Gray Matter

by Kilpatrick, Joel;Levy,David

  I visited with Sam the next several days. We prayed every time, along with his sisters who were there, that God would reverse this paralysis. Maybe the swelling will ease and the spinal cord be restored, I thought. Maybe he would regain mobility just as unexpectedly as he had lost it. Every day he asked me, “Dr. Levy, when am I going to get better? When will I be able to walk?” Every day that went by without his recovering normal function meant a greater chance that his paralysis would be permanent.

  With some of his chest muscles now paralyzed, Sam developed a serious case of pneumonia. As I watched him suffer in these multiple ways, I was overwhelmed by my own sense of failure, even though I still believed that I had done the surgery almost perfectly. Doubts and fears tore at my confidence like jackals. How could this have happened? Was I losing my touch? Had I used the wrong glue mixture? Did I get enough counsel from others? Should I have done the procedure at all?

  Deep inside, I also felt betrayed. Wasn’t prayer supposed to prevent such things? Hadn’t Sam and I petitioned God for a good outcome? Hadn’t I even asked for prayer from people at my church for this case—something I had never done before? Hadn’t I spent hours planning and asking God for wisdom? How could God let this happen? How could God treat this man this way? This was a motivated man who was going to school to train for better work. Of all my patients, why this one? A sense of devastation and loss overshadowed my every waking moment, and nothing would stave it off.

  As I continued to visit Sam to monitor and pray with him, it was clear that the outcome was ruining him emotionally. He was distraught and desperate, inconsolable, constantly asking what could be done to restore the use of his arms and legs. It occurred to me that perhaps the pneumonia he had developed after surgery would keep getting worse and he would die, sparing him what he dreaded: life as a quadriplegic. Perhaps that was the only bearable outcome for him. Maybe it was God’s severe mercy in this situation. Instead, his pneumonia improved on antibiotics, and it became clear that he would live—but his life would be radically changed.

  I could have used a month off to recover from the case, but the following week I had other surgeries scheduled. I had never cancelled a case because of a bad outcome on a different one, and I did not want to start now. In truth, I did not even have the strength to call a patient to cancel. I was mad at God. I had trusted him and he had let me down. I began to wonder if I could even operate again. Or was I just scared that God had left me or, worse, had never been with me and it had all been my imagination? When it came to the big stuff, a high-risk case, God had abandoned me. I felt utterly alone.

  My next operative day was one week after Sam’s surgery, and I wasn’t looking forward to it. With Sam lying in a bed as a quadriplegic at the other end of the hospital, I ascended the stairs to the pre-op area. This time I felt mechanical and joyless. I saw nothing good in the circumstances, but neurosurgeons are trained to lock their feelings away and operate on willpower alone. I had been trained to handle tragedy with poise and calm, never showing fear or self-doubt. Sam was my first major disaster since I had begun praying with patients. Commonly among surgeons, all previous successes are forgotten in the face of tragedy. In “autopilot” mode, I smiled at the nurses and pretended nothing was wrong. Robotically, I checked the chart and reviewed the documentation for the procedure. Any warmth I gave off was manufactured; inside I felt as cold as the clamps and scalpels on the operating table.

  Then came the moment when I had to approach my first patient since Sam, which meant offering prayer. I hesitated. Here was a hurdle too high. Would I pray with the patient waiting for me behind the pre-op curtain? How could I? I felt no connection to God; I didn’t even feel connected to myself anymore. I felt remote, abandoned. As I searched my soul in that moment, I felt well justified in not ever praying for another patient. Why would I, when the results were so random?

  Who was God not to answer my prayer for Sam? Surely, of all the prayers I had offered, this one should have been at the top of the list. He had answered prayers for many other patients who seemed, in my limited understanding, less deserving. But this time prayer had not helped, and instead of being the hero, I was the instrument of destruction. Had I not operated, he would not have been paralyzed, at least not immediately. Was this how I was rewarded for taking the risk of praying with patients? I had made myself vulnerable to them and to God, and God paid me back with failure? No thank you, I thought. I’ll take the conventional, safe route and hide again behind the facade of perfection, the illusion of control, retreating to safety from emotional involvement. I would be friendly but aloof and distant once more. In my pain and frustration with Sam’s case, I began to doubt God’s care.

