Gray Matter

by Kilpatrick, Joel;Levy,David

  “Do you remember the friend who came with me last time?” Gloria asked after we had finished talking about the facts of her case.

  “Sort of, but not exactly,” I admitted.

  “I brought my friend Gail with me for support, remember? You said a prayer for me at the end of the visit.”

  “I’m sure I did,” I said, without having any specific recollection.

  “Well, after you prayed for me, we left your office, went outside into the hallway, and just held each other and wept. We couldn’t figure out why we were crying. This was highly unusual for both of us. We just felt this need to cry after leaving your office.”

  I was intrigued by this. I would not have imagined that kind of response to a simple prayer for her health.

  “About a week later,” Gloria continued, “my friend told me she wanted to have a relationship with God and asked for my help. I took her to church, where Gail went to talk to the pastor and make peace with God.”

  “That’s wonderful,” I said.

  “A few weeks later,” Gloria continued, “Gail found out she had cancer. A month later she died. Within three months of that appointment with you, I was at her funeral.”

  I was stunned. I didn’t even know what to say. She spoke instead.

  “I just wanted to thank you, Dr. Levy, for not being afraid to bring up the option of prayer,” she concluded. “It made a world of difference in my friend’s life.”

  She gave me a quick hug as we walked out of my office. I went through the rest of my day with a profound feeling that even the smallest of decisions can have huge impact on the lives of people I interact with daily, or on the people they bring with them whom I don’t even notice. It often appeared to me that nothing significant happens as a result of my prayers, but I have learned that there is much that I don’t get to see.

  * * *

  By this time nearly all the patients I prayed with were welcoming and appreciative. They seemed pleasantly surprised to discover a neurosurgeon addressing physical, emotional, and spiritual needs while in the midst of what is often a sterile, impersonal environment. My patients seemed genuinely caught off guard when I would make them partners in asking for God’s help in their cases. There was something “undoctorly” and humble about relating to them as human beings.

  Even laying a hand on patients’ shoulders or holding their hands felt strange at first, as though I were violating their personal space. In an environment where touch tends to be cold, mechanical, and sterile, I was touching them out of kindness. This touch was professional yet had a purpose that couldn’t be listed as an item to be checked off on a patient’s chart. It was not the routine touch of someone taking a pulse or fitting a medical band around a wrist, the kind that is purely clinical and that can make any patient feel like a petri dish specimen. It was a touch that, when offered properly and appropriately, conveyed concern, connected two lives, and spoke to the soul. Touching a shoulder or holding hands with a patient or family member, when welcome and always within the bounds of medical decorum, became a leveling and personal experience that said, “We are all human and we’re in this together, each doing our part.”

  Naturally, some people probably agree to pray with me only because I am about to meddle in their brains. I am always keenly aware of the patients’ vulnerability while they are lying on gurneys wearing only hospital gowns, with IVs dangling from their arms, waiting to be wheeled away so someone could insert a tube up half the length of their bodies and operate on the inside of their skulls. For the patient, this is not your typical day. So the obvious answer when a surgeon approaches you in pre-op and asks if he can pray with you is probably going to be, “Okay.” I have had some of those responses. A patient will sometimes look at me askance or with resignation and say, “Whatever you want, Doc. Whatever’s good for you.” Yet most people seem visibly comforted, even those who claim not to believe in God. I have seen many tears and often feel the atmosphere of the room change from tension to peaceful anticipation.

  At some point I even began to rely on this atmospheric shift and look forward to calming fear with prayer. In that moment of petition we could forget we were in a busy pre-op or exam room. We could put ourselves, doctor and patient together, into the hands of God. These experiences became as much a part of my workday as the surgical procedures themselves. I came to enjoy prayer as much as any other part of my routine, because it invited a peace and perspective that helped not only the patient and the family but also me. The best we could do in purely medical terms was to give patients a sedative to reduce their fear chemically. But to also address that fear on a spiritual and emotional level was natural, beautiful, and real. It offered what science lacked—medicine for the soul.

  I was now being authentic about who I was and what I believed, so I was caring for my own soul too. I have always been a perfectionist, as you would want your neurosurgeon to be, and I had also experienced the downside of that approach to the world. Now I was a more relaxed neurosurgeon, a happier perfectionist. I felt mentally and physically better prepared to handle the unexpected challenges that surface during surgery on the blood vessels of the brain. I was certainly better able to handle angry or out-of-control family members. I even felt that providing spiritual care was actually making me a better doctor.

  Sometimes encouragement in my new course of action came inconveniently. One woman, Rosa, a retiree, had an aneurysm and persistent headaches. I treated the aneurysm, but her headaches persisted. This was a common result and simply meant that the two problems were unrelated. Aneurysms can be indicated by severe headaches, but most people with headaches do not have aneurysms. I saw Rosa several times and made repeated scans to check that the treatment had worked. She was convinced that the headaches should have stopped if the procedure had been successful. I tried to explain that this was not always the case and that the aneurysm had been repaired correctly. There was nothing more I could do for her. But she couldn’t understand why she was still having headaches.

