Author: Dean Lohse

Emmanuel, God with us, is a word we use at Christmas to describe the Son of God visiting Earth in human form two thousand years ago. We mark a time in history that changed everything about the way we think, what we value, how we treat one another.

But what does God with us mean? Is He standing next to us, or living within us? Did He come just once two thousand years ago? Are we now alone in the universe? Do the wise teachings of the ancients and the brave devotion of this generation of followers give us only a shadow of the hope of Emmanuel?

Or is God still with us?

“Diener” (pronounced dee-ner) is the German word for servant. You would know this if you took three years of high school German, or worked in a morgue.

A morgue is not a mortuary. A mortuary is where a body is prepared for a funeral or a burial. A morgue is where a body is stored before it gets to the mortuary, located in a hospital or at the medical examiner’s office. A diener prepares the body for either an autopsy or transfer to a mortuary, and also assists the pathologist in the autopsy by doing such menial tasks as sewing up the torso afterward and sawing open the skull for the removal of the brain. It is a job for a servant, but not for the faint-hearted.

I spent most of the summer before I started college working as a counselor at a YMCA day camp for elementary-school-aged boys. Each weekday morning I boarded a yellow school bus with the campers and other counselors and traveled for about an hour into the country where we divided up and I took my ten kids for adventures in the woods, swimming in the leech-infested pond, and playing field games in the open area next to the large poison ivy patch. High in fun level, low in stress level, and even lower in pay level. At the end of the summer I needed a real job.

The university had a student job service. Potential employers called in with job needs that were posted on 3×5 cards on bulletin boards, and students could survey the cards and get contact information to apply for the jobs. My previous job experience–the above, plus paper-boy, dishwasher, janitor, and a short stint as fry cook before I got fired (another story)–didn’t qualify me for much, but I did find a promising lead to a job selling tires at a shop on Lake Street in south Minneapolis. Then I found one more at the University Hospital working in the morgue for nearly double the minimum wage, and therefore double anything I’d ever been paid before. The job duties were vague. I figured it was open because other students were scared of dead bodies (true) and it probably didn’t require anything more than sweeping and mopping the floor (untrue).

I grabbed both cards and headed out the door. The hospital was closer, so I called them first, and to my surprise a got an immediate interview with an administrator. I filled out a quick application form and sat next to his desk as he described a diener’s job. Blessed with German-Norwegian heritage that makes a poker face my natural expression, I listened patiently while planning my trip to the tire store on Lake Street.

Finally he said, “So would you be interested?”

I wanted to be an all-American male. Somehow this was important to me. John Wayne wouldn’t have flinched; neither should I. And already I was calculating that it was Friday and they would offer to train me the following week and by then I would be happily selling tires.

“Sure,” I said.

Then he said what every other job applicant wants to hear, and I did not: “Great! We’ll get you started right away.”

Surprise and near panic severely tested my poker face. If I backed out now, not only would I be a coward, I’d be a liar. Never has anyone been so desirous of selling tires and somehow unable to get out the words to make his new-found dream come true.

He picked up his desk phone and made a quick call to the morgue telling someone that he’d be bringing down the new diener. I followed him out from a maze of cubicles to a maze of hallways, then to a bank of elevators, then down to the lowest floor, through the windowed doors of a quiet hospital ward, and finally to windowless wooden doubled doors placed at a 45 degree angle in the corner of two long corridors.

I have since worked in many hospitals and I can confirm one unmitigated fact about hospital architecture: the morgue is always in the back on the lowest floor.

The administrator knocked twice on the door, told me to stay exactly where I was, and quickly walked fifty feet down the hall. I looked after him, my inner qualms temporarily giving way to astonishment.

He stopped, turned, and said, “I’ve got to go. This place gives me the creeps.” Then he turned, quickly disappearing through the doors to that quiet hospital ward and I never saw him again.

I stood in front of the wooden doors, the mouth on my poker face now slightly agape. One door then opened slowly to reveal an elderly and diminutive Black man wearing a surgical gown and cap, who, in a measured nasal voice, said (in great similarity to the celebrated horror-movie star of the ’40’s and ’50’s, Lon Chaney), “Come in. We’ve been expecting you.”

I stepped into an antechamber with benches and shelves filled with gowns and paper caps and shoe covers. The antechamber opened to two separate procedure rooms, each one on that particular day in the middle of an autopsy. My new supervisor introduced himself as “Howie,” and instructed me on how to don the surgical caps and gowns. Lastly, he showed me surgical gloves, fitted me for the correct size, and warned me not to waste them because they were expensive. Then we both looked up into the autopsy rooms.

The last time I had seen a dead body was ten years before when I attended the funeral of my great-uncle Ole. Ole, in his coffin, looked like he had in real life, except a bit more pale and much better dressed. My grandmother had died at our home when I was twelve but we weren’t allowed to see her. I don’t remember the funeral or what she looked like. Otherwise, I had no experience with death.

Running on momentum rather than courage, I followed Howie into one of the rooms. The autopsy was at midpoint, the torso open. Howie told me that the pathologist needed to dissect something high in the neck and I would have to place my hand into the upper opening and pull the tissue toward me so that he could see what he was doing. The flesh was shockingly cold but I did as I was told. I sensed at my elbow Howie’s approval by his eerie silence and immobility.

