she has pain, because her hour has come;

but when she is delivered of the child, she no longer remembers

the anguish, for joy that a child is born into the world. So you

have sorrow now, but I will see you again and your hearts will rejoice,

and no one will take your joy from you.’

John 16:21-22

Prayer is Just as Sharp as the Scalpel

As he drew near to Jericho, a blind man was sitting by the roadside begging; and hearing a multitude going by, he inquired what this meant. They told him, “Jesus of Nazareth is passing by.” And he cried, “Jesus, Son of David, have mercy on me!” And those who were in front rebuked him, telling him to be silent; but he cried out all the more, “Son of David, have mercy on me!” And Jesus stopped, and commanded him to be brought to him; and when he came near, he asked him, “What do you want me to do for you?” He said, “Lord, let me receive my sight.” And Jesus said to him, “Receive your sight; your faith has made you well.” And immediately he received his sight and followed him, glorifying God; and all the people, when they saw it, gave praise to God.

Luke 19:35-43

 

I can’t quite remember exactly when it was that I started praying for my patients, but I think it may have been right after I operated on Dennis Parker.

Dennis had been experiencing some headaches and ultimately underwent a MRI scan of the brain. This showed he had a tumor at the base of his skull, just underneath the frontal part of his brain and immediately behind his eyes.

Surgery proved to be difficult because there was an extensive amount of hemorrhage from the tumor. Even so, I was able to control the bleeding (or so I thought) and I sent a sample of tissue to the pathologist.

Fifteen minutes later the pathologist called into the operating room after having examined the sample of the tissue under the microscope. He said he wasn’t 100% certain of the diagnosis but in view of the Dennis’ history of cancer he believed it represented a metastasis or spread of the cancer to the brain.

I struggled to remove the tumor, not only because of the hemorrhage but because the frontal part of the brain was swollen and was restricting my ability to expose and see the tumor. Nonetheless, after I had resected what I thought represented a majority of the tumor I decided to close, since further efforts to remove what was left ran the risk of damaging his already swollen brain. And given the likely diagnosis, Dennis would receive radiation to treat what was left.

After I wrote my postoperative orders and dictated my operative note I went to check on Dennis in the Recovery Room. He was awake, talking fine and moving his arms and legs but something didn’t seem right. He appeared to be looking at me but I wasn’t sure he could see me.

I put up two fingers and asked him how many fingers I had up. He said he didn’t know. I asked him if he could see my fingers, and he said ‘no’. I asked him if he could see me. He said ‘no’. I asked him if he could see anything and he said ‘no’. What also seemed somewhat strange was that Dennis did not appear as upset as you would think he should have been.

For an instant, I felt panicked, but as I had been trained I immediately put this out of my mind. There was no place for fear, because that led to uncertainty and that would lead to an inability to act and I knew I had better act quickly or Dennis would be blind for life.

I obtained a CT scan as this could be done quickly. The scan revealed a massive hemorrhage in the area of the tumor, which was twice as big as the initial size of the tumor itself. As a result there was a critical degree of pressure on the nerves that transmitted Dennis’ sight from his eyes to his brain.

I immediately took Dennis back to operating room and prepped him for his second operation of the day although it was now well into the night. The first surgery took 7 hours and I had no idea how long this one would be.

I reopened my previous incision, but this time I enlarged the opening in the skull, extending it to the left side so that the swollen brain I encountered earlier that day would not restrict what I needed to see.

To be certain that this time, I would not have any difficulty in removing the blood clot, I also removed a portion of the frontal part of the brain (lobe) on the right side. I knew with at least 95% certainty that Dennis’ speech area was located in the left frontal lobe, so removing this part of his right frontal lobe would not cause any speech deficit or aphasia.

As expected I now had an excellent view of what I needed to see.

The thing about taking a patient emergently back to the operating room is that your priorities change dramatically and most times this is a good thing. Rather than becoming overly worried about damaging the smallest amount of normal brain, you charge through to the immediate task at hand. After all it’s now truly a matter of life and death. Truth be told, the exposure that I now had is what I should have had the first time around. As a result I performed the second surgery in only a fraction of the time.

I then proceeded to remove the blood clot and the remaining tumor, thus resecting easily 98% of the remaining tumor and relieving 100% of the pressure on the optic nerves coming from Dennis’ eyes. Even so, I was not certain that he would ever see again. Following this surgery Dennis gave me little indication to the contrary as he still wasn’t able to see.

Nevertheless, I had done my job to the best of my abilities and so I figured it really was up to God now. I went home, had something to eat, relaxed a bit and then went to bed. But before I fell asleep, I prayed. I prayed that God would allow Dennis to see again in spite of the fact that my initial inability to remove the tumor completely, had resulted in his blindness to begin with.

The following day I went to check on Dennis in the ICU and what I witnessed was miraculous. He could see. Not only that, but he could see well!

I realize that many people and perhaps most at least in the medical field would believe that recovery of his vision was explainable simply by the fact that the pressure on his optic nerves that caused his blindness in the first place was relieved, and that enough time had not elapsed to cause permanent nerve damage.

