Spiritual Experiences from the Brain

Respect, Responsibility, and the Right Thing to do

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

members may have the same care for one another.

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

is honored, all rejoice together.

1 Corinthians 12:14, 25-26

A Test of My Feelings, Fortitude and Faith

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Matthew 9:12

 

The Price of Friendship

“Every one who comes to me and hears my words and does them, I will show you what he is like: he is like a man building a house, who dug down deep, and laid the foundation upon rock; and when the flood arose, the stream broke against that house, and could not shake it, because it had been well built. But he who hears and does not do them is like a man who built a house on the ground without a foundation; against which the stream broke, and immediately it fell, and the ruin of that house was great.”

                     Luke 6:47-49

 

Just the other day I was thinking about the friendships I have had. There have been some rock solid ones that have stood the test of time, although these are few indeed. Many of them have been built on shifting sand as it were, rarely surviving the first storm that served to wash it away. Then it occurred to me that I have not always been the friend I should have been, standing behind the very people who had stood by me in times of trouble.

Unfortunately over the years I have encountered people who seem to have an ulterior motive in being my friend. In most cases it was when they desired a friendship in order to establish a business relationship, and in these situations, this has made me feel at the very least uncomfortable and many times, sad.

When I order CT and MRI scans and other x-ray tests I can choose from many different facilities to perform these studies, and I usually do so depending upon where the patient lives. Predictably the physicians and other ‘health care providers’ affiliated with these free standing businesses do whatever they can to entice me to refer my patients to their ‘center’.

I have, for the most part, refused these inducements on principle and utilize the facilities based on the quality of the services they provide.

However, many years ago I became friends with the owner of one of these MRI centers. His name was Steven Wright (No, not the comedian). But he was a funny guy and he was an enjoyable person to be around; and I had many interesting and intellectually stimulating conversations with him. I would even admit at the time, if all things are equal, you might as well do business with a ‘good guy’ (and as it turned out the quality of the scans his center produced was just what I needed to make my clinical decisions).

In many ways we were very good friends and I probably bought dinner and drinks as much for him, if not more, than he did for me! We even spent holidays and vacationed together a few times. But I always had this feeling in the back of my mind; if I stopped referring patients to his scanner would we still be friends...?

Over the years I have been in practice I would see patients referred to me from chiropractors. Generally, these patients were no longer benefiting from chiropractic care. In many cases they had a ruptured disc in their neck that was compressing their spinal cord and so chiropractic would not help and even could be dangerous.

Although more often than not they were accident cases and the motor vehicle insurance was exhausted so then they would refer me the patient. The difficult and often uncomfortable issue with this was, while I was grateful for their referrals, I was often made to feel that I had to send them patients, less they ‘lose confidence’ in my skills as a surgeon.

The reality of my practice is that by the time patients are referred to me for possible surgery they have already treated with a physical therapist or chiropractor or both and so there was little need for me to prescribe such care.

Nevertheless, I would, on occasion have reason to refer a patient for conservative treatment. Sal Marino was one of the chiropractors I would send patients from time to time. Interestingly, as long as I continued to send patients to Sal he would send patients that required surgery to me, and we were great friends. But as soon as the referrals to Sal’s practice dropped off, seemingly his confidence in my ability and our friendship dropped out of sight as well….

Then there was Tim Perry. Tim worked for a company that sold spinal hardware - surgical screws, rods and plates that I would use to correct spinal deformities which were caused by trauma, cancer or degenerative disease. Since the company was on the leading edge of technology and the fact that Tim provided outstanding service I worked with him exclusively for many years. Understandably we became friends, although to be honest I kept that friendship at ‘arm’s length’ because I doubted his sincerity.

I often wondered how Tim would (re)act if I started to use another company to provide the surgical instrumentation that I used frequently. And for a period of time I did just that. Not to test the friendship, but I thought that just from a business standpoint it would encourage him to continue to provide a high level of service, and that the hospital might benefit from better pricing.

Tim actually handled it very well and in the end I came to respect him more for his maturity. Actually, distributing the cases fairly equally between the companies became a nightmare logistically and most of the time I felt uncomfortable being around Tim if that particular day I was using the instrumentation from the competing company. So, one day I just shifted all the business back to Tim. And I allowed myself to become better friends with him as well….

