I don’t know if our supervisor’s guardian angels comment was sincere or sarcastic, but to this day I don’t have a better explanation for what happened at the pool or in its aftermath.
Date of event: Spring 2001
A Sea of Blood
Matthew A. Metz, MD
I was a second-year surgery resident, near the bottom of the totem pole in the highly hierarchical world of surgery. I was “scrubbed in” for an abdominal procedure with a team of outstanding surgeons at a world-
class medical center in upstate New York. My role was largely to watch and learn. If I was fortunate, I might be asked to hold the “retractor” tool, or perhaps the surgeon in charge would let me help with closing the surgical skin wound after the important work inside the abdomen was finished.
This was to have been a fairly routine procedure to remove a sarcoma tumor in the groin from an otherwise healthy sixty-year-old woman, but once the head surgeon began the procedure, everything went quickly wrong. As he began to remove the mass, bleeding began. The tumor had grown into the femoral vein, the major vein in the groin, and the attempt to remove the tumor tore the vein, filling the surgical field of view with a sea of blood. To make matters worse, the vein had withdrawn up into the abdomen when the tumor mass was cut away, and the uncontrolled bleeding now filled the entire abdomen.
Frantically, the surgeon tried to find and stem the source of bleeding. But as quickly as the team suctioned the blood away, more blood filled the void. The surgeon reached in with his gloved hand, trying to grip the bleeding vessel, or vessels, to “tourniquet” the gusher. Nothing. He wasn’t able to find the “bleeder” with any of his tools or with his hands.
I was horrified by what I was seeing, and certain, as everyone else around the operating table was, that this was going to be a tragedy for this patient and for all of us. In what must have been a burst of adrenaline and irrational panic, I heard myself saying, “Can I try?” Can I try? What was I thinking? Who was I to even imagine I could do something the entire senior team in the room was unable to do? As soon as the words left my mouth, I knew I had probably committed a career-ending blunder—I’d be politely asked to reconsider my decision to be a surgeon, or perhaps offered a residency as a pathologist where the patients were already dead.
It was a sign of the desperation in the room, the reconciliation everyone felt with the inevitable catastrophe playing out in front of them, that the chief surgeon looked at me with a smirk and said, “Sure, Metz, here you go,” and handed me the tool he was using, a vascular needle driver, a special kind of forceps for holding a needle and a suture (surgical thread) to stitch up a hole in a blood vessel. A great device if you can see the blood vessel and find the hole—neither of which was possible in this case.
What happened next remains a blur after all these years. I grabbed the needle driver and the attached needle and suture and plunged my hand blindly into the sea of blood in the abdominal cavity. Somehow, the needle and suture ended up precisely where the hole in the vein was, and I was quickly able to draw the two sides of the tear together. To the audible awe and amazement of everyone in the room, the bleeding stopped. At that moment, the adrenaline receded from my body almost instantly, and my knees went weak. I leaned against the table, accepting the stunned congratulations from the others surrounding it. The patient not only survived the surgery, but went on to a full recovery.
I would tell my colleagues afterward that I didn’t deserve their congratulations. I have no idea what happened in that woman’s abdomen that morning, but I do know this: it wasn’t me guiding my hand to that blood vessel.
Date of event: Spring 1989
The Miracle Within Us
David Slamowitz, MD
I have always been interested in the unseen forces that shape our world and impact our health. Even as a child I recall being fascinated by such things as magic, sorcery, science, martial arts, meditation, and hypnosis. I tried to read whatever I could find on my subjects of interest. However, when it came to hypnosis, the available reading material in my local library was quite minimal. Most of the literature would describe the characteristics of being in a hypnotic trance without truly explaining the process of how to attain the state itself.
It wasn’t until many years later that I was finally able to witness the power of hypnosis over the mind-body connection firsthand. I had just completed my second year of medical school and was about to begin my clinical rota-
tions. This involved four- to eight-week stints working with supervising physicians in each of the major fields of medicine. Psychiatry was my first clinical rotation. As part of my training, I was fortunate to be able to attend a six-week hypnosis course usually offered only to the psychiatry residents, young physicians who already finished medical school and were now specializing. During the course I learned some of the theory behind hypnosis as well as the practical steps needed to place someone into a hypnotic trance. The instructor spent time guiding me, along with the rest of the group, through the experience of a hypnotic induction, which leads one into the early phase of a hypnotic trance state. I found the course quite interesting intellectually, but could not say that I actually experienced any kind of altered state of consciousness or hypnotic trance. By the end of the course, I was somewhat skeptical about hypnosis as a therapeutic tool and considered the so-called hypnotic trance an interesting parlor trick—if it was actually a real entity at all.
