Fearfully and Wonderfully

  I shall never forget the horror-struck face of one of my London students during one occurrence. He was performing a routine procedure on a woman in our outpatient clinic, excising a tiny lymphatic node from her neck for biopsy. The minor procedure required only a local anesthetic, which meant the patient was fully awake. I was working in an adjacent room when suddenly a nurse appeared in my doorway, her hands and uniform splashed with fresh blood. “Come quick!” she cried, and I dashed next door to find the intern, white as a corpse, working frantically on a woman from whose neck blood was gushing. It was hard to tell who was more terrified: my intern or the patient.

  Fortunately, a masterful teacher had drilled into me the appropriate reflexes. I ran to the woman’s side and, after removing all instruments from the wound, grasped her neck and applied firm pressure with my thumb. As my thumb filled in the broken part of the blood vessel wall, the bleeding stopped, and I stayed in that position until the woman calmed down enough for me to extend the anesthesia and repair the vessel. The intern had inadvertently snipped off a small section of the jugular vein!

  My University College teacher, who bore the grand name Sir Launcelot Barrington-Ward and served as surgeon to England’s royal family, had prepared us his students for just such an emergency. As his assistant, I would hear him ask each new student, “In case of massive bleeding, what is your most useful instrument?” At first the newcomer would propose various surgical tools, and the old teacher would frown and shake his head. There was only one acceptable answer: “Your thumb, sir.” Why? The thumb is readily available—every doctor has one—and offers a perfect blend of strong pressure and gentle compliancy.

  Then Sir Launcelot would ask, “What is your greatest enemy when there is bleeding?” and we would say, “Time, sir.” And he would ask, “What is your greatest friend?” and we would say again, “Time.”

  While blood is being lost, time is the enemy. Second by second, life will leak away as the patient grows weaker. The surgeon must fight the temptation to panic, to grab at vessels and clamp them off with forceps here and there, often causing more damage.

  Once I have my thumb on the bleeding point, however, time becomes my friend. Unhurried, I can pause and plan my next course of action. Meanwhile the body busies itself, forming clots to repair the breach. I can take time to clean up and arrange a transfusion or perhaps call for an extra assistant or enlarge the incision to get a better view. Once, I held a clump of blood vessels in my fist for twenty-five minutes while removing a diseased spleen, operating with one hand while I dammed the flow of blood with the other. All this can happen if my thumb is pressing firmly on the area of bleeding. And when I finally remove my thumb, my assistants poised to act, I usually find that no action is needed. The bleeding has stopped.

  At those moments, in the rush of adrenaline brought on by the crisis, I have a sense of spiritual exaltation. I feel at one with the millions of living cells in that wound fighting for survival. I realize, with a sense of humility and awe, that a common thumb is the only thing preventing my patient’s death.

  After many such experiences in the electric atmosphere of the operating room, every surgeon learns to identify blood with life. The two are inseparable: you lose one, you lose both.

  Why, then, does blood as a Christian symbol seem to contradict what I learn at such moments?

  A Toast to Life

  Although modern worshipers may feel uncomfortable with the fact, the Christian faith is inescapably blood-based. Old Testament writers spell out the details of blood sacrifices, and their New Testament counterparts overlay those rituals with theological interpretations. And daily, weekly, monthly (or whenever, depending on denomination), we are called upon to commemorate Christ’s death with a ceremony centered in his blood.

  I admit at the outset that I sometimes find the associations of the blood symbol distasteful. I switch on my radio on a Sunday morning while driving from my hospital in Carville to New Orleans. A Southern pastor is leading a Communion service in a church in the bayous. The congregation murmurs as he holds up a four-inch thorn and illustrates how barbarously the soldiers jammed a crown of them onto Jesus’ head. He describes the scene of a cross being strapped to a back bloodied by whips. Every occasion for the word blood—the nailing, the thud of the cross in the ground, the spear in the side—seems to give this preacher a fresh burst of energy.

