Gray Matter

by Kilpatrick, Joel;Levy,David

  The anesthesiologist sprang into action. Normally, anesthesiologists are the wallflowers in the operating room, staying quiet behind their protective blue drape. But with Annette’s vitals dropping, it was his duty to try to stabilize her quickly.

  “I need a blood-gas reading,” he said to the tech while drawing blood into tubes from the port in Annette’s femoral artery. “Get me STAT labs on these!”

  The tech rushed the tubes to the lab. The anesthesiologist was already searching the drawers of his cart for glass vials of drugs and injecting their contents into the IV drip to try to get Annette’s blood pressure to stabilize. Her blood pressure continued downward.

  . . . 90 . . . 80 . . . 70 . . .

  “God, what is happening?” I prayed under my breath. “What’s gone wrong?”

  The fact that all of Annette’s vital signs were falling at once was ominous. It meant that major systems had been affected—but by what? To have your heart rate and blood pressure drop at the same time indicates a severe and unusual problem. Usually if the blood pressure goes down, the heart rate goes up to compensate, but with both going down simultaneously, it might be neurological. Had the glue found its way to the brain stem? The possibility made me shudder.

  There might be other possibilities as well. There might have been an air embolus—a bubble of air that is sucked into an open vein from the outside. This is rare, but it can be fatal if the bubble travels to the lungs. Or the problem might be her breathing tube. The anesthesiologist, who was responsible for the endotracheal tube, listened to the lung sounds to see if the tube had become displaced. The tube was in its proper place. And Annette was getting worse.

  The uncertainty was so agonizing that for a moment I had to stop watching the vital signs drop on the monitor. I knew there was nothing more I could do but pray. I turned away and began begging God to intervene. Facing the wall, I implored desperately, “God, you’ve got to help her. Don’t let her die now. Please, we need your help. There’s nothing we can do.”

  Nearby, Dr. Thompson and the neurosurgery resident were in limbo. Just before Annette’s condition changed, they had been putting a calcium paste into the opening of her head to refabricate the skull. Now everyone was frozen in place thinking, as I was, that in a minute Annette would go into cardiac arrest and we would have to start pumping on her chest to try to keep her alive. A three-year-old doesn’t have many reserves. Something had to stop her free fall.

  The sickness in my heart grew to a throbbing mass. I couldn’t imagine going out to the waiting room to tell the family, friends of mine by now, that we had come all this way to have Annette die on the operating table. The only consolation I had was that God would be with me, no matter what happened.

  The anesthesiologist was still barking orders to the nurses and the other tech. Dr. Thompson and I looked across the room at each other, helpless. The alarms beat a menacing rhythm to the unfolding scene. Eventually, the anesthesiologist reached over and slapped them off. Now we stared at the monitors and watched the numbers fall in eerie silence.

  The anesthesiologist yanked open drawers and searched for more vials, glass clinking against glass like wind chimes. Finding the one he wanted, he turned it upside down, pushed in a syringe, and jammed the needle into the rubber port on the IV drip. This medicine would kick-start the heart, stimulating it to pump harder and thus cause the blood pressure to increase. He also opened up the IV lines to put more fluid into Annette’s system, none of which would help if Annette’s system was shutting down.

  . . . 60 . . . 50 . . . 40 . . .

  I began preparing myself to perform CPR. Then, just as I was about to step toward the table, the numbers stopped dropping. We all stared at the monitors.

  . . . 40 . . . 40 . . . 40 . . .

  “Stabilizing,” the anesthesiologist said after a moment. I couldn’t immediately believe it.

  “Pressure’s increasing,” the anesthesiologist said, checking another indicator. Then the number moved again, but this time in the right direction.

  . . . 40 . . . 50 . . . 50 . . . 50 . . . 60 . . .

  Everyone breathed again. The anesthesiologist exhaled audibly. For two full minutes we watched as Annette’s vitals crept upward, indicating that whatever the crisis had been, it had passed—at least for the moment.

  Dr. Thompson and the neurosurgery resident stepped forward and began to resume the work of closing the skull. We didn’t know what had happened, but they knew, as we all did, that we needed to get Annette off the table before it happened again.

  “God, thank you,” I prayed silently with deep emotion. “Thank you.”

  I continued to breathe thanks as I waited and watched. Thirty minutes later they finished applying the calcium putty to the hole in Annette’s skull and sewed the skin over it. Now we would wait for her to wake up.

