When patients or family members demonstrate excessive fear, this can affect a surgeon’s mood. Surgeons cannot share that fear of failure because it is an affront to their professionalism and (if they accept the affront) it can potentially affect the success of a surgery. They may regard a patient’s fear as a challenge to perform flawlessly. Surgeons are perfectionists, but this inevitably heightens their anxiety going into a procedure. This added stress doesn’t lead to better results. In fact, when a demanding patient wants to be treated like a VIP, the chance of an unforeseen problem is usually higher. I wish it weren’t so.
The first thing that comes to my mind when surgery starts going badly is, This person may die or be debilitated, and I am responsible. How will the family react? I know what it’s like to try to control unexpected bleeding while at the same time imagining what it will be like to explain to the family that things didn’t go well and that the patient—their mother, father, son, daughter, or friend—will never be the same person they had known before. It is mental and physical torment.
Prayer would redefine the kind of doctor-patient relationship I had grown comfortable with. It would strike down this idea that I was a demigod. It would make me vulnerable in a way I had never been vulnerable with a patient before. Certainly, I wouldn’t be as vulnerable as someone who is asleep while undergoing an operation, but I would be vulnerable in sharing who I am as a person and in relinquishing the surgeon’s detachment and mystique. I would be deliberately climbing down from the pedestal and admitting my humanity. And in medicine, as in the rest of life, vulnerability is dangerous.
Despite all my apprehension about prayer’s role, I felt that to be authentic I needed to somehow make it part of my patient interactions. I felt there was something sorely missing there. I was doing one of the most technically difficult and highest paid jobs in the world, but somehow I knew there was more. Up until now I had been doing only what I was trained to do: extending life and relieving pain, worry, or inconvenience. What about improving life quality by helping people to be more joyful, loving, and kind? Was it possible for me as a neurosurgeon to help them have a different kind of life, to help them examine themselves and make a course correction, and to do so in a way that would not be offensive? Or could I only extend their lives on their current trajectories?
Through all my questions and doubts I felt an inner voice saying to me, “If you are worried about being misunderstood, I can promise you that you will be. Jesus was. But you still need to do the right thing.”
After practicing neurosurgery for seven years, I knew that praying for a patient before surgery was the right thing to do, and I decided to ask the next patient, regardless of what might happen.
* * *
That opportunity arrived the very next week with Mrs. Jones. I had gone into her pre-op room with the intention of praying, but in the presence of that powerful and intimidating nurse, I had retreated and been forced to reformulate my approach.
Fear was still governing my decisions. Couldn’t I just pray silently for her? I thought. Maybe I’ll pray with the next one.
I leaned against the desk at the nurses’ station, feeling awkward at being there and riffling through papers on my clipboard as if they were of great importance. Nurses, patients, and patients’ families passed by me. I kept my head down and my eye surreptitiously on Mrs. Jones’s gurney, watching for the nurse to leave. For some reason her area and the adjacent bays were a hive of nurse activity. It looked like a receiving line in there. The longer I waited, the more nervous I felt—more nervous, in fact, than I was before any surgery that I could remember. During surgery I am in my comfort zone; here, I was way outside. I, the most highly trained person in the room, felt intimidated by everyone else in pre-op.
Why are so many nurses visiting Mrs. Jones? I thought, growing perturbed. This was a fairly straightforward procedure. What else could there possibly be for them to do?
I looked back down and pretended to be reviewing the chart for as long as this charade seemed to hold. There was little to read: my history from the week before and her blood tests. I carefully examined some of the fine print at the bottom of the page. Then I walked over to the phone sitting on the counter and made some calls. I checked my home voice mail. I checked my office messages. I tried to think of who else I might call—old friends, anybody—but nobody was awake this early. Then I pretended to be on a call, but that lasted only until the dead line turned into an annoying beep, and I had to hang up. The nurses were still busy in Mrs. Jones’s room, checking that her belongings were safely stowed under her bed, entering more data into the bedside computer. Maybe they’re training a newbie nurse, I thought. But I realized if I didn’t act soon, the transportation team would come to get Mrs. Jones and take her to the procedure room. Patients don’t stay long in pre-op—usually less than ninety minutes. The idea is not to park people there at length but to move them on to the main event.
I was about to miss my chance.
Then suddenly, the nurse left. I stood up and began to walk over. I scrutinized the curtained bays next to hers as well, because I had resolved not to pray if a nurse was on either side of the curtain. Could it be? It was true: Mrs. Jones was alone with her two daughters. The two adjoining bays were empty except for patients. Perfect. I headed over, feeling a surge of renewed confidence.
Before I could get there, the anesthesiologist and nurse anesthetist arrived. I smiled at them, stopped short—then redirected my steps back to the nurses’ station. There was no way I was praying in front of an anesthesiologist. I walked over to a sink and washed my hands for the third or fourth time. I tried to find an out-of-the-way place to stand where I wouldn’t be too conspicuous to the nurses, who must have been wondering what a doctor was doing hanging around their turf.
