* * *
In the months after my first meeting with Ron, I took a number of patients through the steps of forgiveness for various offenses and situations. The results were amazing, each in its own way.
One man suffering from a small aneurysm and pain in his back and neck told me that he resented his real estate agent for getting him into a subprime mortgage right before the housing market collapsed. It was a situation that called for him to report the man to the authorities to prevent further harm to others, and he did so—but there were consequences for him as well: he lost his house and was living with his daughter. Also, his wife had died, and he was angry at God for taking his partner of forty-eight years. After releasing God from blame for the death of his wife and after forgiving his real estate agent for helping to get him into a financial mess, his attitude brightened, and to my surprise, his neck pain went away. Once he was talking with God, even though at first it was just to complain, he soon began to realize how God had blessed his life remarkably during those forty-eight years with his wife. This man—who had been given many treatments, tests, and scans and had spent many months looking for a solution to his neck pain problem—found relief when he released those he had not forgiven and was honest with God about the painful loss of his wife.
Another patient, a woman from a traditional Indian family, complained of daily, persistent headaches. She told me that she resented her twenty-one-year-old daughter for moving in with her boyfriend, a lifestyle that was very American but embarrassed their entire family. The daughter was now demanding money for school and expenses, though she was unwilling to live according to her parents’ values. I suggested that my patient forgive her daughter for her choices and for demanding financial support. I also helped her separate her responsibilities to her daughter from her daughter’s personal responsibilities. Her headaches went away immediately.
Rhoda, a woman in her forties, came in one day. She had a church background but hadn’t attended in years. By now my presentation about forgiveness was succinct and fluid, and I told her how people’s health can be affected by things in the past, especially things they can’t forgive.
“It’s interesting you say that,” Rhoda said. “I was just telling someone last week that I think it’s time I forgive my father. He’s been dead for years, but he was such a mean man.”
“You can begin the process today, if you would like. I’d love to help,” I said.
She agreed, and I led her through the steps of forgiveness, as I had done with a dozen others by this time. She forgave her father for influencing her to marry an abusive man. She chose to set aside all questions of why God had allowed things to happen to her, focusing instead on the many blessings in her life that she had taken for granted. By the time we were done, a profound joy had come upon her.
“I feel light,” she said, beaming. “I actually feel like going back to church and getting connected with God again.”
“He has been waiting for you to set those things aside,” I said.
“I’m so glad I did,” she said. “I feel like he has rushed back into my life!”
She got up smiling and I walked her to the door, pleased that the conversation between her and God had been restarted.
Naturally, some people wanted nothing to do with forgiveness or “psychological” treatment. One well-dressed woman came in with a number of diseases: severe arthritis, thyroid disease, and sleep apnea, to name a few. She told me sarcastically that although she had seen many physicians, she got only two hours of sleep each night. I brought up the possibility that resentment or anger was affecting her—anger with God, with others, or with herself.
“I don’t have any of those,” she retorted.
I raised the possibility of her seeing a counselor but did not push the point. I moved on to talk about treating the possible medical causes. The rest of the visit went normally.
On a return visit to discuss a brain scan I had ordered, the first words out of her mouth were sharp and angry: “I did not appreciate your psychoanalyzing me the last time.”
I swiveled in my chair to face her. “I’m sorry I offended you,” I said. “That wasn’t what I intended.”
“I know,” she said more gently, but her point was made. We talked about the artery in question, which the scan showed was not dangerous and not causing her pain. I didn’t recommend any procedures.
She went on to ask if there was a doctor I could recommend for the puffiness under her eyes. It was clear she wanted to treat the symptoms, not look for the cause of her problems. I referred her to a physician who could possibly help, and she left my office. I never saw her again.
I don’t bring up forgiveness with everyone, just those who seem open to it and in need of a greater remedy. Even for those who choose forgiveness, it is a process, not a once-and-for-all transaction. “Forgive and forget” does not usually work. It is a pursuit, a habit that takes time and effort, and the results are always worth it.
But sometimes overcoming the family situation and the medical situation is extremely difficult—especially when the two collide.
* * *
Dave, a short, overweight man in his late forties, landed in the emergency room of the hospital one night. He had suffered a hemorrhage in his brain when an undiagnosed aneurysm had ruptured. Fortunately for him, the hemorrhage had been small and he was not actively bleeding.
I met him in the ER that night. In spite of the clear danger presented by his situation, his manner was blasé, defiant, distracted.
“How do you feel?” I asked.
“Little bit of a headache,” he said.
I noted that his speech was clear, not slurred. The hemorrhage had bled into the cavities of the brain, but not its substance, and there was no damage as a result of the bleed. He had dodged a bullet.
“You’re fortunate to have only a headache,” I said. “Thirty percent of people don’t make it to the hospital. When did this happen?”
“A few hours ago,” he said.
“How did it happen?” I asked.
He was silent for a few moments, expressionless.
“I was fooling around with someone,” he said. “I got a really bad headache all of a sudden. I knew something was wrong.”