I am also certain many will criticize me because I refuse to believe this. Dennis did not just have visual loss, he was completely blind. Not only that, but shining a light in his eyes failed to elicit the normal reflex response in either eye which indicated severe damage to the optic nerves.

Yes, I acted quickly and probably relieved that critical degree of pressure within several hours, but my faith tells me that not only did God act through my hands in that operating room but he also responded to my prayers as well.

From that point on whenever I would perform a complicated brain surgery or perhaps an operation after which I was not convinced I had helped that particular patient, I would pray that God would take over where I may have failed.

People pray for a lot of different reasons. Many times it can be for selfish gain, as I can personally attest to. But as I contemplate about the importance of prayer, I am reminded of interactions of human experience; if I am asked by someone for help, not for him or herself but for someone else I am more likely to feel compassion and a desire to lend a hand even if it requires a degree of sacrifice.

So why would God feel any different? And what is more, if I truly believe my prayers are more powerful than the actions of my mind and hands then why wouldn’t God be more likely moved towards compassion.

    

 Therefore, when Mary came where Jesus was, she saw Him, and fell at His feet, saying to Him, “Lord, if you had been here my brother would not have died.” When Jesus therefore saw her weeping, and the Jews who came with her also weeping, he was deeply moved in spirit and was troubled, and said, “Where have you laid him?” They said to Him, “Lord come and see.” Jesus wept.

John 11:32-35.

 

This doesn’t mean we ignore the abilities that we possess which could potentially alter the outcome of the situation at hand. After all, these are gifts from God and are meant to be used. But at some point I have to acknowledge that my abilities are limited, and without God’s help there will be times that I will fail to help others.

I realize many of my patients have incurable diseases and will die in spite of my surgical skills and my prayers and that is when I must also believe that God has His reasons for allowing these events to occur, and that I can’t possibly hope to understand them. However, He still has blessed me with compassion and though I may not be able to cure their affliction I have come to understand that I can at least lend a comforting and hopeful hand.

Oh, and the tumor that Dennis had…it turned out to be a benign tumor of the pituitary gland!

Walking on Water

'but whoever denies me before men, I also will

deny before my Father who is in heaven.

Matthew 10:33

When people are sick they will say most anything if it means getting well, and if I should happen to ‘cure’ them of their affliction, they often heap ‘praise’ upon me that makes me feel at the very least uncomfortable.

They will say things like, ‘you walk on water’ or you’re a miracle worker. Most times when this happens I am caught off guard and I struggle for something polite to say. I have said things like ‘no, last I checked only two people were able to do that and I wasn’t one of them’, or ‘I'm not the one who works the miracles’.

I often pray that the Holy Spirit will inspire me and give me the correct words to say but it doesn’t always seem that my words are said with conviction.

The odd thing about this type of encounter, is that when these patients say these things, they seem visibly upset when I deflect their ‘words of gratitude’. I sort of understand this because I may appear to them as ungrateful. But while I am truly appreciative of their recognition of what I had done for them, I just can’t accept what they are saying as a ‘gospel truth’!

Perhaps they say these things because they are so overcome with emotion they don’t know what to say. But in part it may be because their faith is not strong enough to acknowledge where the true source of healing comes from. The irony, of course, is that many years ago I would have completely agreed with them.

Human emotion being what it is, we like to be complemented on our accomplishments, particularly when it involves saving someone’s life. But I am always mindful of the fact that I am able to do what I do because I have been blessed by God with intelligence, talent and a 'sixth sense'.

On the other hand, there are other patients that have said to me, ‘I thank God for putting you in my life to help me’, and those times I am in complete agreement.

Recently however, I took care of a woman who said something that really startled me.

Theresa Purvis had been diagnosed with and treated for breast and lung cancer, and surprisingly had done well. That is until she developed a headache and became somewhat confused. An MRI of her brain did not reveal a metastatic tumor, per se, but evidence that the tumor may have spread somewhat surreptitiously to cerebrospinal pathway around the brain.

I was asked by her oncologist to perform a simple procedure, a spinal tap, to obtain some fluid which would be analyzed to see if in fact the cancer had spread to the brain.

To be sure that Theresa would be as comfortable as possible and that I wouldn’t encounter any difficulty with the procedure, I arranged to have it done in the operating room instead of at her bedside on the regular ward. This way she could be easily sedated and I would have available all the supplies I might need.

Everything went very smoothly, and I was done in less than 15 minutes. Of course Theresa had been lightly sedated but when I stood up and leaned over her to tell her I was done, she had a surprised look on her face. Amazed, she said, ‘you’re kidding, right?’ I said, ‘no, I’m done’. She then said boldly, ‘you are God’!

‘No’, I replied. ‘I’m just here to give Him a hand’.

Perhaps it was the medication she received or maybe it was the cancer that had infiltrated her brain, but she appeared to dismiss my remark and turned back to lie down on the stretcher.