Somewhat ironically I recently found myself assessing a friendship based upon how it benefited me from a business standpoint. Although it would be more accurate to say I turned my back on that friendship because of the feeling, ‘there was nothing in it for me’.

For several years Lance Durso and I have worked closely together and over that period of time had become good friends. Not too long ago because the strategic plan for the hospital had changed, Lance found himself making critical decisions that could possibly affect me professionally, and from my perspective, negatively.

Instead of understanding those decisions had nothing to do with our friendship, I lashed out. Not only did I disrespect Lance, I as much insinuated that he was no friend of mine for taking that action. Unfortunately I am not always the most diplomatic when my feelings are strong and I said things I didn’t mean.

The reality of the situation was that there was no way Lance could avoid taking this course of action since it was for the greater good of the hospital and if he refused, his job would be in jeopardy; but I was too immature to accept it.

And so here I was attaching a price to my friendship with Lance, in the same way I that I thought others had done with me. Why? Because the way I had practiced medicine for almost twenty years was about to change and this frightened me. Of course fear is not what I felt; it was anger! I even convinced myself Lance was making these decisions without even considering how it would affect me.

But as I thought more and more about how I allowed my feelings to get out of control I realized that not only was it totally un-Christian of me, I was allowing  Satan to take advantage of my insecurities and harness that anger to blacken my soul and to inflict pain on someone else. Sad to say it was not first time I’ve committed this sin of jealousy and mistrust.

Ultimately, I realized that this new direction could actually benefit me which of course made me feel even more guilty for doubting Lance’s honest intentions.

I guess I have often had a hard time embracing change but this will have to be a topic for another story. Suffice it to say that acceptance is the key to happiness and a good friendship.

A Patient Who Became 'My Brother'

Most patients in my surgical practice I know for only a short period of time.

Some patients I take care of for a longer duration. Perhaps they did not get well following surgery and so I feel a sense of responsibility to oversee their care, referring them to, say a pain management physician hoping to get them some relief of their persisting symptoms. Occasionally, a patient will develop a surgical complication and I take care of them until the issue at hand is corrected or resolves.

Other patients actually over the course of time develop more than one problem for which they will return to see me.

Of those patients I take care of for an extended period of time I naturally develop a closer relationship with. Rarely, however do I develop a bond with a patient that transcends the usual doctor – patient relationship.

Robert Cross, however, was one of those patients with whom I developed a unique friendship.

Robert turned out to be one of those patients that failed to get better after the initial surgery I performed, requiring additional surgery. But he also developed a surgical complication requiring even more surgery; and then developed an unrelated problem requiring another (sixth) operation. Yet in spite of it all he was always grateful for what I tried to do to help him.

I first met Robert in December of 2002. He was 69 years old. He had previously undergone lower back surgery in April of that year by another surgeon and though his condition had improved he re-injured his back causing one of the discs in his lower back to re-herniate

So, on the 31^st of December I re-operated on Robert to remove the herniated disc that was pressing on his ‘sciatic nerve’ causing unrelenting pain in his left leg.

Following surgery he was certainly better, ‘but not 100%’. I then referred him to a pain management physician who performed periodic injections of cortisone in his lower spine to help alleviate his continued lower back pain.

Robert did reasonably well with this form a treatment for about two years. Ultimately the cortisone injections became less and less effective and then he developed recurring pain in both of his legs. Further tests revealed progressive degenerative changes and arthritis in his lumbar spine.

After reviewing the new MRI scan with Robert, I discussed with him the possibility of fusing his spine as I felt it might give him a degree of stability which I believed he was lacking with the advancing degeneration in his discs. He agreed and so on the 7^th of March 2006 I performed a spinal fusion on Robert Cross.

After he recovered from this surgery he was transferred to a rehabilitation facility but was readmitted one week later with severe left leg pain. Tests revealed it was only inflammation in the sciatic nerve and so I was able to treat it with medication.

Robert did well for about a year until the pain once again reoccurred, for which I performed two more surgeries. Unfortunately his continued complaints of pain finally led me to tell him, ‘Truthfully, there isn’t anything further I can do to help your back pain’. He nodded in agreement and thanked me for my honesty.

Later that year, 2007, Robert began having some difficulty walking but this problem appeared to be unrelated to his lower back. A CT scan of his head revealed that he had hydrocephalus so I inserted a ventricular shunt which improved his ability to walk somewhat. Unfortunately Robert also developed a severe peripheral neuropathy which caused his legs to feel constantly numb. As a result he was unable to appreciate where his legs were, particularly in a dark room, and this would cause him to fall frequently.

