Gray Matter

by Kilpatrick, Joel;Levy,David

  At home, however, her symptoms grew worse. During a frightening episode of vomiting and temporary loss of vision and balance, she had to leave the kids with a neighbor while an ambulance took her to the emergency room.

  An MRI showed nothing, so after two days they sent her home to recover, but the episodes of dizziness came every half hour, followed by incapacitation and vision loss. Charlotte began setting out a loaf of bread and water for the kids’ meals. When she made it into work she would bump into walls, and she had lost so much weight that her coworkers were alarmed.

  Finally, convinced that she was dying, she asked a medical colleague for help, and this colleague called a neurologist who ordered a scan. In the meantime, Charlotte and her children moved in with a friend.

  This scan showed something: vertebral artery dissections in both arteries leading to the brain. That means the inner lining of the vessel walls had separated from the outer vessel walls in the arteries just before these two arteries enter the back of the brain. It is a dangerous condition that can cause stroke, brain damage, or death. A common cause is trauma or whiplash. Because the damage was to vessels leading to the brain, Charlotte was referred immediately to me.

  I met her for the first time in my office at nine o’clock one morning. She seemed distracted and unable to focus on one thing for very long. I started evaluating her, but she was so fatigued that she didn’t seem to be paying much attention to what was happening.

  “Am I going to die?” she kept repeating. “Can you fix it? I have a lot to live for. I have two little kids who need me.”

  Each time she said it, it was as if she didn’t remember having said it before.

  I looked closely at the scans. The bilateral vertebral dissections jumped out at me. Just before entering the brain, the vessels suddenly narrowed as if something had taken a bite out of both sides. I rarely see such pronounced dissections on both vertebral arteries at once.

  I turned the computer screen toward her to show her the images.

  “Damage like this is often caused by whiplash or a sudden, traumatic movement,” I said as I looked them over. “Do you have any idea what might have happened?”

  She quickly shook her head. “No,” she said. “Nothing like that has happened to me.”

  It didn’t seem entirely plausible that she would have suffered such an injury without having an idea what had caused it, but whatever the case, the important thing now was deciding on treatment. After carefully considering the options, I concluded that the risks of a procedure would outweigh possible benefits. I recommended that we let the arteries heal on their own.

  “You can’t do anything?” Charlotte asked, exasperated. “I can’t even work or watch my children. I—I’m a wreck.”

  “I really am sorry,” I said. “Surgery will not get you back to work any sooner and may make you worse. This is the best avenue. We will start you on blood thinners to avoid stroke until the body heals the damage. You are not to strain or pick up anything heavy. Your arteries will heal. It will just take time.”

  For six weeks Charlotte stayed home and suffered with her symptoms: the strange feeling that life was in slow motion, and the sudden sensation of electricity that would surge through her and rob her of the ability to see, stand, or walk straight. Eventually, I got another call from her colleague saying that Charlotte was in despair and asking whether there was anything else I could do. Although I didn’t have anything else medically to offer, I was willing to give her another appointment out of compassion and a conviction that perhaps there was more to her case than what we saw in the scans.

  She arrived looking distracted and distraught.

  “Charlotte, we have talked about the dissections: how long they are and how the blood thinner is helping you avoid forming blood clots while your arteries heal,” I said. “And we have been trying to treat your dangerously high blood pressure with limited success.” I paused. “Sometimes these types of problems result from something else going on in your life, some problem that seems unrelated.”

  That was all it took. This woman sitting in my exam room burst out crying. There was nothing proper about it. It was messy and desperate. She looked too spent to be embarrassed, and she was too helpless to stop.

  “I am so angry and bitter at my husband,” she said. “I filed for divorce because he treated us horribly. He drank too much. He was mean to me and my children. He is still harassing me, calling me dozens of times a day, making threats and calling me names. I had to get a restraining order against him. He still yells at me and pushes me around when we exchange the kids.”

  Clearly, there was a lot going on that I didn’t know about.

  “Those are big problems,” I said. “I think they require some serious attention and counseling. You can’t leave yourself or your children in danger. In the meantime, I often pray with patients, and I would like to pray for you.”

  She reacted strongly.

  “I grew up in church. I know about God,” she said with vitriol. “Those people were hypocritical. I resent the whole concept of God. I resent my stepmother for treating me badly and claiming to be a follower of Jesus. I resent my father for letting her do it.”

  She paused for a moment, then dried her tears. I thought she might get up and walk out. Instead she said, “But you can pray for me.”

  “I meant I’d like to pray for you now,” I said calmly.

  “Right here? Right now?”

  “Yes,” I said as gently as I could, and my manner seemed to have an effect on her. She was nervous and agitated, but she seemed to feel an urgent need for something to be done. She agreed to my praying.

  I scooted over on my chair.

  “First, let me explain that my experience tells me that some physical problems have emotional causes,” I said, explaining to her the relationship between forgiveness and health.

  “Forgiveness is not pretending evil never happened, and it is not calling evil good. Forgiveness is setting yourself free by not giving others the power to hurt you again every time you think about them. Given your physical situation, it is the best way I know to help your body continue to heal.”