  She woke up so slowly that we began to worry that she had suffered brain damage. It took an hour before the nurses informed me she was moving her arms and legs, and for the first time that day I felt relief. I went out and talked to her parents.

  “We had a scare, and we aren’t sure why,” I told them, “but the fact that she is moving her limbs means that the glue did not go to the brain stem, which is reason to be very thankful. We might never know exactly what happened, given the complexity of the procedure, but she seems to be okay now.”

  They sighed, hugged each other, and grasped my hand.

  Annette remained in the hospital for two days, then went home and picked up right where she had left off. She started walking again with her walker. She resumed speech therapy. In spite of the scare, our procedure had been a success. I hoped that it was the last one she would ever need.

  * * *

  Neurosurgery, like life itself, is full of surprises. No surgeon, not even the most highly trained, can save a life alone. During this dramatic procedure I was reminded that the outcomes of procedures, and of our very lives, are ultimately in God’s hands. He wants to be involved in the details of everything we do, no matter our position or profession. My practice and my life have been transformed because I have learned to pray with my patients. In the beginning the risk seemed high, but it was meager compared to the gain. I have learned firsthand that, as radiant sunlight melts away fog, God infuses life-giving hope into the darkest circumstances. If we look for him, we will find him,19 and the journey will be amazing.

  A Final Word

  Prayer is for the patient, not the physician. Granted, the physician and staff may also be blessed, but prayer is for the patient.

  In prayer as in surgery, where there is opportunity to do great good, there is also the potential to do harm. I don’t ask to pray with everyone, because prayer with those who don’t want it is neither helpful nor kind. There is no one prayer “prescription” that I advocate, except perhaps that of being open to situations in which prayer would be received as a blessing. Pushing one’s personal faith on another is not recommended in any setting.

  On the other hand, it seems to me that offering medical or spiritual information and considering the patient’s response is caring, whereas withholding information that might help is actually uncaring. Thus I believe that prayer is one of the highest forms of kindness that I can show a person.

  Some people feel uncomfortable by the mention of God in their presence. In particular, those who have been hurt by religious institutions are often especially vulnerable if those in positions of authority speak of God. Whenever offense is given, whether in medical practice or elsewhere, humility helps. This is true in all areas of life; when people sense that we genuinely care, they are more open. Let us remember that we are all on a journey, that none of us have arrived.

  Whatever our profession or station in life, I believe that we all desire to make a difference in the world. In caring for the whole person in my surgical practice, I have encountered life-changing responses that go far beyond the procedures I perform. As with anything of value, though, there is a cost involved. For example, time is a
limited resource; each of us is given the same daily amount. In my practice, my schedule needed to change to allow time for those in need. Through this book I hope to inspire you to approach the relationships in your own spheres of influence, whatever they are, with greater love and authenticity.

  David attended medical school at Emory University School of Medicine in Atlanta, Georgia. He completed his residency in neurosurgery at Barrow Neurological Institute in Phoenix, Arizona, and did a fellowship in Endovascular Neurosurgery at the University of Vienna, in Austria. In 2007 he took a year-long sabbatical that took him to prisons and orphanages in Bolivia, Peru, and Ecuador. In recent years, David has reduced his office and operative schedule, using his off-hours to speak with his patients about forgiveness and other aids to healing. He currently practices neurosurgery in San Diego, California.

  Notes

  1 Curlin FA et al., “Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health,” Arch Intern Med (2007) 167:(7)649–54.

  2 Magyar-Russell G et al., “Ophthalmology Patients’ Religious and Spiritual Beliefs,” Arch Ophthalmol (2008) 126(9):1262–65.

  3 Drawn from the following articles:

  Carson JW et al., “Forgiveness and Chronic Low Back Pain: A Preliminary Study Examining the Relationship of Forgiveness to Pain, Anger, and Psychological Distress,” J Pain (2005 Feb) 6(2):84–91.

  Dezutter J et al., “God, Image, and Happiness in Chronic Pain Patients: The Mediating Role of Disease Interpretation,” Pain Med (2010 May) 11(5):765–73.

  Chronic pain patients with positive God images had greater levels of happiness. One’s emotional experience of God has an influence on happiness.

  Friedberg JP et al., “Relationship between Forgiveness and Psychological and Physiological Indices in Cardiac Patients,” Int J Behav Med (2009) 16(3):205–11.

  Stress, anxiety, depression, and cholesterol were all improved by forgiveness.

