With my crew waiting for instructions, I called for the specific tools I would need to repair the breach. Everything seemed to happen in slow motion, and I felt my frustration rise. There is nothing surgeons hate more than surprises, especially the kind that could rob this family of a wife and mother.
I guided my instruments up the carotid artery just below the bleeding aneurysm and tried another method to stop the bleeding from the potentially fatal tear in the vessel wall. After five minutes of intensely focused work, I injected dye to see if I had succeeded. My heart sank as I watched the screen and saw the dye leak from the top of the aneurysm as she continued to bleed. She had been bleeding into the brain for more than five minutes. Would she survive? And if she did, what would she be like?
It took several more minutes of delicate, painstaking work and periods of agonizing waiting, but finally the bleeding stopped. It took another hour to determine that Maria would survive the bleed and had not suffered a major stroke; she was moving her arms and legs and was talking. As she went into the intensive care unit and continued to improve over the next few days, I thanked God for answering the prayer that Maria and I had prayed together in my exam room. I believe it made the difference for Maria—and for me.
Because in neurosurgery, you never know what might happen.
* * *
I have no way of knowing exactly how many nurses, doctors, surgeons, or even other neurosurgeons take the spiritual lives of their patients seriously or pray with their patients as I do. It’s certainly not a subject that comes up at medical conferences or with coworkers in the elevator or hospital cafeteria. In fact, if spirituality is not introduced in a way that honors the patient and his or her faith, it can lead to ostracism by the medical community or worse—discipline of some kind. The role of prayer in health care is itself a gray matter.
Yet both doctors and patients seem to recognize that some crucial component of patient care is often missing. Though spirituality is almost completely absent from medical interactions, a large majority (75 percent) of more than a thousand physicians surveyed agree that religion and spirituality are important in helping patients cope and in giving them a positive state of mind.1
Patients, too, place a high value on religion and spirituality, particularly in the midst of an illness. In one study, 82 percent of 124 consecutive ophthalmology patients at Johns Hopkins University said prayer was important to their sense of well-being.2
As I have addressed patients’ spirituality and made prayer a regular part of my patient interactions, the response has been impressive. I have seen lives brought to a level of spiritual, emotional, and physical health that my patients had never enjoyed before. In the process, I have learned two important things: that there is a limit to what I can do as a highly trained and experienced surgeon and that there is no limit to what God can do to touch a person emotionally and spiritually, not just physically.
My goal as a professional is to use my skills and knowledge to help people have the best lives possible, for as long as possible. This includes emotional as well as physical health, because the two are interrelated. Emotions can create health or cause disease, and spiritual health affects emotional health. Laughter and joy are known to restore and encourage health, while bitterness and resentment promote disease. Forgiveness has well-documented health benefits. One’s concept of God can cause ongoing joy or ongoing anxiety. These issues are not incidental but are central to health.3
The responsible thing for a doctor to do is to give patients the opportunity to make healthy choices in all areas of life.
* * *
As a neurosurgeon, I see a lot of tough cases. I am at the end of a chain of doctors that begins, usually, with primary care or emergency room physicians. Patients may start the journey toward neurosurgery because of minor problems such as headaches, dizziness, or tingling sensations that prompt them to go to the emergency room or see their primary care physicians. Some are sent to a neurologist, who orders an MRI scan.
Just to be clear, neurologists do not operate on the body; neurosurgeons do. Neurologists are the Ansel Adamses of the brain world, taking pictures of the brain and nervous system with various types of equipment—EEGs, EMGs, MRIs, and so on—to try to pinpoint a problem. Their challenge is to diagnose and treat symptoms nobody else can figure out. They gather a myriad of symptoms, bundle them together, and label them with a diagnosis. Maybe those symptoms point to Parkinson’s disease, multiple sclerosis, or one of the other neurological diseases that have a specific set of symptoms. Or maybe the symptoms form a random collection that doesn’t tell you much of anything. In many cases the symptoms are caused by stress and anxiety. Much of the time nobody really knows why someone has a tingling arm, persistent headaches, or a “weird feeling” in some part of his or her body. Neurologists often have to tell patients, “I can’t find anything to explain your symptoms.” After all, most people with symptoms such as headaches, dizziness, or tingling do not have a brain aneurysm. Neurologists try to figure out who actually has disease. They have a difficult job.
The MRI scans neurologists order often prove invaluable because they can reveal an aneurysm or other malformation in the brain that nobody knew was there and that usually has nothing to do with the symptoms. We call this an incidental finding, and it is one of the reasons patients are redirected to me. They usually have small bumps on the vessels that are of no consequence. Occasionally—as in Maria’s case—they are life-threatening problems.
