This is another area in which to proceed very delicately, and I am sensitive to allow nurses to say no if they wish. I have to be careful not to misuse the authority and responsibility I have as the lead physician. It would be wrong to compel a nurse to pray, just as it would be wrong to compel a patient to pray. I choose my phrasing carefully and make sure my tone is welcoming but not commanding. I have never heard a complaint from a nurse. Some continue working as if uninterested, but some are actually quite animated and will even add an “Amen” of their own.
Once I became open to including nurses if they desired, the unity of the pre-op prayer experience suddenly seemed complete. I had learned early on that when some people pray, they like to hold hands and “circle up.” Some families did this automatically when I prayed for the patient, and soon I began to encourage family members to hold the patient’s hand and one another’s. The act of forming a circle gave us a strong sense of unity unlike anything I had experienced in a medical setting. Brothers and sisters who hadn’t gotten along would come together and unite around someone they loved, reminding them of what was truly important. Family from far away would draw in close. Prayer united us all in our desire to see a successful surgery for the person we cared about.
Now the nurses are sometimes part of those prayer circles. Certainly I always knew that most nurses truly care about their patients, but their occasional willingness to join those pre-operative prayers adds a warmth and collegial spirit that is unique in my experience.
The nurses’ response was more than I could have wished for. But that wasn’t the end of my road to authenticity—there was more to come.
* * *
I was offering to pray with patients before and after each surgery. The habit had breathed life into my practice and into the lives of those around me. Wherever prayer happened, the atmosphere often changed for the better, and I became convinced that I should be praying at every juncture of every procedure. That necessarily brought me to the next threshold of bravery: praying in front of those who help me in surgery.
It was one thing to pray in front of nurses; we see each other for only a few minutes each week. There is another group of people, however, with whom I work daily, who know me much better and whose opinions matter more to me—the technologists, the people who spend hours helping me during the actual surgeries.
Technologists work with X-rays. They are not doctors, but they are highly trained specialists. Their career paths usually start with taking basic X-rays of the hand or foot; if they choose, they can train to assist in interventional procedures in the body or brain. The team of seven techs with whom I had worked for seven years by this time are my extra sets of hands during surgery. They prepare and hand me the delicate instruments and run the multimillion dollar, computerized imaging system that allows me to do the work in the brain. They have come to know how I operate, the types of devices and mixtures I prefer, and when I usually take pictures during a procedure—not to mention the tone of my voice, how quickly I work, how I react to stress, and what I am likely to do when we reach an impasse. We are a tight, battle-tested team. I not only know them by name, I know their histories and their families. Our intimacy befits the seriousness of the procedures we tackle together.
To introduce prayer into our shared routine would be my biggest step yet because it would change a long-standing relationship into which we all had invested a good deal of trust. However, by this time I was more confident than I had been in the past, and more resolved. I knew there was still the possibility that my team members would react poorly to prayer and might even reject me personally, but that wasn’t going to stop me from at least asking. I could no longer deny that there was more than technology and chance at play in our procedures. For years we had never acknowledged that our work had a spiritual component, even when aneurysms ruptured and people died on the table before our eyes. Now I had seen the effects of prayer and believed that God helps those who ask—how could I keep pretending that all success was due to my skills or to blind luck? Ultimately, I believed prayer was the best thing for my patients, but did I have the boldness to ask God to affect outcomes in front of others?
Before every procedure, the techs and I gather in the reading room, a small five-by-ten space with backlit panels on one wall to hang the X-rays and a tall computer screen that depicts the brain in 3-D rendering. You can rotate the image of the brain in any direction using a trackball. There we discuss the day’s procedures in detail before heading in to perform the surgery.
On the day I decided to pray, techs Jeff and Heather were there along with a sales rep from a medical device company. We discussed the aneurysm shape and the vessels leading to it. I had my own ideas, but that day I asked for everyone’s opinion on which devices to use for the repair. Of course we expected the medical device representative to recommend his devices, and he did. When I couldn’t think of another angle to bring up about the case, and I could feel my heart pounding with anxiety, I simply said, “I would like to say a prayer for this patient before we begin. I need to ask you all if you are comfortable with that. I respect the relationship that I have with each of you, and it is very important that I not coerce or force you. You don’t need to stay for this.”
All three of them stood there not saying a word, absorbing the new wrinkle in their routine and perhaps wondering if I had lost my mind. Then they seemed to give a collective shrug, as if to say, “Whatever.” They didn’t know what to do while I prayed; they just stared at the floor. It was awkward for all of us, but nobody left.
“Heavenly Father,” I said, “we thank you for our jobs and that we have the opportunity to fix this aneurysm on Mr. Simmons. We ask for your wisdom on what to do and when to stop. Thank you for Jeff and Heather, and bless them with keen eyes and ears as they help in this case. Please bless their families this week. Give us joy as we do the surgery today. In Jesus’ name, Amen.”