He didn’t know it, but one of the most common times brain aneurysms bleed is during sexual activity. Many people don’t exercise, so sex is the most stress their circulatory system experiences. Their aneurysm reveals itself at a very inconvenient time.
“Then what happened?” I asked.
“I fell down but was able to call my son,” he said. That seemed difficult for him to admit. I sensed there was shame regarding the circumstances that had caused the bleed.
After reviewing the scans, I decided to do the surgery the next morning. Though there was a bleed into the brain spaces, called the subarachnoid spaces, there was minimal blood in the left temporal lobe where the aneurysm was located. If I had found an expanding blood clot, I would have rushed him into surgery, but there was not much swelling or pressure from the bleed. Dave was clearly awake and had not lost his mental or physical faculties.
In such situations there is no need to rush in, especially when the crew has just put in a full day of work. Doing technical procedures at night adds an extra layer of risk because the members of the team are not at their best; brains and bodies are clumsier when people are weary. The aneurysm had bled a little and stopped; Dave was not actively bleeding. There is a statistically small risk of rebleeding by waiting twelve to twenty-four hours with an untreated aneurysm. Because there is a statistically small risk of rebleeding and because these cases require significant concentration and technical skill, neurosurgeons typically wait until normal surgery hours to treat them.
“We’re going to treat this first thing tomorrow morning,” I said. “I need to discuss the risks with you. The aneurysm could bleed again during surgery; the procedure has a risk of stroke or death. Your problem is serious. Do you have any questions?”
I understand that there is guilt and shame involved in many of the things that bring people to the hospital. It is like getting caught with your hand in the cookie jar. You have been doing your own thing over in the corner, and suddenly your little secret escapes. When some people get caught, they become humble and penitent. They recognize that they have gone too far and want someone to help them make peace with God and get rid of the guilt and shame. These powerful negative emotions can cause significant stress on our bodies. When we are in danger of facing consequences for our actions, the body responds with stress hormones that raise our blood pressure and keep us from sleeping as we think of ways to get out of our predicaments.
I didn’t want to exploit the situation, but I wanted to offer Dave an opportunity to have a clear conscience if he had crossed a line somewhere. I sensed that he was feeling so ashamed that his health might suffer. I could have waited until the next morning, but considering even the small risk of his bleeding overnight, I felt that it was necessary to ask him now so that he could sleep. I lightly touched his forearm and looked at him with kindness.
“Were you raised with a faith or religion?” I asked.
“I was raised Protestant, but I’m nothing now,” he said.
“This is a serious situation in your brain,” I said in a soft voice. “If there is something you need to clear up or if you need to make peace with God, this would be a good time.”
He looked at me with muted scorn, rolled his eyes, and exhaled sharply through his nose, mocking my offer.
“I would be glad to call a chaplain,” I suggested, in case he was uncomfortable with his surgeon knowing the details of his life.
“No, I don’t need that,” he said.
Accepting this, I went on. “It is my habit to pray with patients. Your aneurysm has a risk of bleeding until we get it fixed tomorrow. Is it okay with you if I pray?” I asked.
While I waited, he looked around the room as if avoiding the question.
“I don’t have to pray if you are uncomfortable,” I said.
“No, it’s fine,” he said.
I put a hand on Dave’s shoulder.
“God, you know all about Dave, and you love him. I am asking you to keep him safe tonight and to keep this aneurysm from bleeding until we can fix it tomorrow. I ask for skill and wisdom in surgery. In Jesus’ name, Amen.”
I left the ER, and Dave seemed as unconcerned about the aneurysm as when I first came in. His mind was on other things. I went home knowing I would see him again soon.
The phone woke me up early the next morning. Dave’s aneurysm had bled again, producing a larger blood clot in the left hemisphere of the brain, where his speech and understanding centers were located. But since the left side of the brain controls the right side of the body (and vice versa), it was Dave’s right side that was affected. When I went in to see him, his condition had significantly changed. He was having trouble speaking and understanding, and his right arm and the right side of his face were weakened, as if in the aftermath of a stroke.
There was another wrinkle: before we could get him into surgery, I was told by a nurse that the police were waiting to speak with me. Neurosurgeons are rarely surprised by any new twist, so I calmly walked into the waiting area to talk to them.
“Hello, officers,” I said, shaking their hands. “How can I help you?”
“We’re here to interview a patient of yours, David Jackson,” one of them said. “We understand he was admitted last night.”
“He was, but unfortunately he can’t talk,” I said. “The bleeding has put pressure on his speech center, and it’s rather serious.”
They paused, quietly frustrated.
“When do you think he might . . . regain his faculties?” one of them asked.
“There’s a chance he may never regain them. We won’t know for a week or so after the surgery, and that’s assuming the surgery goes well.”
They thanked me and left. I turned to the nurse, who had been hanging back, listening.
“I wonder what that was about,” I said.
“I heard them say something about an underage girl,” she said, then turned with disgust and went back to her duties.