  She seemed to understand this.

  “So before we pray, I think it would be a good idea for you to forgive anyone who has been hurting you.”

  She thought for a while.

  “I need to forgive my father,” she said. “He married a woman who did not love me, and he did not defend me from her. She was always against me.”

  “Anyone else?” I said.

  This time the silence lasted longer.

  “I need to forgive my husband,” she finally admitted. “I feel like I married a man I didn’t know.”

  “What do you need to forgive him for?” I asked.

  “Harsh words. Suspected affairs. Drinking. Putting me down. Making me believe something is wrong with me, that I’m unattractive. Even killing my dog.”

  Taking it all in, I nodded.

  “Then let’s forgive him for those things,” I said, and together we directed ourselves to God and went through the steps that were familiar to me by now, naming each offense and giving it over to him. Charlotte started crying. Her face swelled and reddened. Years of loneliness and anger seemed to be pouring out of her.

  After forgiving her father and stepmother, she repeated these words in forgiveness of her husband: “I forgive Alan and I leave him in the hands of God, who is just and doesn’t need my help. I drop any desire for vengeance, and I set Alan free.”

  I was surprised at the depth of her despair and pain, and as she continued, she embraced the process. Soon she was searching her memory as if it were an old attic, finding every bit of junk to throw away. I knew she couldn’t cover it all in one visit, but already she seemed to have hope.

  When we finished, she looked limp.

  “How do you feel?” I asked.

  “Lighter and freer emotionally,” she said. “I feel better. My head still hurts a little, but I’m no longer dizzy.
”

  “You will feel better,” I said. “Give it a bit of time.”

  She paused.

  “This feels like the beginning of something for me,” she said. “I have a peace I’ve never had.”

  “That comes from God,” I said. “You have just let go of a whole lot of baggage. It will try to come back, but you don’t ever have to pick it up. If you feel the resentment again, just start to forgive.”

  She wiped her eyes. We walked out together and scheduled her for a follow-up scan.

  “Thank you, Dr. Levy,” she said.

  * * *

  Alan and Charlotte were eventually divorced. Because of Alan’s continued bullying, the judge limited him to supervised visits, and after a while Alan stopped showing up at all. Charlotte didn’t hear from him for five months. In the meantime, she had completed her training and was a family-practice physician. She came back for a number of follow-up appointments. I checked a scan at three months and saw that although the progress was slow, her arteries were healing. She was eager to pray the next time she saw me, and soon I referred her to two women with whom she could pray on a more regular basis. These women would pray with her, sometimes for hours. When I asked Charlotte one day how this was going, she told me they had become like the sisters she’d never had.

  Her vessels healed; her symptoms decreased in severity and frequency, from fifty episodes a day to ten, then two. Finally one day in my exam room, Charlotte broke down and admitted what Alan had done to her. We were looking at her scans, and the reality of what had caused her dissections seemed to overwhelm her.

  “I know how this happened,” she whispered, her voice trembling. “My ex-husband . . . he would put his hands on me. One night he dragged me off the bed by my hair.”

  She sobbed quietly. I listened.

  “He hurt me many times, bruising me, shoving me around. But this time was the worst,” she said. “I think it nearly killed me.”

  I was not surprised to hear it. I felt a deep sadness that she had kept her secret for so long but also shared her relief that the truth was out. It is widely recognized that confession, whether in church or out, is good for the soul, and Charlotte was benefiting from it before my eyes.

  “I’m so sorry for being a liar,” she said. “All these people have been trying to figure out what had happened to me, and I knew all along that it was him.”

  She hung her head. As a member of the medical community, she was embarrassed by this revelation. I reassured her that I did not think less of her; the trauma did not change my treatment or diagnosis.

  I was glad her life had taken a new direction.

  * * *

  Charlotte soon recovered enough to return to work full time. She was able to care for her children again. Her life became more stable with the help of a good nanny, and she hadn’t heard from Alan in months. Then one day, her cell phone rang.

  “Hello, this is a nurse in the intensive care unit at the hospital across town,” the voice said. “Are you the ex-wife of Alan Hanson?”

  After some hesitation, Charlotte replied, “Yes.”

  “I’m calling because Alan is extremely ill. He coded today—his heart stopped and we had to bring him back. He is awake now but is crying and would really like to see his children. Can you please bring them? I’m not sure how much time he has left.”

  Charlotte was torn. Should she see the man who had caused her so much misery? Should she allow him to see his children before he died? Or should she let him die alone?

  What about the journey of forgiveness she had been through? What about all those offenses she had laid down? Could she really face this man who had nearly killed her? Could she do him a kindness? Should she?

  She consulted with a friend at work, who recommended against it. “He doesn’t deserve it after all that he has put you and the kids through,” her colleague said. “He doesn’t even visit them.” While Charlotte waited a day wrestling with these questions, the nurse from the other hospital called back again.

  “Alan is in bad shape,” she said. “He keeps asking to see his children—and you.”

  “I’m not sure I can come,” Charlotte said.

  “I beg you to hear the wish of a dying man,” the nurse said, “if there’s any way possible.”