  I drive along in bright Louisiana sunshine, glancing outside at the stately egrets, white as clouds, bobbing for food in the canals lining the highway. As if in mocking contrast, the theme of death spills from the car radio. The preacher asks his parishioners to think of their recent sins, one by one, and to contemplate the horrible guilt that led to such a bloody death on their behalf. A ceremony follows, the sacrament itself.

  My mind, jarred from the solemn church service, returns to the literal substance of blood—not the watery purple liquid filling Communion cups but the rich, scarlet soup of proteins and cells that keeps my patients alive. Again I wonder: Has something been lost over the centuries, something foundational? The Louisiana pastor focuses on shed blood—but does not the sacrament center also on blood that is shared?

  Medically, blood signifies life and not death. Blood feeds and sustains every cell in the body with its precious nutrients. When it seeps away, life falters. Has our modern use of the symbol, as illustrated by the radio preacher’s fixation on death, strayed so far from the original meaning?

  Deep in the biblical record lies a fundamental association of blood with life. In a covenant with Noah, God commanded, “You must not eat meat that has its lifeblood still in it” (Genesis 9:4). Later, in the formal legal code given to Moses and the Israelites, God reiterated the command as “a lasting ordinance for the generations to come.” Why? “Because the blood is the life, and you must not eat the life with the meat” (Leviticus 3:17; 7:26-27; 17:11, 14; Deuteronomy 12:23).

  Old Testament Jews felt no squeamishness about blood, and in that sheep-and-cattle culture everyone witnessed the bloody deaths of animals. Even so, every good housewife checked her meat to see that no blood remained. The rule was absolute: do not eat the blood, for it contains life. Kosher cuisine developed elaborate techniques to ensure that no blood contaminated the meat.

  In view of this background, consider the shocking, almost revolting message Jesus proclaimed to that culture:

  Very truly I tell you, unless you eat the flesh of the Son of Man and drink his blood, you have no life in you. Whoever eats my flesh and drinks my blood has eternal life, and I will raise them up at the last day. For my flesh is real food and my blood is real drink. Whoever eats my flesh and drinks my blood remains in me, and I in them. Just as the living Father sent me and I live because of the Father, so the one who feeds on me will live because of me. (John 6:53-57)

  Those words, coming at the peak of Jesus’ popularity, signaled a turning point in his public acceptance. The Jewish audience became so confused and outraged that a crowd of thousands, who had pursued Jesus around a lake in order to crown him king, silently stole away. Many of his closest disciples deserted him; enemies plotted to kill him. Jesus had gone too far.

  Jesus spoke as he did not to offend but rather to effect a radical transformation in the symbol. God had said to Noah, if you drink the blood of a lamb, the life of the lamb enters you—don’t do it. Jesus said, in effect, if you drink my blood, my life will enter you—do it! For this reason, I believe Jesus intended our ceremony to include not only remembrance of his past death but also realization of his present life. We cannot sustain a spiritual life without the nourishment his life provides.

  The ceremony we call Eucharist (or Lord’s Supper or Holy Communion or Mass) has its origin in Jesus’ last night with the disciples before his crucifixion. There, amid a stuffy roomful of his frightened disciples, Jesus first said the words that have been repeated millions of times: “This is my blood of the covenant, which is poured out for many for the forgiveness of sins” (Matthew 26:28). Jesus commanded
his disciples to drink the wine, representing his blood. The offering was not merely poured out but rather taken in, ingested. “Drink from it, all of you” (v. 27).

  That same evening Jesus used another metaphor, perhaps to underscore the meaning of shared blood. “I am the vine; you are the branches,” he declared. “If you remain in me and I in you, you will bear much fruit; apart from me you can do nothing” (John 15:5—echoing the wording of John 6:56). Surrounded by the vineyard-covered hillsides that ringed Jerusalem, the disciples could more easily comprehend this metaphor. A grape branch disconnected from the nutrients of the vine becomes withered, dry, dead, useless for anything except kindling. Only when connected to the vine can the branch bear fruit.