I apparently passed the final job interview. I few minutes later I could release my hold, and Howie proceeded to demonstrate the key duties of the diener which involved assisting in the removal and preservation of the brain and sewing up the body afterward.

After that, we had only to call the mortician, wash the body and the metal table, disposing of any discarded organ parts, and sweep and mop the floor, and call the mortician. Sometimes we would have to put the body back in the refrigerator that separated the two rooms, and sometimes we would have to get a body out from the refrigerator onto the dissecting table, an awkward task when working alone.

After two weeks of on-the-job training with Howie, I worked alone on nights and weekends. Getting “call” pay was nice when an autopsy wasn’t needed, and even when called in, I had plenty of down time between autopsies and waiting for morticians. I remember completing “War and Peace” while at the morgue office desk, and feeling quite sorry when my escape to nineteenth century Russia ended.

I learned a little about death through a word progression that starts with body. As in my body, your body, everybody, anybody, nobody. Dead body.

A body is brought to the morgue where it becomes something else: a corpse. A corpse isn’t a body, it isn’t anybody, it isn’t even nobody. It’s a corpse. It’s made up of tissue that used to be a body, even used to be a human body. But now it’s a corpse. It’s cold. Parts are washed down the drain. Bits and pieces can be placed in formaldehyde and sliced up and examined under a microscope, things you couldn’t do, wouldn’t do to a body, a human body. But you can do it to a corpse.

The mortician takes the corpse and sometimes transforms it into something that looks like a body. The transformation surprises us. We say, “Doesn’t she look natural?” because we don’t expect it; we know she’s a corpse.

Sometimes a generous person bequeathes their body to science and the progression from body to corpse takes one more step, the step to cadaver. Four years after Howie introduced me to the morgue, I met my first cadaver in the anatomy labs of medical school, only a few hundred yards away. Unlike the morgue, the anatomy lab was in a well-lit room with big windows on the top floor in the front of the building. Unlike the other students on their first day, I was not shocked.

I lasted three months as a diener. After a particularly busy weekend on call, including participating in the autopsies of a young woman and an infant, I had a nightmare. In the dream I realized that one of my close friends was dead (he was not in real life), and was greatly saddened by the loss. I ran into mutual friend after mutual friend, and at each encounter I would say, “Have you heard that Richard died?”

And each mutual friend would reply, “Why, no. Huh. That’s too bad.” Then they would go about doing whatever it was they had been doing before, and I would go to the next mutual friend and the same encounter would repeat itself.

As nightmares go, it doesn’t sound too frightening, and perhaps frightening is the wrong word. Mostly I was left with an overwhelming sense of sadness that the life of such a bright, funny, and capable guy, someone who I had swum alongside on the high school swim team, and laughed with during those German classes, and survived alongside through fraternity hazing, could be dead and nobody mourned.

Early on the following Monday morning, Richard picked me up in his VW to give me a ride to the university. I kept stealing sideways glances at him, assuring myself that he was really alive, that this was reality, that the dream was only a dream. I thought about telling him about it, but somehow any conversation starting or ending with “I dreamed you were dead” didn’t seem likely to go well. But I mourned him in an odd and secret way. I mourned his mortality. I mourned that someday–hopefully in a far distant future–he would indeed be dead. So would I.

I had to step back from death. I had to quit being a diener. I had to learn to love and celebrate life before I could again deal with death. It would be a long time before I considered medicine as a career, and it would be a sober decision when I did.

I learned a little about death–that it is inevitable, can claim the very young and the very old and everyone in between, after either a long illness or a sudden accident. Mostly I learned that an unfathomable gulf exists between a dead body and a living human being.

As a scientist, I understand death. I understand each cell needs oxygen and nutrition, warmth and acid-base balance, protection from mechanical disruption and toxins. I understand that a complex organism like a human being requires, at every moment in every organ system, a critical mass of cells to escape death. It’s a delicate balance of environment and coordinated survival of individual cells. Of course the balance is doomed to fail. Systems tend toward entropy. Death is inevitable.

I don’t understand life. Two cells fuse, mix up their genetic codes, give instructions that allow their descendent cells to multiply and change and function as a self-supporting interconnected organism for many decades to follow. The statistical likelihood of this succeeding seems so low. System failure and death seem always to be the more likely outcome. But, somehow, organisms survive, the species survives. We re-produce; while one dies, another is born. Order comes out of chaos. Entropy is defied again. Quite rightly we speak of the “miracle of life.” Biological life is a miracle, but even more unfathomable is that biological life creates human consciousness. Sometimes we refer to this as “the divine spark.”

Divine seems like the right word. Emmanuel. God with us. God within us. God as literally flesh and blood.

I have had my hands on, even within, a human being when that body transforms into a corpse. Consciousness becomes unconscious. Motion stops. Tissue cools. A life ends. God leaves.

Somewhere “Life” goes on. Somewhere a child is born, somewhere someone falls in love, somewhere someone is rescued. But when it’s my hands on the body, or it’s a person I love, those things are hard to remember, even harder to believe, and I feel the tug of of despair and sorrow.