  Compassion tugged at Charlotte’s heart. She composed herself and hours later walked into the intensive care unit alone. A cardiologist was walking out of Alan’s room. Charlotte pulled him aside and introduced herself as Alan’s ex-wife and a doctor.

  The cardiologist seemed to open up in the presence of another medical professional.

  “I just pulled 500 cc’s of bloody fluid from the sac around his heart,” he said, shaking his head. “There is massive buildup of fluid in both lungs. We’ve taken five liters off in the past few days. It’s not looking good. He may be in his early forties, but he has the heart and lungs of an eighty-five-year-old man. He’s barely hanging on.”

  He gave her a grim look and walked away.

  Slowly, Charlotte made her way into Alan’s room. The man in the bed did not look like her ex-husband. He was emaciated and weak. His eyes drifted to the door as if expecting another nurse, but when he saw it was Charlotte, his face lit up with an almost desperate recognition. He summoned his energy and waved her in.

  “I’m so happy to see you,” he said in a hoarse whisper.

  “Alan, what’s wrong?” she said. “What happened?”

  “I don’t know. I couldn’t brush my teeth, couldn’t change clothes.”

  He paused to take extra breaths.

  “I guess it’s real bad,” he concluded. “Where are the kids?”

  “I didn’t bring them,” she said. His face dimmed.

  Because Charlotte was still scared of Alan and did not know in what condition she would find him, she had left the children in the waiting room. Seeing him now, she realized that Alan obviously didn’t have much time left. He was only a skeleton of the large, muscular man she had known, and she was moved with compassion.

  “Alan,” she said. “I want you to know that I have forgiven you for all the terrible things you did to me.”

  He shook his head woefully as it lay on his pillow, looking as if he felt he didn’t deserve to hear those words.

  “I wish I could make it up to you,” he said. “All the things I did to you and the kids. Everything I put you through . . .”

  “Alan, you need more than my forgiveness. What you really need is God’s forgiveness,” she said.

  He looked at her weakly.

  “Okay,” he said, nodding.

  “Would you repeat a prayer after me?” she asked with trepidation.

  “Okay,” he said softly, nodding again.

  “Jesus,”

  “Jesus,” he said flatly,

  “. . . I know I’m a sinner.”

  “. . . I know I’m a sinner.” This seemed to hit him harder.

  “I’ve done terrible things to people . . . ,”

  “I’ve done terrible things to people . . . ,”

  “. . . including my family.”

  “. . . including my family.” Now he was speaking from the heart. His voice broke as he continued to follow her lead: “I accept your forgiveness. Thank you for paying the price for my sins on the cross. I want to live with you in heaven forever. Amen.”

  He looked at her with tears in his eyes and nodded.

  “Alan,” she said, “I’ll go get the kids.”

  Charlotte and the children visited his hospital room every day for the next several weeks. His condition was getting worse by the day. He was constantly short of breath. Daily he was producing a liter of bloody fluid that had to be drained from his lungs.

  “Jesus, help me,” he would say with labored breathing. “Lord, help me.”

  The doctors found a cancerous lymph node in his left groin, meaning the cancer had spread throughout his body, seeding the sac around his heart and the pleura around the lungs. One day the oncologist showed Char
lotte the scans. She looked at them and cried. No part of his lung looked normal. As one doctor to another, the oncologist confided, “He’s not going to make it out of the hospital.”

  A few days later his breathing became so compromised that he was fitted with a mask that sealed around his nose and mouth and brought pressurized oxygen into his lungs. When the children sat on his lap, they could barely see him because the breathing apparatus almost obscured his face. Nevertheless, Charlotte could see a major difference in the man who had once terrorized her. His condition had humbled him; his having received forgiveness from God and Charlotte had begun to transform him. He had even begun to compliment her whenever she was there, telling her how pretty she was. He was natural and loving with the children.

  Once she was sitting quietly by his bed when he said, “By the time I finally get it and am at peace with myself and love God, he’s going to take me away.” He looked away with chagrin.

  One day on the way to the hospital she stopped by the store to buy a CD player so she could play worship music in Alan’s room. She was in the checkout line at the store when the nurse called her. “His kidneys and liver are shutting down,” she said. They both knew what it meant.

  At the hospital, Alan’s body was cold and clammy, but his eyes were wide open. Charlotte remained calm and put on the new worship CD. He lay in bed listening to it. At one point he took a pen in hand to write a note: “How much longer?” He passed it to Charlotte.

  “I don’t know,” she said. “But you’re ready.”

  She left briefly to get lunch at the hospital cafeteria, and when she returned, the ward was in a frenzy. Nurses, doctors, and respiratory techs were running in and out of Alan’s room, and as she walked in, he was looking at the ceiling, crying. She knew he was on his way out of this world, and she grabbed his shoulders, looked him in the eye, and said, “Alan, God loves you!” As she straightened up, a nurse watching the heart monitor announced that Alan’s heart had stopped. The torso of his body rose up and then collapsed, rattling the bed. When Charlotte looked down at him, he was different than he had been seconds earlier: he was an empty shell. The green flat line and silence of the monitor told her he was gone.