  Finally, partly out of exasperation, I offered to pray for her headaches just as I had prayed for her before and after surgery. Rosa agreed. I put my hand gently on her head and asked God to take away her headaches. When the short prayer was done, she said, “Thank you, Doctor. I feel better.” And then she walked out the door.

  I was not expecting to see her again. About six months later I was surprised when I saw her name on my schedule. I asked my receptionist why she’d been given an appointment—I had nothing to offer. She said Rosa had insisted on seeing me. I had been looking for time to add yet another patient into my packed schedule, yet there Rosa was in my exam room.

  Pausing at the door to the exam room, I put a smile on my face and decided that I would treat her with respect even though I was already behind schedule and knew that another consultation was a waste of time. I walked into the room to find her surrounded by her loved ones—children, grandchildren, and other family friends. Rosa was smiling and happy to see me.

  “What can I do for you today?” I asked, sitting on my rolling stool and smiling pleasantly as if I had all the time in the world.

  “I’m having headaches again,” she said.

  I gritted my teeth, trying to be kind.

  “As I told you before, there is nothing more I can do for you,” I said. “We have looked at the angiograms together. Your aneurysm was repaired and is not causing your headaches. There’s nothing more I can do.”

  Then, as a consolation, I added, “But if you want, I’d be glad to pray for you again.”

  She looked at me as though I were the one who didn’t understand.

  “But that’s why I’m here, Doctor,” she said. “I don’t want pills or another surgery. When you prayed for me last time, my headaches went away. A few weeks ago they came back, so I’m here to have you pray for me again.”

  She smiled and settled in, ready to receive. Feeling contrite and a bit relieved, I walked over, put my hand on her head, and prayed for her headaches
to go away. After I said “Amen,” she smiled and said, “Thank you,” as if to say, “Was that too much to ask?” She had been given just the prescription she wanted. Her family members smiled, shook my hand, and thanked me profusely as they left. I never saw Rosa again.

  * * *

  Tears became common during and after my meetings with patients, and I quickly learned not to be flustered or alarmed by emotion. I began to see tears as an indicator of something positive, an honest reaction to fear or to feeling cared for. Patients felt safe to display feelings in my office that they could not display at home or with friends. I became comfortable with tears and simply handed out tissues. Many times a patient would leave my office dabbing his or her eyes after we had consulted and prayed together.

  I only realized how common this emotional response had become when I walked into the exam room one day and introduced myself to Darla, a thin, fit, blonde woman in her late forties. This was our initial consultation for an aneurysm on the carotid artery in her neck that needed attention.

  I extended my hand and introduced myself.

  “You’re not going to make me cry, are you?” she asked immediately.

  I was taken aback. Nobody had ever said that to me. I must have worn my puzzlement on my face.

  “Because I don’t have my waterproof mascara on,” she said, “and I need to go back to work after this appointment.”

  I was so caught off guard that I didn’t even ask why she thought I would make her cry, but I reassured her I would not. We proceeded to talk about the facts of her case. Reflecting on it later, I thought she may have seen other patients reenter the waiting room crying and wondered exactly what was in store for her.

  As common as the good responses are, not all patients are eager to have God addressed or acknowledged during their visits to the doctor. Some are annoyed, some resistant, and some downright hostile. I have had to learn how to handle those types of people with grace as well.

  Chapter 4

  Skeptics

  Although most of my patients appreciate spiritual care, some want nothing to do with it. Diane, a forty-three-year-old businesswoman, came to see me with a host of physical problems. Aside from the irregularity in her brain, she had diabetes, kidney trouble, skin problems, depression, and a number of other afflictions. It was going to take a lot of doctors and medical attention to make her well. She mentioned during our appointment that she had been treated poorly by people in her past. It was clear to me that she saw herself as a victim, and it was easy to feel sorry for her. I recommended she see a professional counselor, and at the end of that appointment I offered to pray with her. She agreed.

  The next time I saw her, a year had gone by. She came in for a checkup. Her repeat scan showed no progression of her small aneurysm. She told me she had started going to counseling, was getting a lot stronger physically, and was off antidepressants. I celebrated the good news with her. Just before the appointment ended, I said, “I would be glad to say a prayer for you.”

  “No,” Diane said, turning suddenly cold. “I’m learning to be more assertive about what I want and don’t want. And I don’t want prayer.”

  I smiled and told her that was okay with me and that I appreciated her letting me know her wishes. I walked her to the waiting room, put my hand on her shoulder, and smiled.

  “You have come a long way,” I said. She smiled and thanked me. She was enjoying her assertiveness, and I took no offense.

  Another couple had a New Age belief system that was unclear to me. They were young, wealthy, and professional. The husband had a type of neurological disease that had no medical solution. Surgery would not help him. As the appointment came to a close and they were about to leave, I offered, “I would be glad to pray with you.”

  “No. We have our own beliefs,” replied the woman sharply. The husband said nothing but looked soberly down at the floor. This couple’s response fit an interesting pattern: it is almost always the healthy partner who steps in and says “no thanks” to prayer. The person with the brain problem almost always welcomes prayer, or at least tolerates it.