I finished my psychiatry rotation and moved on to my next clinical experience, obstetrics and gynecology. On the first day, as I was just getting my bearings, I was told to visit a patient who had just undergone surgery for an ectopic pregnancy. An ectopic pregnancy occurs when the fetus begins growing in the fallopian tube rather than in the uterus. Those pregnancies cannot continue to term and surgery is typically required to remove the fetus before it ruptures the fallopian tube, which can be very dangerous. Both the ectopic pregnancy and the surgery to treat it are very painful. When I entered the patient’s room, I found a twenty-something-year-old thin woman, moaning in pain, with no other healthcare staff in sight. At that moment, I certainly could have left the room in search of a nurse and pain medication for this young woman. However, a different spirit took hold. Without much thought, I asked her permission to attempt a hypnotic induction that I had recently learned from the hypnosis course to see if I could ease her pain. If it didn’t work, I would immediately seek out some pain medication for her. She agreed to let me begin.
“Close your eyes and listen to what I am going to tell you,” I told her. She did as she was asked, though she continued to moan in pain. I then worked through the induction steps as I had been taught. Surprisingly, the first thing I noticed was that her moaning stopped and she became quiet and still as her eyes remained closed. Did she fall asleep? That’s when it started getting interesting. I moved on to the deepening phase, which follows the trance induction. I suggested to her that as her hand started to become lighter and lighter, her pain would begin to decrease. Well, to my utter amazement, her left hand began slowly lifting off the bed as if being pulled from above by a string. Not only that, once her hand attained a height of about six inches, it became stationary and perfectly still, remaining suspended in midair above the bed. I stood there almost in disbelief. Wow! Maybe there really is something to this hypnosis! I then suggested to her that her hand would start to become heavier and heavier, and as this happened her pain would continue to become less and less. Her hand slowly descended and once again rested lightly on the bed. Finally, I continued on to the alerting phase of the hypnosis session, transitioning her back to full consciousness. During this phase, I suggested to her that when she opened her eyes she would be fully awake and alert but would feel no pain. As she opened her eyes, the first words out of her mouth were, “Doc, I don’t feel any pain!” And from the look of relief on her face, I truly believed she did not!
The experience of that special moment soli
dified my appreciation for the power of the mind and its ability to profoundly affect the body’s physiology. Hypnosis is not a miracle, in the traditional sense. Neither, for that matter, is acupuncture, meditation, biofeedback, or relaxation therapy a miracle in the traditional sense. Unless, of course, you’re the patient whose pain, stress, in-somnia, anxiety, or panoply of other physical and mental health conditions has been relieved by mobilizing the power of the mind-body connection. These therapeutic tools are not like the magic and sorcery that so fascinated me as a child—the medical and scientific literature are filled with peer-reviewed studies (research published only after rigorous review by experts in the field) showing the benefits of each of these “alternative” therapies.
As a physician, what I believe is “miraculous” is the power within each of us to affect our health and our healing. Prescribing medicine is easy. Too easy. Empowering our patients to harness the power of their mind-body connection may be more difficult, more time-consuming, and less remunerative—but in some ways may be even more rewarding. That’s why physicians should endeavor to practice more of this type of health care, or at least be open to it, when solid evidence exists for its utility.
As a postscript, I went on to receive additional training in hypnosis, and a little over ten years after my patient raised and lowered her hand to relieve her pain, I began successfully using hypnosis as a therapeutic tool to treat insomnia. Now, many years later, I continue to use hypnosis regularly in my sleep medicine practice.
To ignore the power of the mind-body connection and to leave it un-tapped is to ignore the miracle within us.
Date of event: Late 1990s
Witnessing the Unknown
Meredith Belber, MD
It was early in my career and I was caring for Lois, a woman in her late eighties with a serious heart condition, in the critical care unit. Her aortic valve was not functioning effectively, a potentially life-threatening condition not uncommon for someone her age. In an attempt to avoid open heart surgery, Lois underwent a less invasive procedure to repair the valve in hopes of providing her a few extra months of life to spend with her family.
The procedure was successful. A few days later while making my daily visit, I witnessed something I have never previously seen. I was standing next to her hospital bed, on her left, when she suddenly turned toward the door on the right and began talking to someone. She was engaged in this conversation for several minutes, speaking calmly, rationally, but with frustration. At first I thought she may be talking to someone out of my line of sight, but soon realized there was nobody there. Obviously, I only heard her end of the conversation, which consisted of her telling this person that she wanted to go. Lois said she was ready. She then became upset and asked why it wasn’t time. Lois turned back to me and I asked to whom she had been speaking. She said, sounding surprised that I didn’t know, “My husband.” Her husband had died many years earlier. Instead of being frightened or unnerved, I remember feeling relieved. I wasn’t the only one watching over Lois, responsible for the outcome of her life.
Several months later I saw Lois in my office for a follow-up visit. She told me that since the hospitalization, her husband had been visiting her regularly in her sleep and told her she could now join him. Lois died two weeks later.