With that, we entered the procedure room and did our jobs, while acting as though nothing unusual had occurred. The next week I did the same thing, and nearly every case thereafter. Nothing immediately changed in our relationships. Nobody protested, even though some were members of other religions or of no religion at all. Over the ensuing weeks I noticed that I had more joy during the procedures, and it seemed that we were having fewer complications. I saw the staff exhibit greater care and humanity toward the patients and toward one another. They saw that I took faith seriously but that I did not judge them. Talking to God was not some empty ritual but something active and alive.
Still, I wondered what they really thought about this new habit. Maybe they were resigned to working with an eccentric surgeon, or maybe they didn’t want to lose favor with me. I soon saw it was more than that. One day I went in to an emergency procedure and was so rushed that I forgot to pray. I had put on my gown and gloves and was approaching the table where a teenage boy was lying. Lydia, whose long hair was tucked under a blue surgical cap, came between me and the table.
“We need to pray,” she reminded me.
Of all the techs to say this, she might be the one some would least expect. Lydia was an attractive woman with a big heart toward vulnerable patients. She was also living a lifestyle many religious people would find offensive. And she loved praying before procedures. Behind her safety glasses, there was a serious look in her eyes that let me know she was not pretending. She had a genuine concern for the patient. She really wanted me to pray.
“You’re right,” I said beneath my mask. I grabbed her sterile-gloved hand in mine and touched the patient through sterile draping with my other hand.
“God, be with this boy,” I prayed, as Lydia closed her eyes and touched his blue-draped leg with her other hand. “Give us wisdom and skill. Keep us alert and aware of things we need to know to do this well. In Jesus’ name, Amen.”
We opened our eyes and looked up at each other. There was a certain sparkle and assurance in her gaze. I felt better. God was strengthening us as individuals and a
s a team through this simple act of prayer.
Some weeks later one of the other techs, Heather, cornered me while I was in the reading room dictating a case. She sat down, looking at me strangely.
“Something has happened to you over the years,” she said. “I can see it. You’re different than you were.”
“Am I?” I answered noncommittally.
“Tell me about your faith,” she said. “How did it happen? Did you come to it suddenly?”
I stopped what I was doing.
“It was gradual,” I said, and I explained a little about how I had discovered that there was much more to life than using my gifts for my own glory and financial gain—that life could have a greater purpose, but you had to make the effort to pursue it.
Heather was quiet for a while.
“My husband lost his job,” she said finally, tearing up.
“I’m sorry to hear that,” I said. She waved it off professionally, but with evident emotion.
“For the first time in our marriage we prayed together last night,” Heather said. “I thought you would want to know.”
“I’m glad to hear that,” I said, feeling a swell of joy. “How did it feel?”
“It felt great. We needed it,” Heather sighed.
“I am really proud of you—I hope you will continue,” I encouraged.
She nodded in agreement.
“We all really appreciate it when you pray before procedures,” she told me, and in the pause that ensued, I could sense that she wanted more than just conversation; she wanted some sort of help.
“Do you mind if I pray for your situation right now?” I offered.
“Sure. Go ahead,” she said, exhaling.
“Heavenly Father, you know Heather and you know Bruce,” I said. “You know the financial struggles that they’re going through at this time. I know that you have good things planned for them in the future, because you are good. Bruce needs wisdom right now to make the best decisions for his career and family. I ask for a blessing on them even this week, something special so that they would know it is from you. In Jesus’ name, Amen.”
I looked up. She was wiping away tears. The same peace that pervaded the reading room in the mornings when we prayed was here this afternoon, flooding her heart. She had moved toward God, the source of that peace.
A short time later Bruce decided to make a career change, returning to school to become a medical technologist. This proved to be a positive breakthrough for them. After that, Heather and Bruce found a church they enjoyed and began taking more steps to know God.
* * *
The next hurdle for me was praying with my fellow M.D.s. I had few opportunities to pray with other physicians, and I was not looking for them. Of all the groups in the hospital setting, I most feared judgment from other doctors.
Occasionally I am called on by device manufacturers to train others in the use of new medical devices. One week I traveled to a hospital in another city to teach two physicians, one of whom I knew to be a Muslim and the other a Hindu, to use a new intracranial stent for complex aneurysms. I was a proctor, essentially a consultant, observing and adding the extra information and experience they would need to use the device correctly on a human being.
I was not even sure that the patient in this case knew I was involved. I didn’t intend to interact with her or address her. I would merely be present in the procedure room while she was undergoing the operation and give suggestions from the back of the room. However, when the other physicians and I huddled on the morning of the procedure, they unexpectedly asked me to accompany them to see her in pre-op. Somewhat reluctantly, I walked with them to her bedside.
“This is the doctor we’ve told you about,” they said proudly.
“Oh, from San Diego. I’ve heard all about you,” she said. Dottie, an Australian, was fifty but looked sixty-five because of her two-pack-a-day smoking habit. She had a complex aneurysm that required a stent, the device I would be teaching them to use. We smiled and shook hands, but I felt a tightening on the inside. Now that Dottie knew I was involved as the expert, I felt I had a greater responsibility to her. I needed to offer to pray for her because that’s what I did for all my patients.
The problem was these two other doctors. How would I introduce prayer when it wasn’t my patient and wasn’t even my hospital? How would they react, being from different religions? Was prayer appropriate in this context where I was simply teaching others to use a medical device? I had so many unanswered questions; surely I could make an exception in this case and not pray. It was too uncomfortable. Surely God would understand and let me off on a technicality.