One day, not too long after I inserted Robert’s shunt I began to think of him more as a friend, and not a patient. I was in church and was returning from communion when I saw Robert sitting in a pew by the aisle. Without even thinking, I was drawn to him and I reached out my hand to him and extended a greeting of peace.

He was alone and I’m not sure he needed me to acknowledge him but I crossed the aisle shake his hand nonetheless. Actually, that meant a great deal more to him than I could have imagined. Several times after that day when I would see him he would remark about the event prominently, almost with a sense of gratitude, as if I lifted him from a moment of despair.

Actually, Robert had very good reason to be depressed. He was a very sick man, having multiple medical problems which over the ensuing three years caused him to be admitted to the hospital over 15 times; and during those hospital admissions he would undergo six more operations by two other surgeons! In addition, it was becoming increasingly difficult for his wife Joann to take care of him at home.

He wasn’t always admitted to Mease Dunedin, but when he was I would either find out he was there from Francy, my nurse or I would happen to stumble upon him making rounds on my surgical patients. Always I would stop by to at least say hello and to see how he was doing. And always he would turn to the other patient in the room if there was one and say, ‘This guy is a good man’. Slightly embarrassed I would say, ‘You are too kind’ and then reach out my hand to shake his, saying ‘It was good to see you brother’. ‘You too, brother’, he would reply.

Each time I saw him in the hospital he appeared to be getting weaker and weaker. Ultimately, because of his frequent illnesses, the amount of nursing care he required grew exponentially and so he had to move into a nursing home. The last time I saw Robert Cross in the hospital was in December of last year, 2010.

He had developed a pulmonary embolus or blood clots in his lungs. His spirits appeared good although he just seemed tired. I stopped by briefly to say hello, thinking I would stop back later in the week.

I never did see him again. He was discharged only to be readmitted on Christmas day at another hospital with pneumonia. Less than a month later he had a cardiac arrest and died, at 77 years of age.

A week or so later, his wife Joann called the office to let us know, and to ‘especially thank us for taking care of Robert over the years’.

Shortly after I felt compelled to write this story about him because, ‘He was a really good man’ and I wanted to ‘especially thank him for being my friend and ‘brother’ all those years.

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.

An Unusual Way to Die

I have been practicing neurosurgery for over twenty years and two weeks ago something happened to me that I have never experienced before…

Tracy Schlachter was a 67-year-old gentleman who had undergone two craniotomies in the early 90’s for presumably a benign meningioma. As a result he was left with some right-sided weakness and over time he had to resort to using a walker to help him get around.

In fact within the past few years he had several falls requiring hospitalization.  Each time it was thought he may have had either a stroke or a seizure. Each time, tests failed to reveal the reason for his falls. Nonetheless he was placed on an anti-seizure medicine just in case.

Though these ‘falls’ were often accompanied by periods of confusion, in general he was ‘alert, pleasant and fully oriented’. That was of course, until he fell, for the last time, that Sunday night.

I received a call from Chad, my PA, telling me that Tracy was in the ER at Morton Plant Hospital. He had been told he had an epidural hematoma which, of course, was a neurosurgical emergency.

I logged in to the hospital computer system from home and reviewed Tracy’s CT. There was a hematoma but it was a subdural; still it was causing a great deal of pressure as well as a shift of the brain structures from right to left. I called Matt at the transfer center who then set up a conference call with Dr. Davis in the emergency room.

Apparently Tracy had fallen several hours earlier and when he began to have a seizure at home his wife had called 911. Initially when he was brought to the ER he was conscious but shortly thereafter he had begun to have another seizure and he quickly became comatose. Dr. Davis had spoken to his wife who agreed that Tracy should be placed on the ventilator because of his condition.

As I spoke to both Matt and Dr. Davis I ascertained that Tracy still had brain function and though the appearance of the CT scan indicated to me that his prognosis was poor I decided that emergency surgery should be performed in the hope that Tracy would survive and recover. I directed Matt to arrange emergency transfer and that EMS should bring Tracy directly to the operating room at Mease Dunedin Hospital, where I would be waiting. Dr. Davis then spoke with Tracy’s wife who consented to the emergency transfer.