I operate on the brain. If surgery is necessary—on a tumor, an aneurysm, a knot of malformed vessels, or something else—there are a few ways to go into the head to solve the problem. Open surgery enters in the “traditional” way: cutting a hole in the skull to reveal the melon-sized gray matter that functions as the repository of our memories, habits, knowledge, personalities, and everything else that make human life what it is. In the case of aneurysms, most of which are on the base of the brain between the lobes, open surgery involves peeling the lobes apart to work on the vessels. For aneurysm surgery, we must operate while constantly looking through a large, suspended microscope that is wheeled into position over the patient, a transparent sterile covering allowing it to be close to the open brain. I always enjoy that first look, when the dura mater—Latin for “tough mother,” the leathery covering inside the skull—is pulled back and the glistening surface of the brain is exposed. It is like putting on a diving mask and looking beneath the surface of the water at a coral reef: a whole new world opens up, and I become completely absorbed by it. The microscope illuminates and magnifies the brain’s awe-inspiring beauty, and the focus control brings it into sharp detail under powerful light. Against a nearly white background run arteries like red vines, branching into smaller arterioles and coursing through the sulci and gyri—the peaks and valleys of the cortex, the undulating surface of the brain.
People often ask me what it’s like to operate on the brain, to look at it, touch it, and mend it. I tell them that working directly on the brain is simultaneously challenging and invigorating. The vessels—the arteries and veins—glisten and pulsate beautifully. The architecture of the brain itself and the vascular system that supplies it with blood and oxygen are staggeringly complex—far more complex than any spacecraft, supercomputer, or anything else built by human hands. The brain is the command center of the body. Everything we need—from basic body functions to the creation of art and music, speech and complex technology, love and every human endeavor—is contained in this elegant and relatively tiny package. To repair its vessels, to restore blood flow to the command center, is amazing. It is exhilarating to work around something so vital. This is the human body’s most valuable real estate. Working in that neighborhood is one of the highest privileges I have.
I started out, like other neurosurgeons, doing open neurosurgery—drilling off a piece of the skull, putting my hands and instruments inside the brain, repairing the problem, and putting the skull piece back on. Later, I began to specialize in
endovascular (“inside the vessels”) work, which I could see was the future of the field. Because many problems in the brain occur in the vessels (the arteries and veins), technology increasingly allows us to treat them without drilling open the skull. We can insert our instruments into the femoral artery (in the leg) and travel three feet “north” into the brain itself. This type of surgery is less invasive. No cutting bone or opening someone’s head. Most people like that idea.
There is nothing routine about going inside the brain, though, no matter which direction you’re coming from. Endovascular neurosurgery is still difficult and dangerous. In fact, it is one of the most dangerous of all the specialties of neurosurgery, because anytime you’re dealing with a damaged vessel, as in the case of an aneurysm, you know that the vessel wall has been injured or compromised. Sometimes any touch, any manipulation, can cause a damaged vessel to rupture and fill the brain with blood.
Every parent knows that head wounds bleed profusely. What turn out to be minor cuts appear at first to be massive gashes that somehow produce copious amounts of blood. That is also true within the head. The brain is a blood hog. A measure of its importance is that, although the brain represents only 2 percent of total body weight, it receives 15 percent of the body’s blood supply.
The brain’s high demand for blood and oxygen, along with its lack of appreciable energy reserves, makes it uniquely susceptible to disruptions of the blood supply. When an aneurysm ruptures during open surgery, the blood streams out so freely and quickly that the operating field is flooded, making it difficult to see what you’re doing. A straightforward procedure suddenly takes on the character of fixing a leaky pipe under muddy water: stopping the flow is not easy.
When you’re operating on other parts of the body, you can clip vessels here and there to stop the blood flow and clear up your field without much consequence. However, in the brain you have to be exponentially more careful. This is a high-rent district, the information headquarters for the patient’s entire life. There is no backup system. When the blood flows, you can’t start blindly putting clips on whatever is nearby, because you might injure a vessel or nerve that allows the patient to sing, dance, swallow, read, talk, or recognize his or her grandchildren. The brain is a minefield of wonders, and you must move carefully. A sudden hemorrhage might obscure your vision and invite rash movements to stop it, but it is easy to make a bad situation worse. Even small movements of fingers and instruments can have big consequences, so neurosurgeons must develop a finely honed technical ability. They must also know where the bleeding problems are likely to happen and how to stop them.
I was fortunate to train under some of the finest neurosurgeons in the world and have had a successful practice for more than fifteen years, but it is still a challenge to keep calm while adrenaline is pumping into my own bloodstream during a complicated surgery. With stroke or death looming large, controlling my own fear and rising panic becomes a learned skill. When things are going badly in neurosurgery, the potential loss is tremendous. I promise you, the neurosurgeon feels it. Everyone else in the operating room can go home and sleep well after another day of work, but I often lie awake wondering what I should have done differently. In a sense, surgeons work utterly alone.
The complexity and challenge of the brain contribute, at least for me, to the great satisfaction of operating on it, but that comes with great stress and, at times, frustration. Even if you do the procedure technically perfectly, you can still end up with a bad result—a ruined life, a mental deficit, an erased memory. Unexpected things happen. Operating on the brain is a high-wire act that rarely offers you a safety net.