  Of course other surgeries had involved complications, and some had even gone poorly or failed to solve the problem, but I hadn’t experienced anything as wrenching as this since I began bringing prayer into my practice. Prayer had raised my expectations, and now I felt betrayed. Was God listening if I couldn’t feel him? What would be the harm of not praying today?

  Just as my thoughts reached a crescendo of confusion, a simple phrase came forcefully to mind: “Do the right thing.” I recognized those words. I had heard them when I first began praying for patients and feared what others would think of me. They now gave me a new and unexpected sense of resolve. The phrase swept away other arguments like pieces removed from a chessboard. The answer was obvious: the right thing was to go against my feelings and do what was good for the patient. I had seen the results and could not deny that praying was the right thing to do, even if in my anger I didn’t feel like it was. I hesitated no longer and walked up to Lupe, a fifty-seven-year-old grandmother with a brain aneurysm, and smiled as best I could. She had no idea what my last week had been like. With some emotional difficulty, I reviewed the risks of death, blindness, paralysis, and coma that could result from surgery in the vessels of the brain. Each word haunted me, as images of Sam lying immobile in his bed flashed through my mind. Lupe said she understood the risks.

  “Do you really?” I wanted to say.

  Instead, I spoke the words that by now had become routine to me: “It is my habit to pray before surgery. Would that be okay?”

  “Yes,” Lupe said quite willingly. I had never prayed for a patient while suspecting that God was not interested in helping me or the one with whom I was praying. I didn’t know if I would be able to go through with the prayer or if I would stop in the middle and not be able to finish. I put my hand on her shoulder. Out of sheer habit I began, “God, thank you for Mrs. Cortes.”

  Somehow as I said the words, I began to feel again—the ice around my heart began to melt. The more I prayed, the more energy I received; the fog lifted. I continued to my conclusion: “I ask for wisdom and success for the surgery. In Jesus’ name, Amen.”

  It was not a long prayer, but by the time I finished, I felt something that had been missing for days: hope. I had begun the prayer purely out of conviction that it was the right thing to do, but I had ended it knowing that my doubts had been misplaced. God was at work and I did not want to operate without him, even if I didn’t get what I wanted. The pain had caused the fire in my heart to go out, but he had blown gently on the embers hidden deep in the ashes.

  Lupe smiled. “Thank you,” she said. Then something happened that had never happened before. From the other side of the curtain separating one gurney from another, I heard a deep voice say, “Hey, Doc, when you’re finished there, would you come over here and pray for me? My doctor didn’t pray with me.”

  Lupe and I smiled, and I felt tears form in my eyes. God had not abandoned me. He was here with me as I did my best to care for the people that he sent my way. I walked around the curtain and found a man who was alone. His name was Travis, and he was the pastor of a church. He was having abdominal surgery that morning, but for some reason his wife and family could not be there with him, and he was afraid. I put my hand on his shoulder and reminded him that God was with him as I prayed for his surgery.
When I opened my eyes, he was crying and wiping his eyes. He heaved a sigh that was so loud it might have summoned the nurses to see what was going on. He smiled at me, relaxed and at peace. I smiled too, patted his shoulder, and walked out of the pre-op area.

  As I walked down the hall, I felt at peace, too, as if God were telling me, “I haven’t abandoned you. Remember, it’s not about you. There is no formula for getting your way, and pouting only shows your immaturity. Trust me with what you don’t understand. I love you very much and nothing can change that. My love for Sam is greater than yours. I invite you to ask me for whatever you want, but prayer does not guarantee the result.”