Now, I must clarify my position regarding treatment of gravely ill patients. In circumstances where the patient has an injury that has caused (likely) irreparable damage from which the patient cannot recover, or if he or she does recover it would result in vegetative state I cannot argue with a family’s decision to withhold extraordinary measures.

However in most cases, the outcome is usually in doubt and so I usually advocate doing what we can. If there is no improvement and the family wants to withdraw ventilator support I honor their wishes.

Of course if the patient is in their 90’s and/or was severely incapacitated either physically or mentally beforehand, I can hardly disagree with providing comfort measures only and allowing the patient to die peacefully and with dignity, if that is what is to happen. However, as far as I could tell Tracy did not fit into any of these categories so I believed we should do what we could.

A soon as Tracy arrived at Mease approximately 1 hour later he was taken immediately back to OR room #2. After the anesthesiologist connected Tracy to the anesthesia machine, I positioned him on the operating room table. I then shaved his head and marked my incision and directed Bill to start prepping his scalp.

It was at this point I received a phone unlike any other I have ever received at this point in a surgical procedure. The ICU nurse told me that he was bringing Tracy’s wife to the surgical department.  She wanted to speak with me immediately… and she meant, ‘right now!’

As I walked through the automatic doors of the operating room out into the hall, there was a woman standing there staring at me as if she had expected me at any moment and yet she was distracted. I said, ‘Mrs. Schlachter?’ She shook her head ‘no’ and with a strange, almost fearful look on her face peered around the corner and motioned toward the other woman whose footsteps I could hear walking quickly and determined in my direction.

She was eating a health food snack and she talked and ate at the same time. ‘What do you think you are doing?’ she demanded. Immediately I was taken aback (and what rarely happens to me), I was put on the defensive! I said, ‘Well I had planned to remove the blood clot that is pressing on your husband’s brain and threatening his life.’

‘Why would you want to do that?’ she stammered.

I felt as though I was a resident again being interrogated by one of my attending surgeons. Before I could answer she began listing the reasons why surgery was not only a bad idea it was the dumbest one she ever heard of!

‘He’s already had two brain surgeries for brain tumor… he has a seizure disorder… and despite all the tests he has had, the doctors still can’t figure out why he falls all the time.’

I was confused by her reasoning. First of all the brain tumors were benign and the surgeries were 20 years ago; his seizures were controlled by medication and most of the time he walked just fine, albeit with a walker. It wasn’t as if he had terminal cancer or had been confined to a nursing home with Alzheimer’s disease for the last five years.

It seemed to me she was talking about mere inconveniences, not life threatening illnesses. ‘Well, I thought I would perform the surgery to give him the best chance of recovery’ I said.

‘Why, so he can wind up in a nursing home? No, you are not doing anything!’ she said as she stared directly into my eyes with pinpoint accuracy.

To say the least, I found her behavior a bit odd because usually when something sudden and unexpected happens, most family members want everything done. If not just to see if recovery is possible but also partly because they don’t want to feel guilty that they didn’t do everything that they could.

But it was clear that this woman was not going to change her mind so I said, ‘Fine… we will transport your husband to the ICU and when you are ready he can be taken off the ventilator and allowed to pass’. She nodded emphatically and gestured towards me, as if to dismiss a servant, took another bite of her snack and turned to go to the ICU and wait for her ventilated husband to arrive.

As I arrived at Tracy’s ICU room there was an older woman in a wheel chair, to whom Tracy’s wife was almost reprimanding. ‘Do you want him to be in a nursing home for the rest of his life?’

A taller woman with dark hair approached me and asked, ’Doctor, what do you think his chances would have been?’ The answer to this question really didn’t matter, but before I could say anything, Tracy’s wife practically pushed her to the side and said, “I don’t care what his chances would have been.’ To which I replied, ‘Yes mam, you made the perfectly clear’, and I turned to sit and write my progress note.

Tracy’s wife went to his bedside and the other women remained outside his room, the taller one mumbling that this decision would never sit right with her.

I didn’t really know what to think about what had just happened. In reality, Tracy was likely terminal anyway since as soon as the ventilator was removed he died shortly thereafter. But his wife didn’t know that and I couldn’t be 100% certain he wouldn’t have survived either.

In the end I have to respect the family’s wishes even if I don’t agree with them… although most of the time I do.