How strange, I thought. It was as if I were casing her room, waiting to commit a crime.
After an achingly long time, the anesthesiologist and nurse anesthetist left. I saw no transport team approaching. The nurses had gone to other rooms. This was my final opportunity. I darted over, trying to seize the territory before anyone else could. I glanced at the patients on both sides, uncomfortable with the fact that they might hear me. For once I was happy that their television volumes were loud enough to possibly obscure my voice. I cringed as I noticed the thin curtains separating us.
Mrs. Jones was sitting up on the gurney with an IV in her arm, looking as relaxed as could be expected before such a major surgery. Her daughters were seated by the bed. The overhead fluorescent lights seemed to drain all faces of color. When they saw me, they stood up to receive whatever news I had.
Only then did I realize that I had not even thought of how I would introduce the subject, let alone what I would say in the prayer. I assumed it would be simple and obvious. Maybe I had thought that too much planning wasn’t desirable when it came to spiritual things. Now my mouth felt like sand; my heart raced as if I’d just been injected with epinephrine. Gone was the good-natured confidence I had always been able to count on. Gone was the air of superiority I had carried before like a shield. I had just committed myself to do something for which there was no standard. The only example I had was what had happened to me in the dental office—on a weekend with no one else around, not even a hygienist. Here I was in the middle of the three-ring circus known as pre-op.
Mrs. Jones looked at me, concerned, as if to say, “Is there something new about the surgery? Something else I need to know? Should I be worried?” Like any other patient, she was highly attuned to the words and actions of her doctor, reading me for any clue about her status. Her daughters, too, stared at me, waiting for me to say something important, but I couldn’t summon the courage. I felt as if I were about to drive my car off the highway and into the wilderness. Where would it lead? How was I going to introduce this subject? Would they think I was crazy and call off the surgery? I noticed the red emergency button on the wall of the room. It was for summoning nurses when urgent help was needed. Maybe o
ne of the daughters, after hearing my offer to pray, would sidle over to the button and push it while keeping a wary eye on me.
Finally I could stand it no longer. I blurted out, “Can I pray with you?”
Mrs. Jones looked surprised, as if something had gone badly wrong since I last saw her. Then her face softened as she considered what I had said, and she responded, “Okay.” I felt embarrassed but relieved. She was acting guarded and unsure about the offer. She seemed to be going along just to give me what I wanted. More than anything, she seemed confused. I imagine my offer was as unexpected as a pastor, priest, or rabbi asking if he or she could remove a mole during a counseling visit. I had no real choice but to press through it with some modicum of confidence.
Neurosurgeons don’t mind touching people. We just prefer that they be washed with a sterile solution, covered with blue drape, and anesthetized first. Then we touch them only with a very sharp scalpel. Nevertheless, recalling how my dentist friend had put his hand on my shoulder, I carefully put my hand on Mrs. Jones’s shoulder. As if by routine, her daughters moved in and bowed their heads. I froze. No words came. My mind was as blank as the whiteboard in my exam room.
I forced myself to start. “God, we thank you for Mrs. Jones . . .” It was an awkward beginning, small, not nearly what I had been hoping for. It reminded me of those tentative prayers given at Thanksgiving by children.
I paused. Then, I thought of whom we were talking to and not where we were. Out of nowhere, I felt a wind at my back, pushing me on. Without any forethought, the prayer began to flow like a river cascading downhill.
“God, you’ve been with Mrs. Jones since she was a baby. You know all about her vessels, and I know that you can help me fix them. Please give me wisdom and skill. I ask for success in this surgery, in the name of Jesus, Amen.”
I looked up, not knowing what to expect. Mrs. Jones was crying and smiling peacefully. So were her two daughters. I was embarrassed and amazed. The prayer had been so brief that I couldn’t believe it had produced such a dramatic and heartfelt response. I had closed my eyes seconds ago among three apparently skeptical people. When I opened my eyes, they had become puddles of emotion. My scientific side marveled.
I also felt a little flustered. I had not thought through the possible responses and certainly had not anticipated tears. What did it mean? I had no idea how to respond to their emotional display. Snapping back to my aloof professional manner, I decided to do what any emotionally vulnerable doctor would do: leave it for the nurse to deal with.
I patted Mrs. Jones’s hand and turned away quickly. Sure enough, just as I was pulling aside the curtain, the nurse came back. Right on time, I thought. She surveyed the scene and handed them a box of tissues as I ducked out, hit the automatic door open button, and exited pre-op thinking, Wow! What was that? My heart was still pounding, but the peace and comfort that had brought Mrs. Jones to tears had also touched me. It wasn’t the smoothest or even the most empathetic beginning, but I had done it. I had prayed with a patient. The world continued to spin. There were no shifts in the time-space continuum. I looked behind me in the hallway, but there was no squad of medical-industry police ready to grab me by my arms and hoist me onto an elevator, making sure I would never be seen practicing medicine again.
Rather, something wonderful had happened. Peace had overshadowed fear and created a different dynamic. It wasn’t a dynamic that made sense to me yet or that I could describe, but something was different—and better.