  One of the saddest episodes to take place in my exam room involved a devoutly atheistic family. Sally, the elderly mother of the family, had denied the existence of God her entire life and raised her children to believe that God was a myth for weak-minded people. Now Sally had a degenerative brain disease that neither medicine nor surgery could correct. She was fragile and clearly approaching the end of her life. As our consultation concluded, I offered to pray for her. Sally’s adult son and daughter virtually launched themselves between us.

  “No, no, we don’t believe that,” the son exclaimed. They planted themselves next to their mother like bodyguards protecting her from imminent danger. But I could see that their mother was deeply torn. Sally had not turned down my offer. Her eyes pleaded with me in some unspoken way. A great sadness came over me.

  “I’m asking her,” I said calmly, trying to avoid an incident with her son. All three of us looked at their mother, but she wouldn’t say anything.

  “She doesn’t believe that,” the son repeated, as though he were trying to convince his mother of her own beliefs. The daughter chimed in, as if to warn me off: “She doesn’t believe that.”

  Sally sat there, uncertain, saying nothing. She seemed unbearably sad and clearly desired the hope she had detected in my offer. The four of us held our tense silence. Briefly, I considered asking Sally’s children to leave the room, but that would have been too confrontational. Finally, there was nothing more to do or say.

  “Okay, then let’s go out to the front desk,” I said. The old woman looked numb. Her children helped her get up and collect her things. I led them silently out of the room, but I was left with a hollow, chilled feeling. She had convinced her children that God did not exist. Now, probably in her final days, they were there to return the favor and make sure she did not stray from the family belief—the belief that there was nothing and no one outside our medical system to help her.

  * * *

  On one occasion, it was prayer that alerted a patient to the seriousness of the operation he was about to undergo, even though this was not my intention.

  Daniel was a British man in his sixties who wore a handlebar mustache and was unfailingly jolly. Every other comment of his was a lighthearted joke. He didn’t seem to take life too seriously, and that included his brain ailment and his medical treatment. He was also a longtime smoker. Every time I saw him, his wife, Nellie, was with him. They seemed close and very much in love after many years of marriage.

  Daniel had a basilar tip aneurysm, one of the more difficult kinds of aneurysms to treat. It was bell shaped, with a wide neck. The basilar artery travels in front of the brain stem and divides, forming a T at the very top. A basilar tip aneurysm forms when the wall of the vessel is weak, and the blood doesn’t stop at the T but pushes out the opposite wall, creating a bubble on top.

  To repair a brain aneurysm through the blood vessels (the endovascular route), we fill it with soft platinum coils, which reinforce it and prevent it from growing, like filling a pothole with asphalt. The coils go into the catheter straight and then assume a spherical shape once inserted into the vessel. These ingenious little devices come in different sizes, from 1.5 to 24 millimeters in globelike configurations. It is much easier to repair a narrow-necked aneurysm, which has a wide bottom and narrow neck, resembling a balloon, because the neck can hold the platinum coils inside. A bell-shaped, wide-necked aneurysm has nothing to keep the coils from spilling out and blocking the native vessels and therefore the blood flow to the brain. For Daniel’s aneurysm, I would need to use a stent and possibly other devices to re-create the wall of the vessel before inserting platinum coils, which would act as blocking agents. Each additional device would mean additional risk to the procedure.

  I explained the risks to Daniel and Nellie in detail. He seemed to shrug them off. I thought perhaps this was how he handled stress. The medical-consent form echo
ed what I said and made abundantly clear all the possible disasters that could befall him, including death. This was a high-risk procedure; the chances of having a stroke, being paralyzed, or even dying as a result were well above normal. He casually signed the form, appearing to put the risks immediately out of mind.

  While he was lying on the gurney awaiting surgery, I asked, as I normally do, if I could pray for him. Daniel’s ever-present smile suddenly disappeared, and his wife looked at me with concern. It seemed as if they were asking themselves, Did we hear this guy right? Are we in a hospital? Did the neurosurgeon just ask if we wanted to pray?

  “Okay,” Daniel said after an awkward hesitation. So I said a brief prayer. When I opened my eyes, I could tell that, like many others, they had kept their eyes open the whole time. Daniel looked like a deer in headlights. His mood had changed completely: he was stunned and quiet, and he even looked pale. The joking and easy conversation stopped. I wondered about his change in disposition as I told Nellie I would see her in the waiting room after surgery.

  Daniel’s procedure proved to be extremely difficult. The aneurysm was located as expected at the T-shaped intersection in his brain, where a vessel branches off into two opposite directions. This is a common place to find an aneurysm, but this case was not common.

  In Daniel’s case, just getting to the T-shaped junction with the catheter was arduous. His vessels were horribly diseased from all the years of smoking. The vertebral artery, the vessel I was trying to use as our passageway into his brain, had a kink and stenosis—a narrowing within. Just getting past these took two hours as I gingerly maneuvered the catheter through the calcified and fragile vessel.