A Chance Encounter with a Patient... or an Angel?

A few weeks ago I was in the mall and I saw by a big, tall man with a cane. He limped slightly as he walked. As I passed by, I looked at him and realized he was somewhat familiar, and old patient of mine I thought. I smiled and mouthed ‘Hi’ as I continued on to my destination, a health/vitamin store.

As I turned from the shelf from which I grabbed a box of fitness bars, I was startled because that big tall man was right there in front of me. He must have walked softly because I didn’t hear him come in. Of course there were two other customers at the counter and the sales girl talking so that must have covered up his footsteps.

He began, ‘Doctor Colbassani?’ I said ‘Yes’. He said, ‘You still doing that brain surgery thing? Feeling slightly uncomfortable with it being put that way, I nodded yes.

Up close his size was more readily apparent. He was over six feet tall (although he was bent slightly forward leaning on his cane) and weighed at least 260 pounds. When he reached out to greet me I felt dwarfed by the size of his hand.  Face to face he reminded me of my father’s cousin who used to play for the New York (football) Giants.

‘You may not remember me’ he said; to which I interrupted, ‘yes, you are familiar, but it has been a long time’. ‘1996’, he said. He then continued, recounting his recollection of when he first met me…

‘I remember lying in my bed in the ICU when you came in and said’, ‘You are lucky to be here’. And I said ‘What do you mean?’; Then you said, ‘You should be downstairs’. ‘Downstairs, what’s downstairs?’ I asked you. Then you told me, ‘the morgue!’

At this point I felt a bit embarrassed, because I didn’t think I would ever say such a thing, at least not in that manner. But, given my arrogance at that time of my life, I might have said just about anything.

 ‘Then you told me you were going to have to operate but that I probably would not survive the operation anyway, but that I had no choice. And I remember my wife standing outside my room with our pastor and they came in and he prayed over me.’ ‘It’s hard to take the knee but sometimes you have to’. To which I replied, ‘Well sometimes being on your knees is the best place to be’.

The interesting thing about this encounter was, here was this big tall grizzly-like man speaking to me and not quietly, but no one else in the store turned around to look. You would think the words ‘brain surgery’ or ‘morgue’ would pique someone’s attention to look over.

As he continued to speak of his problem and my treatment of him I gathered he had a severe problem in his spine, and at this point I vaguely began to recall his illness. He mentioned something about having a high fever and an elevated white blood cell count, so I remembered he had an abscess pressing on his spinal cord.

‘So you did the surgery’, he continued, ‘and I did survive and my temperature became normal and my white blood cell count dropped to normal as well. But when you came in to my room the next day you said, ‘OK you made it through but you will never walk again’. ‘Well here I am and I guess not doing too bad.’

Usually when I encounter patients that I have treated, if they come up to speak to me, it is usually to say thank you. But this gentleman never said that, and yet it didn’t seem like he wasn’t being critical of me either.

I have been to that mall hundreds of times since 1996 and never once saw that gentleman before so I’m still not certain why I had this chance meeting with him. In fact I had just finished in the office and it was late, and I was going to forgo going to the mall but my wife told me, ‘no you should go and check out that bed we were thinking of buying’. As I was leaving that particular store, I saw the GNC store out of the corner of my eye and figured I would go and buy those protein bars I had been meaning to get.

At one point he asked me how my family was which I found curious, because in 1996 I was not married and though I did have a daughter and a son, I had not yet starting dating my wife seriously at that time.

When he finished his story, I still felt a bit uncomfortable, perhaps even a bit guilty, so I shook his big hand and told him ‘Well it was good to see you and I’m glad to see you are doing well’, to which he lifted up his cane and shrugged his shoulders. Struggling for something else to say I blurted out ‘Well, it is still a good day when you’re upright and able to walk’ (And I’m glad I was wrong about that too, I thought).

That night when I got home I searched my records for this gentleman’s name. I had my notebooks of my surgical cases from 1988 through 1998 but for some reason I had misplaced the one that had the list for 1996. At the office the next day I asked about the medical charts for patients that year and was told after 10 years the charts were destroyed.

So here I was at a loss to find out what was this man’s name, and why our paths had crossed the night before.