As we made small talk with Dottie for a minute, I wondered what to do. I felt vulnerable. For me to assert something like this in someone else’s hospital would take another level of courage.
So I stalled, hoping that the other doctors would find some reason to leave me alone with her—not likely. Then, as I extended the small talk past its normal duration, the words head and shoulders flashed into my mind. Head & Shoulders? I asked myself. What does dandruff shampoo have to do with this situation? Then I thought of that part of the Bible where Saul was anointed king of Israel. It says that he stood head and shoulders taller than his fellow countrymen in terms of height, but when it was his time to shine at his coronation party, they found him hiding among the baggage.11That was me, hiding among the baggage. I felt that God was telling me that as their teacher, I was in a position of honor. Professionally speaking, my experience was much greater, and I did not need to hide myself or my special treatment of patients from them.
That was enough for me. I knew that I at least needed to offer to pray for her. I looked at Dottie, smiled, and forced the words out.
“It is my custom to pray with patients before surgery,” I said to her. “Do you mind if I pray with you?”
Dottie looked at me curiously. “All right,” she said.
I grabbed her hand. The other doctors had fallen silent. My words seemed to have frozen them in place—they stood fixed and staring at the floor. When I bowed my head, they quickly bowed theirs.
“Gracious God,” I began, and I prayed for the success of her surgery. When the prayer was over, the other doctors came back to life but didn’t know what to say. Dottie smiled quizzically, as though she’d just been given a gift she didn’t know what to do with. After a moment she said, with that wonderful Aussie accent, “Thank you. I’ve never heard of a doctor praying before.”
I bet these other two docs have never heard of it either, I thought.
My colleagues were much less conversational as we walked out and prepared for the surgery. To break the silence, I brought up a technical aspect of the case, which put them very much at ease as we walked down the stairs. Prayer was simply part of my approach. Indeed, I was teaching something that I hadn’t intended.
We performed two surgeries that day, and both went well. The Muslim doctor had to be elsewhere for the second one, leaving me with Rajiv, the Hindu doctor. Again, we visited a patient in pre-op in need of a brain stent. This time I did not hesitate to ask to pray. The patient agreed, and I grabbed his hand. Before I knew what was happening, Rajiv walked to the other side of the gurney and grabbed the patient’s other hand. He then reached for my hand, which I gave him, and we formed a small prayer circle. My colleague clenched his eyes shut and waited for me to pray. What a joy it was to see that Rajiv, typically reserved, wanted to be on the inside this time, part of whatever was taking place in the spiritual realm. When we finished, he was smiling and much more at ease than before. He was even jovial as we walked out. We both acted as if nothing of consequence had occurred, but I noticed a certain levity as we discussed the technical aspects of the next case.
That experience liberated me further. There are always new challenges and obstacles. No matter how many times I have prayed, I remain conscious that my offer may be offensive to some. It still takes courage when any new person is added to the mix—a visiting do
ctor or medical student, for example. I simply announce that it is my habit to pray before surgery and ask if that is okay with everyone, and I look at each person for his or her response. Almost everyone says it is.
By degrees, my profession was becoming bigger than the technical aspect of my cases. Prayer in support of my neurosurgery practice was becoming my calling. This was a long way from where I had started.
Chapter 6
From Mechanic to Medical School
It’s not unusual for surgeons to talk about the “mechanics” of the work we do, but I am the only neurosurgeon I know who actually began his career working on cars.
The idea of being a doctor didn’t enter my mind as a young man. In high school I had no goals or motivation and made little effort at my studies. I did only what came easily. My parents were pretty sure I would do poorly in college, so they suggested that I instead look into a school for auto mechanics. I shrugged off even that modest goal because I could already fix cars and was in fact working as a gas station attendant. Nothing in my life said “higher degree,” much less “medical school” or “brain surgery.”
Then one day my older brother, who had gone to work on an oil rig off the coast of Louisiana, mentioned that the “college boys” on the rig seemed to have easier jobs that didn’t involve grease up to their elbows. They made more money and got to boss around those who hadn’t gone to college. That caught my attention. Then my aunt sent enough money for me to take one class at the local college. About this time I had started dreaming of being an actor, so I decided to get a college degree as a fallback plan, then work on an oil rig until I made enough money to buy a motorcycle and ride to Hollywood, where I would begin my true career on the silver screen. Real practical.
In the meantime I was working at the gas station and tire shop with the station owner’s son. One day there was a lull in the action, and we were leaning on the gas pumps talking. He told me he was taking the MCAT—Medical College Admission Test—and hoped to go to medical school. It was the first time I had heard of someone actually preparing to be a doctor—the first time I understood there was a pathway toward that kind of career. I didn’t think much of it, but later that week I had something akin to an epiphany. My car was making a funny noise when I shifted gears, so I got underneath it and started taking apart the transmission. As I held one of the parts in my grease-covered hands, it occurred to me: if I could fix cars, I could fix people. The idea of repairing a “machine” as complex as the human body captivated me.
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