  Even in the doom-shrouded atmosphere of that last night, at the meal from which the sacrament derives, the image of life wells up. For the disciples, the wine would symbolize Jesus’ blood, which could vitalize them much as the sap does the grapevine.

  If I read these accounts correctly, they correspond to my medical experience precisely. I do not believe that blood represents life to the surgeon but death to the Christian. Rather, we come to the table also to partake of his life. “For my flesh is real food and my blood is real drink. Whoever eats my flesh and drinks my blood remains in me, and I in him”—at last those words make sense (John 6:55-56). Christ came not just to give us an example of a way of life but to give us life itself. Spiritual life is not ethereal and outside us, something that we must work hard to obtain; it is in us, pervading us, like the blood that flows through every living body.

  Theologian Oscar Cullmann, in Early Christian Worship, presents a fresh interpretation of Jesus’ first miracle, when he turned water into wine at a wedding banquet in Cana. Cullmann says this miracle or “sign,” points to Jesus’ new covenant, linking the wedding wine to the wine of the Last Supper. The setting could hardly be more appropriate to introduce this great symbol: a wedding feast, filled with joyous music, the laughter of guests, the clink of pottery, the sounds of celebration—so different in tone from the dreary sounds I heard on my radio in Louisiana.

  The very institution that recalls the death of Jesus is also a toast, if you will, to the Life that conquered death and is now offered freely to each of us.

  Transfusion

  The history of blood transfusion, like that of so many other medical techniques, began perilously and quickly sped toward disaster. In 1492, the same year Columbus set sail, a doctor in Italy tried transfusing blood from three young boys into ailing Pope Innocent VIII. All three donors died of hemorrhaging, while the thrice-punctured pontiff barely outlived them.

  Not until the nineteenth century did medicine achieve some success with the mysterious procedure of transfusion. In England, Dr. James Blundell saved the lives of eleven of fifteen women who were hemorrhaging after childbirth. Extant etchings record the scene: a solemn Blundell looks on as a healthy volunteer, standing, delivers her blood through a tube directly into the vein of a dying woman. Those etchings capture the human-to-human essence of shared life that today gets lost in the formality of computer-matched blood banks and sterile containers.

  Even so, for many years blood transfusions involved great risk. Decades of bewilderment passed before researchers sorted out the complexities of blood typing, Rh factors, and the prevention of clotting. During World War I, the benefits of blood transfusion finally began to outweigh its dangers. Word spread rapidly among the troops: “There’s a bloke who pumps blood into you and brings you back to life even after you’re dead!”

  The dramatic experience of watching a blood transfusion at London’s Connaught Hospital had drawn me into medicine. Twelve years later, with medical and surgical training behind me, I found myself back in the land of my birth, India. I arrived as an orthopedic surgeon at the Christian Medical College in Vellore, which was recruiting specialists from all over the world. These included Dr. Reeve Betts from Boston, who went on to become the father of thoracic surgery for all of India.

  When Betts first arrived, he ran up against an immediate roadblock— the lack of a blood bank. Betts had the experience and skill to save the lives of patients who began streaming to Vellore from long distances, but he could do nothing without blood. Thus, in 1949, a blood bank became my number one priority. I had to learn the skills needed for typing, cross-matching, and screening donors for health problems. In India, where so many people were afflicted with parasites or a hidden virus of hepatitis, we struggled to make our system foolproof.

  The attitudes of Indian people themselves offered the biggest challenge. They instinctively understood that blood is life, and who can tolerate the thought of giving up lifeblood? Their resistance dearly tried Betts’s patience. “How could anyone refuse to give blood that would save his own child?” he would mutter darkly after emerging from a lengthy family council.

  In a typical case, Betts scheduled surgery on a twelve-year-old girl with a diseased lung. First, he informed the family that the girl would die unless he removed the lung. The family members nodded with appropriate gravity. Betts continued, “The surgery will require at least three pints of blood, and we have only one, so we need you in the family to donate two more.” At that news, the family elders huddled together, then announced a willingness to pay for the additional pints.