Although as I think about it, I’m not sure any of that matters. Of course we always want to know the reasons why things happen but sometimes it is just best to trust in God that there is a reason and leave it at that. I do realize that is not enough nor is it possible especially when tragedy strikes our lives. We feel despair, we are confused, and angry all at once.

And at those times it may be difficult to believe God truly loves us but it is precisely at these times when He wants us to turn to him for comfort and peace.

Now I am not certain how it is that my story which began with a chance encounter with an old patient of mine turned into comments about loss and grief, but it did. I am not sure of the reason anymore than I know why I met that man on that night at that particular time. Maybe it was to keep me from being somewhere else had I just gone into the store, bought my protein bars and left.

Or maybe while he was grateful for what I had done for him, he really needed remind me that I didn’t have all the answers and I wasn’t the one with power over life and death.

It is likely I will never know, at least here on earth. I just trust God sent him as an angel to be there for me.

 

‘he will cover you with his pinions,

and under his wings you will find refuge;’

 

‘For he will give his angels charge of you

to guard you in all your ways.’

Psalms 91:4, 11

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’.

Charity and the Price of Eternal Salvation

‘And Jesus looking upon him loved him, and said to him,

“You lack one thing; go, sell what you have, and give to the

poor, and you will have treasure in heaven; and come, follow me.”

At that saying his countenance fell, and he went away

sorrowful; for he had great possessions.’

Mark 10:21-22

How difficult is this request for us to follow?  I suspect for most of us, myself included, if we are to be honest, it is practically impossible! And not only does Jesus want us to give up our material possessions, he also wants us to follow Him, relying not on the life that allowed us to accumulate those things in the first place. And I believe, in these words also is the inference that Jesus wants us to be happy with the choice.

This command not only pertains to material possessions, but our time and talent as well. And it is with these gifts that I am not always such a ‘cheerful giver’.

In the course of my practice I am on call for emergencies and not every patient that is brought to the emergency room has insurance. And for many of these patients this is the reason they stay away from the doctor in the first place.

Granted, many of these patients are there because of self-destructive behaviors, such as abuse of alcohol and drugs. But, there are some who find themselves incapacitated, frightened and without a choice. It is these patients that remind me that God has given me a gift that I must give freely to others.

Darnell Benjamin is a patient that reminded me of this recently.

In April, Darnell decided he would get back in shape since he was about to begin a construction job he was lucky enough to have landed. During one of his workouts he felt a pop in his neck followed by some pain but he figured it was a muscle strain so he just took some Tylenol and ignored it.

Over the next few months he developed some weakness in his hands and actually noticed some of the muscles had atrophied but since he could still lift and haul the lumbar that his construction job required he quietly went about his work. His daughter tried to convince him he should see a doctor but since he did not have health insurance he told her ‘no’. In late October, Darnell began to notice his legs were a bit sore and weak but he just figured it was due to all the hard work he had been doing.

About 3 weeks ago he awoke one morning and his legs were so weak could barely get out of bed. And when he tried to stand up his legs gave out from under him and he fell to his bedroom floor. It was at this moment he also noticed he could barely pull himself back up because his hands and arms had gotten much weaker as well.

Unable to ignore his problem any longer he allowed his daughter to call 911. Shortly after he was brought to the Emergency Room by the EMTs, he was examined by the ER physician on duty who then ordered an MRI scan of his neck and lower back. As soon as the radiologist interpreted the scans and informed the ER doc of the results, I was called.

Darnell was actually in a hospital 20 miles to the north of Mease Hospital where I practice and because the emergency room doctor there believed a neurosurgical emergency existed, she wanted Darnell transferred because they did not have a neurosurgeon to take care of the problem there. After reviewing the MRI scan I agreed Darnell would need surgery.

Darnell had ruptured a disk in his neck and because there also was injury to the ligaments of his spine it created additional weakness that resulted in damage to his spinal cord. Not only would I have to operate on his cervical spine through an incision in the front of his neck and remove the disc and fuse the vertebra together; I would also have to operate on his spine a second time through an incision in the back of his neck and insert screws and rods into his spine to prevent further damage.

(When I meet patients I try not to be judgmental, but unfortunately since I make assessments and deductions based upon the patients’ history, examination and MRI scans all the time, I too often make conclusions why they have come to see me. Often it is obvious; they are in pain and want to know what their options are to alleviate or eliminate the pain. In other cases it is not so clear; the person may have been in a car accident or had an injury at work and they may only want to collect a monetary settlement or obtain a medical disability so they do not have to return to work.