I went into the room to see Dave, wondering about his life situation. He was no longer sitting up in bed, but lying back, his eyes registering alarm. He had not been informed about the police visit, but he seemed to know that his physical condition had gotten much worse in just a matter of hours.
“Good morning, Dave. How are you feeling?” I asked.
He tried to speak, but the words were unrecognizably slurred; the right side of his face was not working. He tried several more times to speak, but nothing intelligible came out. He exhaled hard through his nose and, with a look of frustration, stopped trying.
“That’s okay,” I said. “Can you move your arms for me?”
He moved his left arm, but his right arm remained immobile.
“Can you move your right arm?” I asked.
He moved his left arm only and smiled slightly as if that was what I had asked. When he smiled, I noticed that his face was not working on the right side. I held up his right arm for him and asked him to move it. Nothing.
“Do you know whose arm this is?” I asked.
He shook his head. “Ohh,” he moaned, meaning no.
This new blood clot was putting pressure on the left hemisphere of his brain, causing something called spatial neglect, a condition that prevents a patient from feeling a limb or recognizing it as his own. He was becoming trapped in his own body, unable to move one side or to speak.
It was time to fix the aneurysm to prevent him from bleeding again, but this serious damage from the new bleed was something I could not fix. The techs were already preparing the procedure room, but I had an ominous sense that Dave’s condition would continue to deteriorate. I also knew that there was something about his recent encounter that required the police to talk to him. I do not ordinarily bring up the issue after it has been rejected, but this time I wanted to give my patient another chance—perhaps his last chance—to get right with God.
I said, “You’ve suffered another hemorrhage, which is why you are having trouble speaking. This is an important moment for you. Is there anything you want to talk to God about? You can do it in your own heart without speaking any words.”
He shook his head no. I gently grasped his hand.
“I’d like to say another prayer, if that is okay.”
He shrugged his shoulders and stared straight ahead. I wasn’t sure what he wanted, and I never want to push prayer on people who don’t want it—even if they can’t speak. So I asked again, “Is it okay if I pray for you? I don’t have to if it makes you uncomfortable. I need you to nod your head if you want it.”
He grabbed my hand and nodded his head. He seemed comforted as I spoke to God on his behalf.
Twenty minutes later I was in the reading room with my techs looking at the CT angiogram on the 3-D screen. There was Dave’s aneurysm in all its three-dimensional glory. I spun the image around using the trackball to view it from all sides. This was a mean one, with multiple pear-shaped lobes and measuring more than ten millimeters, and he had a new blood clot that had not been there the night before.
Hemorrhages can repeat. Upon bursting, blood pours out of the aneurysm at high pressure (arterial blood pressure is normally 120 mm Hg), filling the low-pressure brain cavity (which is normally ten times lower, around 12 mm Hg). Dave’s first hemorrhage had bled around the base of the brain, filling the cavities there but clotting off before doing any significant damage. The second hemorrhage had not clotted off as quickly, and the artery had shot blood up into the brain like a concentrated jet of water into soft mud. This had damaged centers
of speech and mobility of his right side: face, arm, and leg. No wonder Dave was having trouble talking and moving.
There was really nothing medical science could do to repair the damage he’d suffered. We had to let the body take care of that. I was going after the aneurysm itself to prevent future ruptures.
I knew it was going to be tricky, and now I had a decision to make: open surgery, by drilling open his skull and dealing with the aneurysm directly, or going through the vessel in his leg and closing the aneurysm off with tiny coils. Both options were worth considering. Open surgery would allow treatment of the aneurysm in person, so to speak, and this could arguably be more effective. I would be dealing with the actual vessel and would put a clip on it. There was something to be said for having that kind of access to a difficult aneurysm like this.
Still, an open surgical procedure would require manipulating Dave’s brain, pushing its lobes apart to reach the aneurysm. That would cause more harm to his already injured left hemisphere and speech center. Damage is almost inevitable when you push a swollen, injured brain around on your way to an aneurysm. I concluded, as I watched the screen, that the best course was to do this with minimal invasion, leaving the damaged brain alone and going up through the vessels.
Moments later I entered the procedure room and saw Dave on the table, anesthetized and draped in blue cloth. I couldn’t help but think of the visit from the police and Dave’s defiance each time I had asked him about making peace with God. This wasn’t just brain surgery; someone’s soul was in the balance. My opinion was that Dave wasn’t ready to meet his Maker. Maybe he felt as if he needed to suffer for his sins. Maybe he had a destructive lifestyle and wasn’t ready to give it up. Whatever the case, something seemed unresolved.
I stood next to his body, inserted the needle into his femoral artery, and got to work filling Dave’s aneurysm with platinum coils. The tricky part would be filling the pear-shaped aneurysm in such a way as to inhibit the blood from reaching the dome of the aneurysm, which contained the rupture site. One coiled ball wouldn’t do—that would leave room on the other side of the aneurysm for blood to flow around it. I would have to construct an effective barrier, essentially a small dike, or dam, to keep the pressure of the circulatory system from pushing against the weak side of the aneurysm. And I had to do it all within the tiniest of spaces.
Gray Matter Page 12