Mrs. Jones’s surgery went well. I treated the aneurysm and noticed that I had unusual joy while performing the procedure—not something I had normally experienced during surgery. Certainly I always felt relief and happiness when a difficult case was over. The techs, doctors, and nurses are able to enjoy a certain banter involving cynical or gallows humor, and there might be light conversation about the ball game or something in the news. But once a neuroendovascular procedure starts, there isn’t a relaxed moment for me, because at any point something could go wrong and cause a stroke. That day, however, I felt lighthearted, free to perform well without fear hanging over me.
After the procedure was complete and Mrs. Jones woke up, I went into the waiting room. As is my custom, I called the family out into the hall to speak to them privately. The faces of the two young women were taut with concern and expectation.
“I’m happy to report that things went well,” I said. They sighed audibly and smiles lit up their previously anxious faces.
I explained that their mother would be released the following day and gave them some post-op instructions so they would be aware of what she should do for the next couple of days. Then I asked them if they had any other questions.
They looked at each other, shared a moment of silent consultation, and the older one turned back to me.
“We wanted to tell you,” she said, “that the prayer you said for our mother meant a lot to her—and to all of us. It really gave us all peace.”
Now it was my turn to smile.
“I’m very glad,” I said, trying to look appreciative and professional at the same time.
“We wanted to thank you for doing that,” she said. The other nodded affirmatively.
Looking awkward, she continued, “Can we . . . hug you?” Her sister agreed and nodded.
“That would be fine,” I said, and I hugged them individually. They were reaching in their purses for Kleenex as I walked down the hall toward the recovery room.
In their appreciation, I felt encouraged that I had done the right thing. I had another surgery that day, and I prayed with that patient as well. He was equally thankful. When I finally got home and had a chance to reflect on what I had done, I realized I had communicated something important and unusual to the patients. I was saying, in essence, “You may be looking to me for your outcome because of my skills, my confidence, and hopefully a glowing recommendation from other doctors, but I am willing to admit before you and your family that I am not God. I am good at what I do, but ultimately I cannot control the outcome of your surgery. Whether we like to admit it or not and no matter how simple or complex the case, my skills are not enough. We need God’s help, and I am not ashamed to ask for it.”
It required humility and honesty—and it felt great.
I also realized I had brought another dimension of the human experience into that room: the spiritual. When people have a spiritual experience, at best they feel that God is with them. At the least, prayer provides a catharsis for fear, which makes room for peace and hope during difficult times.
* * *
From that day forward I have offered to pray for nearly every patient before surgery. It has clearly blessed many people as they dealt with the illness and loss of control.
I began to actually enjoy surgery more than I had previously. Trying to control outcomes and therefore what people thought of me had taken the joy from my practice of medicine and from my life. Throughout my training I had used performance, perfectionism, and fear of failure to hone my technical skills. Adrenaline had been a necessary and welcome part of the job; I lived for the rush and the drama of a difficult procedure. I loved believing that my own intelligence and skill had snatched someone from the jaws of death. But when I took all the credit, I also took on all the pressure: constant stress, lack of sleep, the need to be absolutely perfect, and an overarching dread of failure or lawsuit. Of course, no one is absolutely perfect. Although I do have intelligence and skill, I believe I have been given them by God—which means I would not have them without him. When I began giving God the credit and responsibility for the outcome of my work, I realized that I could not remember a time when I had enjoyed the cases so much. By openly acknowledging that I was not God but that I worked for him and with him, I was able to stop carrying the entire burden on my shoulders.
A little while after I began praying with patients before surgery, it struck me that we were doing a lot of asking but not a lot of thanking God for the results. So I began praying with pa
tients after surgery as well. When they awoke from anesthesia, I would lean over and whisper a prayer in their ear, thanking God for answering our pre-operative prayer and asking him to continue to guide and heal. If there was a problem, I would pray with them for the resolution.
When I first see patients in the office, I generally ask two questions related to “spiritual history”: “In what faith or religion were you raised?” and “Are you practicing now?” This gives me some spiritual background on each patient and helps me not to offend anyone. As a surgeon, I want all my patients to know and feel that I personally care about their complete welfare, not just the part of their health for which they are seeing me. I want them to enjoy the best physical, emotional, and spiritual health possible, according to their own definitions. And I want to encourage them wherever they are on their spiritual journeys with their own faith, not to push my faith on them. It is not my job to insist that they address spiritual issues any more than I insist that they exercise, which is also good for health.
I generally offer to pray with everyone before surgery. I offer to pray with many patients I see in the office, as well, although I have no formula and do not offer to pray with every patient. If I don’t think it will be a blessing, I don’t offer. Then, if I detect any hesitation when I inquire about their emotional and spiritual health, I make sure they know that I did not mean to make them uncomfortable and that my desire is for their total health. Then I move right along to other topics. It is not right or productive to force them in any particular direction. My job, as I see it, is to give them the opportunity to make good choices in all areas pertaining to their health. I make it safe to accept or reject the offer.
Gray Matter Page 4