In some respects it is up to me to try to make this determination so I can decide whether the patient truly is injured and may need surgery or whether they are malingering.

But sometimes I find myself making superficial judgments as to the patient’s appearance. When patients’ such as Darnell are brought in to the Emergency Room and are poorly dressed and without impeccable hygiene, the thought, ‘do they have insurance and will I be paid for the surgery I might have to perform?’ may cross my mind. In those cases I say a prayer to myself and refuse to look at the patient’s face sheet which indicates this information before I have decided what needs to be done and I have done it.)

By the time Darnell arrived at Mease Dunedin it was the following morning. He was then prepped for surgery and brought to the preoperative holding area. As I walked in he looked frightened, which was understandable since he could barely move his legs and could not move his arms much more. I introduced myself, took his hand to shake it and told him what I would be doing. He nodded and thanked me.

The surgery went well and by the next morning he could move his arms and legs quite a bit better. As I walked in to the preoperative holding area this time Darnell was actually smiling. I asked him, ‘Are you ready for round two?’ He said, ‘Yes’.  This operation was more difficult than the first but everything proceeded as planned and there were no complications.

When I rounded on Darnell the following morning he was sitting up in bed eating his breakfast, feeding himself which he was unable to do the previous day. I asked him how he was doing and he said, ‘Very well’. He went on to say, ‘Thank you so much for what you have done. I was so afraid because I could not walk and my hands were so weak. And now I am so much better. Thank you’. I smiled and said, ‘You are very welcome’. As I left his room and walked to my office I felt grateful for being able to help him.

By the end of the week Darnell was walking without any assistance and was discharged home. I figured I would not see him again until his six-week postoperative check in my office. Unfortunately that would not be the case.

Thanksgiving morning, though I was not on the schedule for emergencies, I received a call at 5 am from the ER of another hospital to the north. Apparently something happened to Darnell at home and he became unconscious. When the EMTs arrived his blood pressure was more than fifty points lower than it should have been. By the time he arrived at that hospital he was awake but the ER physician examined him and found him to be almost completely paralyzed in his arms and legs once again. I told the ER physician to transfer Darnell back to Mease Dunedin Hospital.

At this point I thought, ‘Boy, God is really testing me now. Not only did He want to see if I would be cheerful operating on Darnell, gratis, He wanted to see if I would still be smiling now that my Thanksgiving plans might be completely disrupted!’

By the time Darnell arrived in the ICU at Mease Hospital the movement of his arms and legs was almost back to where it had been when he was discharged. After reviewing the scans that were done at the other hospital I concluded Darnell became weak because the blood flow to that damaged area of his spinal cord was compromised when his blood pressure had dropped so low. Fortunately, he would recover completely.

When I returned to see him the following morning, Darnell’s weakness had continued to improve and as we talked about his condition he told me that everyone in the ICU had been great except one nurse who had taken care of him the night before. In fact he told me that nurse was actually mean to him. He then proceeded to tell me in a very articulate way that he had said to the nurse, ‘I want to apologize to you if I had said or did anything that had upset you (‘which I did not’, he said as an aside to me) because I really need your help and I don’t want you to be mad at me and ignore those needs’.

I told him I was sorry that he had that experience and that I would look into it. Darnell then looked at me and said, ‘and I’m sorry if I have inconvenienced you in any way over this Thanksgiving holiday’. I told him not to worry about that and with lump in my throat and a slight feeling of guilt myself I said, ‘that is why I am here, to take care of you’ as I grasped his hand tightly and looked deep into his eyes. Darnell merely said, ‘thank you’ as I turned to leave his room.

Lately, collections have been off a bit and yet the bills continue to pile up and it is hard to ignore when I spend no less than 15 hours operating and taking care of a patient without physical payment. What Darnell reminded me however, was that my time spent was hardly in vain and that God will truly pay me back a hundred fold if I am a ‘cheerful giver’.

 ‘The point is this: he who sows sparingly will also reap sparingly,

and he who sows bountifully will also reap bountifully. Each one

must do as he has made up his mind, not reluctantly

or under compulsion, for God loves a cheerful giver.

And God is able to provide you with every blessing in abundance,

so that you may always have enough of everything

and may provide in abundance for every good work.

2 Corinthians 9:6-8

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