Nonetheless, afterwards I felt deeply grateful that for the first time I was able to say the right thing at the right time, regardless of whether the patient was inspired by my remark or not. After all there were others nearby, nurses, doctors and perhaps a patient or two that may have overheard what I said.

In the end we never may know the full impact of what we say or do on the lives of others. All we can really do is try to be the best version of ourselves and have faith that others follow our example.

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.

Leaping without Looking (more closely)

When a patient arrives at the Emergency Room and I am called, my initial response is to rapidly evaluate the seriousness of the injury and determine whether the patient’s life could be in danger. Often times I can do this by looking at a CT scan. If that appears to be the case, I am trained is to correct the problem at hand in an effort to save the patient’s life.

In some cases after an initial discussion, the patient’s family will say upfront they do not wish anything ‘extreme’ to be done, like surgery. And when the patient is elderly and infirm, of course, this makes sense. In other cases the patient’s condition is so far-gone that functional recovery is not only unlikely, it is impossible.  

With other patients, the decision is clear – surgery should be performed immediately.  However, if I were to sit down and have a discussion with the family of another patient I might discover that while they may have been ‘relatively independent’ before their injury, in reality their existence was not a happy one. In fact, even if they were to recover from the surgery fully, I might not be doing them any favors.

And in general, at 80 years of age, it is highly unlikely their recovery following a head injury and brain surgery will be complete.

The problem that I am often faced with is being presented with an emergency while I may be performing another surgery, and I have to make the determination what to do, based on limited social information.

As it turned out recently, I wished I had known more about Gertrude Anthony, before I operated on her.

The night before she was admitted, Gertrude had fallen. Because she became very confused and was vomiting uncontrollably, her niece became concerned and called 911. A CT scan on arrival to Mease Countryside Hospital revealed she had a large subdural hematoma pressing on the right side of her brain.

Because I was told Gertrude was ‘functional’ prior to her fall and that the family consented to surgery, I instructed the nurse at the Transfer Center to arrange transport of the patient to Mease Dunedin for surgery.

Prior to taking Gertrude back to the operating room I spoke to Gloria, her niece about the nature of the procedure, its risks and the likelihood of successfully removing the hematoma. I did not, however, have a discussion about the potential outcome, and how it might affect Gertrude’s capacity to take care of herself post-operatively and her ability to enjoy the life she had left.

Unfortunately, the reality of the situation is that time is of the essence. Gertrude had fallen quite some time ago and it took an additional amount of time to transfer her to Mease Dunedin to have the surgery. All the while the hematoma was causing undo pressure on the brain and the more time that passed, the more likely it was to cause permanent damage.

So it is not always possible to have an in-depth discussion of whether surgery should be performed at all.

Surgery went well. It took only a little over an hour and there was not a lot of blood loss. All in all, I fully expected Gertrude to return to her previous level of functionality.

As it turned out prior to this last fall she really wasn’t all that ‘functional’.

Gertrude had hypertension, heart disease, a history of heart failure and she had a pacemaker. She also had the neurologic disorder, myasthenia gravis, which caused her to have daily weakness and fatigability. She lived in an assisted care facility and required frequent help with her walker and when she was too weak to walk, her wheelchair.

In fact, she fell frequently; and as a result sustained several spine fractures and recently had been hospitalized for rib fractures caused by another fall.

Immediately post-operatively I was primarily concerned with whether or not Gertrude was alert, that there was no paralysis and that her CT scan revealed that I had completely removed the hematoma. On all counts, everything checked out perfectly.

However, when I walked into her room on Hospital 3, one of the medical wards of Mease Dunedin Hospital, I quickly realized how limited she was. Every time I visited her she was in bed, unable to get up by herself. And every time she tried to pick up a cup to get a drink of water she would spill it all over the floor or her bed sheets.

When she tried to speak, because of the myasthenia gravis, not only was her voice almost a whisper, her pronunciation was garbled as well. Consequently, it was as much of a chore for her to speak as it was for me or anyone else listening to understand what she was saying.

As I stood there speaking with her and her niece I thought to myself, ‘so, what good have I accomplished for this woman?’ The only thing I did was to put her back in a wheelchair or bed, and back into a nursing home.

Partly because of the guilt I felt, I would visit with Gertrude every day I was in the hospital. Not to check on her medically, because she had recovered from the surgery, but to spend time with her and just talk. I almost came to feel like I was visiting my own grandmother.

She actually had a good sense of humor and would often make me laugh. But in the end the words that rang in my ears was what she said the last time I saw her. She said, ‘I pray to God that He either cures me or takes me’. I don’t think she said that to make me feel bad but I definitely didn’t feel like I had been a good steward of the gifts God had given me.

In reality, even if I didn’t operate, Gertrude may have survived and had been the same or more likely worse off.

So in searching for something to say to her as I was about to say good-bye for the last time, I said, ‘I will pray for you’. She smiled and replied, ‘Thank you for your prayers and for everything you had done for me’.

In that moment I was reminded that the patients I take care of, are people whose lives are made up of so much more than a CT scan that needs to be made to look better.