Recently, I related this episode to a physician friend, who said his 101-year-old grandfather had a similar experience near death. After days of lying in a hospital bed with barely enough strength to move, drifting in and out of consciousness, his grandfather suddenly and vigorously lifted both arms straight up in the air. He began waving his arms, pointing, and repeating the phrase, “All the people, all the people,” seeing what no one else in the room could see. This was disturbing and confusing to those watching it occur. The hospital chaplain happened to be one of those in the room at the time. When asked what had just happened, the chaplain said, “It’s hard to ever know for sure, but we see this sometimes as patients are near death. They see things we don’t.” My friend’s grandfather had no further episodes like that before his death several weeks later.
As a doctor, it always amazes me how much connection exists between this world and somewhere else. A dying patient’s desire to spare the pain of those they love who will be left behind often seems to impact the outcome of events. Sometimes, when patients are near death, they seem to have some control over when the actual end occurs—perhaps making it quick to minimize the pain of those watching in agony, or lingering for a few hours longer to give traveling family members time to arrive from out of town and say their good-byes.
Sometimes I wonder if, as physicians, we do too much to interfere with these patients’ transitions. There are times, I think, where we should just step back and let the patient decide how and when events should happen. It seems that’s just what Lois did.
No matter what someone’s religious beliefs may be, there is, without question in my mind, something greater that controls our lives, which the most intelligent physicians and modern science cannot touch. To me, that is more than just mysterious. It’s “miraculous,” and makes me feel honored and proud to be a part of something so special, being able to witness and acknowledge the unknown.
7
Global Miracles
In developed countries like the United States, where most of the events in this book take place, the miracles we witness as physicians typically involve individual patients. Yet in the developing world, where the needs of over-whelming numbers of people with devastating diseases are so great, the most effective type of health care is often that administered by global and public health providers who treat entire populations.
Two of the essays in this chapter are written by global health physicians describing miraculous encounters in their work that changed their lives, their careers, and their perspectives on health care in developing nations. The other essay is from a public health doctor fighting in the trenches of the AIDS war in Africa, where finding a way to sustain therapy for the neediest patients can require a miracle.
Date of event: 1988
The Miracle of a Single Sentence
Frank O. Richards Jr., MD
Once I was young and so unsure
I’d try any ill to find the cure
An old man told me
Tryin‘ to scold me
“Whoa, son, don’t wade too deep in Bitter Creek”
—The Eagles, Desperado album, 1973
I am a public health doctor, which means that my “patients” are entire communities and populations rather than individuals. Yet there was this poor old man living in the middle of nowhere who had one of the most significant and lasting impacts on my career and on my view of medicine. I think of him often, and I can see him as if it were yesterday. He helped me, scolded me, and also—perhaps—warned me about what I was wading into.
The setting was Guatemala in 1988. I was there as part of the public health team hoping to eradicate a parasite disease called “river blindness” or, more technically, onchocerciasis. Onchocerciasis is a leading cause of infection-
related blindness in the world. The worm that causes it (Onchocerca volvulus) is transmitted by bites of certain black flies, and at that time the disease was rampant in Guatemala. In fact, the country was the most affected in Latin America, and the area where I was working was the most affected area in Guatemala. Today, thanks to public and private health sector collaboration, Guatemala (and Latin America) is 95 percent of the way to reaching elimination of river blindness. That has been an important part of my life’s work.
. . . But I’m getting ahead of myself.
“Once I was young and so unsure
I’d try any ill to find the cure . . .”
A leading pharmaceutical company in 1987 had generously offered to donate a very effective medicine (tablets) to the world to eliminate river blindness. The idea is this: when a black fly vector (an insect that carries germs) bit
es an individual infected with the parasite, the fly can then transmit the parasite to the next individual it bites. Only humans carry the infection; if humans aren’t infected, the disease will perish. So the plan was to provide these tablets to treat everyone (known as mass drug administration) in the community older than age five years every six months to eliminate the parasite from their bodies and thus stop the spread. The treatments would have to be sustained for many years.
So in 1988 there were many questions about whether these poor and largely indigenous communities in Guatemala would accept the medicine. Working in developing countries, I’ve become accustomed to cultural differences that often impede the delivery of what the best-intentioned of us believe to be good practice. Issues of communication, trust, and education can be paramount. We needed to understand the people of these communities more fully to determine how to communicate and gain the trust and cooper-
ation needed to get enough people to agree to take the treatment every six months for years and years. Paramount to success was good and sustained treatment coverage of the entire local population.
To understand how to do this, we were visiting terribly impoverished coffee plantations on the slopes of Guatemalan volcanoes, where the rivers cascading down the slopes created perfect breeding grounds for the black flies and river blindness parasites. It was in these areas that blindness was epidemic and more than 80 percent of villagers were infected. With skilled interviewers, we conducted a “knowledge, attitudes, and practices” survey, hoping to find out what health issues were highest on the villagers’ list of concerns. Of course, a finding that river blindness was a significant concern to the villagers would predict a greater chance of success with our mass treatment approach; if river blindness was not a priority for the villagers, we would have an educational challenge ahead of us. The most important question on the survey: “What do you think are the major health problems in your village?”
Miracles We Have Seen Page 21