That sense of challenge is also a major reason that I pray—not because I lack confidence but because I am realistic about what I am able to do and confident about what God is able to do. Surgery can treat the immediate problem, but much more is involved in healing than just this physical aspect. Surgery is reactive, not proactive. Surgical outcomes are never completely predictable. Some technically perfect procedures result in stroke or death for patients, while some potentially catastrophic bleeds in the brain result in no loss of function at all. Most surgeons chalk this up to fate, chance, or luck (“better lucky than good”) because we cannot explain it, but I am convinced that there is much more at work than just “chance.” I believe God wants to be involved—and will be, if we ask him.
This book tells the story of how I, a practicing neurosurgeon, began to address the spiritual and emotional aspects of health and to pray with the people I operate on. My journey to combining medicine and faith did not start easily. At first, I was not graceful or confident about it. I made some people uncomfortable. I’m reminded of the old bit of wisdom that if you want to do something well, you have to be willing to do it poorly at first. I began with no road map for praying with patients. This wasn’t the kind of stuff we were taught in medical school or during residency. Even so, over time prayer worked into my normal routine and became natural. It made things better. I believe it changed outcomes.
Does everyone I pray for get better? No, and that is frustrating. I’m still waiting to receive that magic wand doctors are supposed to receive with their licenses to practice medicine. But I have seen many positive results from prayer, and I’m convinced they go beyond any physical or psychological explanation. Not only have people’s brains been healed, but many people have been released from shackles of bitterness, anger, and resentment, which can be the root cause of serious physical problems. I have discovered that God sees the whole person, not just the particular problem that is flaring up in his or her head. Patients generally appreciate being seen as more than their medical problems.
I have been in this profession for a good number of years and am intimately familiar with most of the new techniques, procedures, medical devices, and drugs hitting the market. Many of them are ingenious, and I use them regularly in my practice. I have consulted for several companies to develop better devices and have traveled the world teaching others to use them. I admire and am grateful for modern medical technology. But though technology can prolong a life or reduce pain, it cannot always make life better.
My experiences have convinced me that spirituality is a crucial element to the well-being of a person as a whole; moreover, if we let him, God can do powerful, supernatural things in our everyday lives. That’s why I began inviting God into my consultations, exams, and surgeries. Many would be surprised that a neurosurgeon—a man of science, logic, and human progress—would be such a strong believer in God and divine intervention. Yet the experience has been nothing short of phenomenal.
Chapter 2
How I Began Praying with Patients
It was decision time.
My heart was pounding as I climbed the back stairs at the hospital and entered the pre-operative area, the large room through which all patients pass on their way to surgery. Pre-op has the feel of a busy port: nurses, anesthesiologists, and doctors rush here and there holding charts and IV bags, pushing carts, carrying syringes and vials of medicine. Machines beep, dozens of worried family conversations mingle, televisions chatter, and everywhere you look are gurneys gliding by with patients on their way to surgery. It’s a scene that normally fills me with confidence and energy. I am rarely nervous before surgery and am typically the portrait of the calm and self-assured neurosurgeon. Even the smells of the hospital—rubbing alcohol, latex, sterilized steel and plastic—trigger feelings of cool control in me before I reach the patient. This is my arena, my playing field.
But today I was terrified.
I had made up my mind to pray with a patient for the first time. Not only had I never done that before, I had never even seen it done by anyone in the medical profession. Ours is mostly a faithless occupation where spiritual matters are kept firmly outside the boundaries in which we function. For most doctors, faith and feelings are something for the chaplains, nurses, or family to deal with, like a messy or irritating side effect or even a weakness in the patient. Those o
f us paid to operate on the body, to make physical things right, to restore life are supposed to be above spirituality somehow. We are surgeons and scientists, people of facts and high training and confidence that can sometimes border on (or bound boldly into) arrogance. But I could no longer deny what I felt God had been encouraging me to do, even though it seemed unthinkable. With one decision I was about to put my reputation, my professional relationships, even my career on the line.
Like most doctors, I had always made a habit of speaking with each patient before surgery. Traditionally this serves several purposes. First, it verifies that this, indeed, is the person you’re supposed to be operating on, and not some guy down the hall. People love telling stories about doctors removing the wrong organ or amputating the wrong limb, though these incidents are very rare. To avoid giving those stories any more credence and to avoid ruining or complicating someone’s life with a wrong procedure, I talk face-to-face with patients on the day of surgery. Second, this visit assures that we are all—surgeon, patient, family—on the same page about what we are doing, the risks involved, and what we want the outcome to be. If someone, maybe a family member, has not understood the risks fully up to now, this is the time to make them clear. Third, it gives the patient and family confidence in me as a surgeon. If the doctor exudes confidence, they have confidence too. That’s good for morale and, arguably, for outcomes. This brings up the last and usually unstated reason many doctors, and certainly I, have often enjoyed meeting with patients in pre-op: it gives us a sense of accomplishment. There we stand in our white coats and scrubs at the foot of the bed, about to work on a person’s brain with tiny, expensive medical instruments while he or she is unconscious. We are entrusted with people’s very lives. That is why we hold an exalted place in society, why we are paid well. It is the apex of all we have worked to achieve.
Gray Matter Page 2