  Lupe’s surgery went well, and she went home the following day. As for me, I had found my way through a major crisis of faith. Doing the right thing when I didn’t feel like it had brought a blessing to two patients, Lupe and Travis. I had chosen to trust the character of God and not my feelings. He was good even when I couldn’t see it.

  But there was still Sam.

  * * *

  Sam stayed in the hospital three weeks before being released and sent to a nursing home. He had not regained his mobility. Three months later he and his sister came to see me in my office. I cringed when I saw his name on the schedule. He was the last person I wanted to meet with. Seeing him would dredge up all the feelings of failure, betrayal, and personal grief at his incalculable loss. I had seen the wheelchair being pushed past my office door and could already feel the disappointment. Before going into the exam room where he was, I took a moment alone in the bathroom; splashed some water on my face; and prayed, “God, help me.”

  I paused outside the exam room door. It took all the strength I had to finally walk in. I knew it would be difficult to see him, and it was. He was in a wheelchair, emaciated, completely different from the man I had first met. He had recovered a little movement of his left arm and leg, but his right side was spastic and stiff. He had learned to use some prosthetic attachments to feed himself with his left arm, but both hands had fingers like claws with wasted muscles. I sat in my chair and looked at him. “How are you, Sam?” I asked.

  He didn’t answer but made a gesture with his head that was the equivalent of, “What do you think?”

  “Tell me about the surgery,” he said bluntly. “What went wrong?”

  I slid my chair over to the whiteboard, where once again I drew pictures of his spine, aneurysm, and AVM. I explained in as much detail as I could what might have gone wrong—the precarious aneurysm, and the lack of tolerance for swelling of any kind—hoping that he would be satisfied and find peace with the outcome.

  “Sam, I never wanted this for you,” I said as I finished. He looked away. “I can’t tell you how sorry I am that this happened,” I said.

  He said nothing.

  I offered to say another prayer; I had nothing else to offer him. It seemed trite considering the many that we had already said. He nodded unenthusiastically. He was wearing a sweatshirt, and as I put my hand on his shoulder, I realized just how much he had wasted away. There was hardly any muscle; it was all bone. I said a prayer asking that he would walk again.

  I opened my eyes. Sam had never closed his. He was staring at the far wall, smoldering. A few minutes later, after we had gone through the necessary information for his checkup, his sister wheeled him out of the room, and I left it, too, as if walking away from a problem too difficult to face.

  I didn’t see Sam until a year later, when he returned for another checkup. An MRI showed that his spinal cord had changed completely. It was small and withered below the damaged area, and he had developed a severe bend in the angle of his neck.

  When I had finished talking to him about his latest developments, he looked at me with pain-saturated eyes.

  “What happened?” he asked again. “Why did the surgery leave me like this?”

  “Sam, we’ve talked this through many times,” I said. “I am very sorry that this happened to you. Yours is the case that has bothered me more than any other in my career.”

  He did not appear comforted, and I could tell that he was angry with me.

  “Is there anyone who can help me?” he asked.

  I wrote down the name of a doctor who specialized in scoliosis, but I knew that more surgery would not help him. He was grasping for solutions that did not exist. I prayed for him again before he left, but he remained as upset as he had been a year earlier. The prayer made me feel better but seemed to do nothing for him. His body had not healed, and neither had his spirit.

  No surgeon likes to deal with complications, poor outcomes, or unhappy patients, but time generally allows us to let go of past cases. Sam’s stayed on my mind. Three years later, I had a nagging feeling that I needed to see him one more time. I wasn’t sure why, but something felt unfinished. I wanted to see again how he was doing before he slipped away into my past. I could have asked him to come in and see me, but I knew what was required for someone with limited use of his arms and legs to get to the hospital. My only other option was to go visit him. Though calling a former patient is not necessarily unusual in the course of follow-up care, asking to visit one is out of the ordinary for me. Yet I felt that I needed to make this exception. I called him one afternoon from my office.

  “Sam, it’s Dr. Levy,” I said. He paused for a moment, clearly surprised.