  Hansen MJ et al., “A Palliative Care Intervention in Forgiveness Therapy for Elderly Terminally Ill Cancer Patients,” J Palliative Care (2009 Spring) 25(1):51–60.

  Hope and quality of life significantly improved in cancer patients who learned forgiveness.

  Lawler KA et al., “A Change of Heart: Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict,” J Behav Med (2003 Oct) 26(5):373–93.

  Lawler KA et al., “The Unique Effects of Forgiveness on Health: An Exploration of Pathways,” J Behav Med (2005 Apr) 28(2):157–67.

  Webb JR et al., “Forgiveness and Health-Related Outcomes among People with Spinal Cord Injury,” Disability and Rehabilitation (2010) 32(5):360–66.

  Spinal cord injury patients who forgive others reported significantly higher health status.

  Whited MC et al., “The Influence of Forgiveness and Apology on Cardiovascular Reactivity and Recovery in Response to Mental Stress,” J Behav Med (2010 Aug) 33(4):293–304.

  Forgiveness positively affects cardiac recovery from stressful events.

  Worthington EL et al., “Forgiveness, Health, and Well-Being: A Review of Evidence for Emotional Versus Decisional Forgiveness, Dispositional Forgivingness, and Reduced Unforgiveness,” J Behav Med (2007 Aug) 30(4):291–302.

  4 MacLean CD et al., “Patient Preference for Physician Discussion and Practice of Spirituality,” J Gen Intern Med (2003 Jan) 18(1):38–43.

  5 King DE, Bushwick B, “Beliefs and Attitudes of Hospital Inpatients about Faith Healing and Prayer,” J Fam Pract (1994 Oct) 39 (4):349–52.

  6 Maugans TA, Wadland WC, “Religion and Family Medicine: A Survey of Physicians and Patients,” J Fam Pract (1991 Feb) 32(2):210–13.

  7 Matthews DA et al., Religious Commitment and Health Status: A Review of the Research and Implications for Family Medicine,” Arch Fam Med (1998 Mar-Apr) 7(2):118–24.

  8 Larimore WL et al., “Should Clinicians Incorporate Positive Spirituality into Their Practices? What Does the Evidence Say?” Ann Behav Med (2002 Winter) 24(1):69–73.

  9 I cannot remember everything I said to Joan after she experienced the “cloudlike” feeling. What I have included here is what I typically would say to someone who wanted to move toward God.

  10 Letter reproduced with the permission of “Dr. Willard,” whose name has been changed.

  11 Samuel brought all the tribes of Israel before the LORD, and the tribe of Benjamin was chosen by lot. Then he brought each family of the tribe of Benjamin before the LORD, and the family of the Matrites was chosen. And finally Saul son of Kish was chosen from among them. But when they looked for him, he had disappeared! So they asked the LORD, “Where is he?” And the LORD replied, “He is hiding among the baggage.” So they found him and brought him out, and he stood head and shoulders above anyone else. Then Samuel said to all the people, “This is the man the LORD has chosen as your king. No one in all Israel is like him!” And all the people shouted, “Long live the king!” (1 Samuel 10:20-24).

  12 A cheerful heart is good medicine, but a broken spirit saps a person’s strength (Proverbs 17:22).

  13 If you forgive those who sin against you, your heavenly Father will forgive you. But if you refuse to forgive others, your Father will not forgive your sins (Matthew 6:14-15).

  14 If we confess our sins to him, he is faithful and just to forgive us our sins and to cleanse us from all wickedness (1 John 1:9).

  15 Confess your sins to each other and pray for each other so that you may be healed. The earnest prayer of a righteous person has great power and produces wonderful results (James 5:16).

  16 If you forgive those who sin against you, your heavenly Father will forgive you. But if you refuse to forgive others, your Father will not forgive your sins (Matthew 6:14-15).

  17 The details of this story and these remarks were printed with the permission of “Charlotte,” whose name has been changed.

  18 We know that God causes everything to work together for the good of those who love God and are called according to his purpose for them (Romans 8:28).

  19 “I know the plans I have for you,” says the LORD. “They are plans for good and not for disaster, to give you a future and a hope. In those days when you pray, I will listen. If you look for me wholeheartedly, you will find me” (Jeremiah 29:11-13).

  Those who search will surely find me (Proverbs 8:17).

  I tell you, keep on asking, and you will receive what you ask for. Keep on seeking, and you will find. Keep on knocking, and the door will be opened to you. For everyone who asks, receives. Everyone who seeks, finds. And to everyone who knocks, the door will be opened (Luke 11:9-10).