  I watched Betts flush red. The veins in his neck began to bulge, and his shining bald head made an excellent barometer of his remaining tolerance. Working to control his voice, he explained that we had no other source of blood—it could not be purchased. They might as well take the girl home and let her die. Back to the conference. After more lively discussion the elders emerged with a great concession. They pushed forward a frail old woman weighing perhaps ninety-five pounds, the smallest and weakest member of the tribe. “The family has chosen her as the donor,” they reported.

  Betts fixed a stare on the sleek, well-fed men who had made the decision, and then his anger boiled over. In halting Tamil he blasted the dozen cowering family members. Although few could understand his American accent, everyone caught the force of his torrent of words as he jabbed his finger back and forth from the husky men to the frail woman.

  Abruptly, with a flourish Betts rolled up his own sleeve and called over to me, “Come on, Paul—I can’t stand this! I won’t risk that poor girl’s life just because these cowardly fellows can’t make up their minds. Bring the needle and bottle and take my blood.” The family fell silent and watched in awe as I dutifully fastened a cuff around Betts’s upper arm, swabbed the skin, and plunged the needle into his vein. A rich, red geyser spurted into the bottle and a solemn “Ahh!” rustled through the spectators.

  At once there was a babel of voices. “Look, the sahib doctor is giving his own life!” Onlookers called out shame on the family. I reinforced the drama by warning Betts not to give too much this time because he had given blood last week and the week before. “You will be too weak to perform the surgery!” I cried.

  In this case, as in most others, the family got the message. Before the bottle was half full, two or three came forward and I stopped Betts’s donation to take instead their trembling, outstretched arms. In time, his reputation spread throughout the hospital: if a family refused blood, the great doctor himself would contribute.

  Old Symbol, New Meaning

  In a time when blood transfusion was unknown, Jesus chose the perplexing image of drinking his blood. Who can describe the process by which Christ’s body and blood become a part of my own? Jesus used the analogy of branches attached to a vine, and the more contemporary metaphor of blood transfusion helps me to grasp a deeper symbolism.

  My experiences with blood transfusion, beginning with that night at Connaught Hospital, underscore the life-giving power of blood. The Communion service reminds me that Christ is not dead and removed from me, but alive and present within me. Every cell in his Body is linked, unified, and bathed by the nutrients of a common source. Blood feeds life.

  Thus, the Lord’s Supper has become
for me, not an embarrassing relic from primitive religion but an image of startling freshness. I can celebrate the sensation of coming to life through the symbol of Christ’s blood transfused into me. The woman at Connaught Hospital escaped death because of the shared resources of a nameless donor; Dr. Reeve Betts’s patients gained new hope through the contributions of individual family members; similarly, I receive in the Eucharist an infusion of strength and energy by availing myself of Christ’s own reserves.

  Under the old covenant, worshipers brought the sacrifice—they gave. In the new, believers receive tokens of the finished work of the risen Christ. “My body, which was broken for you . . . my blood which was shed for you . . .” In those phrases, Jesus spans the distance from Jerusalem to me, cutting across the years that separate his time from mine.

  When we come to the table we come short of breath, with a weakened pulse. We live in a world far from God, and during the week we catch ourselves doubting. We muddle along with our weaknesses, our repeated failings, our stubborn habits, our aches and pains. In that condition, bruised and pale, we are beckoned by Christ to his table to celebrate life. We experience the gracious flow of God’s forgiveness and love and healing—a murmur to us that we are accepted and made alive, transfused.

  “I am the Living One,” Christ said to the awestruck apostle John in a vision. “I was dead, and now look, I am alive for ever and ever!” (Revelation 1:18). The Lord’s Supper sums up all three tenses: the life that was and died for us, the life that is and lives in us, and the life that will be. Christ is no mere example of living; he is life itself. No other New Testament image expresses the concept of “Christ in you” as well as blood. As George Herbert writes,