  “Hello, Dr. Levy,” he said. I continued on quickly so he would not think I had come up with a new strategy for restoring his mobility.

  “I don’t have anything new to tell you, but I was wondering if I might come by and visit you sometime when I’m in that part of town, just to see how things are going.”

  It seemed as though he didn’t know what to say at first.

  “Fine,” he said warily. “Sure. I don’t mind.”

  “Great. I’ll call you in advance,” I said. “I hope it will be in the next few weeks. I’ll see you soon.”

  “Okay,” he said.

  A few Saturdays later I drove to his neighborhood and parked my car in front of the small home where he now lived with his mother and sister. His sister answered my knock on the door and invited me in. Sam was there in his electric wheelchair. He gave a weak smile when he saw me, a little surprised that I had followed through on my promise. He was dressed in sweatpants and a sweatshirt; he looked gaunt like a rag doll, and miserable. His black hair had lost its luster, his brow was furrowed, and his face was joyless. He could move his left arm just enough to run the chair by way of a joystick. His right arm was rigid; he was unable to move it in any useful way.

  I sat on the couch opposite him and struck up a conversation.

  “So tell me what you’ve been doing,” I said.

  “Not much,” he said with little attempt to appear happy. He let several seconds lapse between phrases. “I get outside occasionally. I found some alternative therapies on the Internet.”

  “Oh? What kind?” I asked, hoping that he had finally found a reason, any reason, to hope.

  “Aromatherapy,” he said. “But it doesn’t actually help. I mean, what can help me now?”

  With his chin he indicated his own skinny body in the wheelchair. Though he said nothing after this, I felt again that he was seething with anger toward me. I had felt this before from him but had forgotten about it in the months since we’d last met. It felt harsh and accusatory. He was staring away from me in silence.

  I had come only with the intention of making a friendly visit, seeing where and how he lived and sharing a bit of his life, perhaps even “growing” from the experience. Now, however, I sensed that I needed to do something else: apologize to him. This was not something I had ever done to a patient before, and I didn’t like the idea. After all, I had done my professional best on his procedure. Using my skills, I had even given him a chance at a normal life, when other physicians might not even have tried. I had already told him many times how sorry I was that this had happened, even telling him at one point, “We prayed about it, and still it happened,” hoping
that he would stop blaming me and take up the matter with God. Something still told me I needed to apologize for my part in putting him in the wheelchair. I had done my best, but that did not erase the fact that he had trusted me and I had injured him.

  I felt uncomfortable with the idea because I knew it was not required of me, yet I felt impressed that Sam needed something from me so that he could move on. I sat on that couch and wrestled inwardly, not sure that I could do this even if I wanted to. My pride resisted, but my compassion pushed me on. Finally, after a long, tense silence, I decided that whether or not I felt I was in the right, I was willing to humble myself if it might help him to heal. I knew from my study of forgiveness that an apology is the most helpful step in opening someone’s heart and encouraging him or her to forgive. I cleared my throat.

  “Sam, I am very sorry for what happened to you,” I said, using the same words I had used in my office a number of times. “I never meant for it to happen, and it is the last thing that I hoped would happen. Your case is one of the most painful of my career.”

  It was the quintessential professional apology, conveying how bad I felt about his condition without accepting any blame. He nodded and looked into empty space. He had heard all this before. Although I could justify myself in a court of law, we were not in a courtroom. In order for him to heal, I needed to apologize for my part in his pain, and it would be one of the hardest things I had ever done. Taking an enormous risk, I continued, slowly and deliberately.

  “Sam, I want to apologize to you for what happened. The procedure that I did paralyzed you. You trusted me, and I let you down.”

  He turned to me with a startled look in his eyes, as if asking me silently, “Did you really say that? Did you really mean it?” Then, as if I had uncorked something inside him, tears began forming in his eyes faster than he could wipe them away with the back of his clumsy, partially paralyzed left hand.