Unless I remember Emmanuel.

God did not make this universe as His video game which He watches from on high, and toys with the controllers when He’s not busy. He wrote, and continues to write, Himself into the script. He is willingly part of each and every one of us, each and every day. He gets down and dirty with us, gets tortured and even killed. The life of Jesus Christ was a historic event, but in some cosmic or mystical sense, that life is lived out in every moment in every day for eternity.

When a kid gets hit by a truck, Jesus gets hit by a truck. When Uncle Ole gets cancer, Jesus gets cancer. When Mom has her heart attack, Jesus has his heart attack. When my brother gets Parkinson’s Disease, Jesus gets Parkinson’s Disease. When he gets COVID pneumonia, Jesus gets COVID pneumonia.

God suffers with us and He dies with us. He weeps with us. He wept with Mary and Martha over Lazarus. When I weep over my brother, Jesus weeps.

But cold flesh does not get the last word. A body may become a corpse, and a corpse may become a cadaver, but when life leaves the body behind it can’t just evaporate. It is too miraculous, too divine. 

God promises to wipe away every tear. Every one.

Then He promises something more. When Jesus rises from the dead, so does that kid who got hit by the truck. So does Uncle Ole, and Mom, and my brother. This is Emmanuel. This is God with us. To this Emmanuel, I am a willing servant.

So, Merry Christmas. Celebrate hope, celebrate Emmanuel. God be with you and within you, fellow servant.

The following chapter was written as a prologue to the novel “The Surgeon’s Sin.” Luke, a secondary character in the novel, is on the Appalachian Trail battling through hid dark night of the soul. Ten years later, Luke, in chapter 14, page 121 of the print version, refers to the prologue events as he tries to explain the revolution in his life to Dr. Peter Jenson, our main character.

I cut it from the novel after trusted advisors felt that the events were too distant and Luke’s character not dominant enough, and the plot took too long to get to the point where the prologue narrative made sense to the reader.

Still, what I like about the abandoned prologue is that it vividly describes that watershed in Luke’s life where everything before meant one thing and everything after meant something else. It also introduces a character, Joshua, who never makes it into the novel. He’s still important though, because he is the evangelist, the carrier of the faith. I believe that faith is not so much discovered as it is passed on through a long line of saints extending all the way to Jesus. In this case, from Joshua to Luke to Peter.

Enjoy the story! Comments, as usual, welcome.

Luke in the Wilderness, a Prologue

Silence. It was the same every night, always ending in silence. Luke had this conversation over and over, but as long as nobody listened, nobody knew he was crazy. The wilderness offered a cushion for his madness. Each night he hoped for a different ending, a happy ending. Or, if not happy, then at least not painful.

He stared into the rain and darkness beyond the small halo of warmth and light provided by the fire in the Appalachian Trail shelter. In the darkness beyond, he conjured the thin, small form of Jane, her sad blue eyes and face surrounded by a tight ring of blond curls.

“It must be cold out there,” he said. “Couldn’t you come closer?”

No. I couldn’t. I’m fine. Really.

“I’ve missed you.”

I know. You told me.

“Tell me why you left.”

You know why I left.

“Yes. But I needed you”

And I needed you.

“But then, why? We could have done it together.”

You weren’t there.

“I tried. Well, I would have tried, Jane. Really. I would have.”

Outside the firelight, rain poured down into the darkness that was as black as the space between the stars. Luke directed his side of the conversation to that point in the night where he saw Jane’s apparition. Wind brought mists swirling at the edge of the firelight, and the air smelled of pine, wet grass, and decaying leaves. Sometimes the a gust blew through the little fire, and acrid smoke rose into Luke’s face, and his eyes filled with tears.

He gave an involuntary start, sorrow giving ground to fear, as Jane’s ghost took form. A hooded person burst through Jane and closed fast toward the fire. Luke stood and took a step back. Though he could converse with Jane the ghost, he was not prepared to deal with her resurrected from the dead.

A hiker stepped into the firelight under the roof of the three-sided shelter and threw off the hood of his poncho. Droplets of water hissed into the fire and dripped onto the packed earth.  His dark beard and ponytail startled Luke, who still expected Jane’s blond curls. The hiker looked about the empty shelter. One pack, one sleeping bag, one pair of boots, and one man.

“Who’s Jane?” he said.

Luke willed himself back from the edge of madness. He again sought those behaviors that govern human contact. But his heart regretted losing his hallucination.

“Sorry,” Luke said. “Didn’t see you coming. Must’ve been a strange welcome.” As long as he could hide his grief and anger, he could appear sane.

“Joshua,” he said.  “Folks call me Josh.”  He held out his hand.

Luke hesitated even at the small touch a handshake would require. He steeled himself not to flinch. “Name’s Luke,” he said, taking the stranger’s hand.

Josh found a hook for his dripping poncho and shucked off his pack. His eyes met Luke’s, and stayed fixed and friendly. Luke had become accustomed to strangers seeing him with a gaze that glanced off quickly, usually followed by a step back, or at least to the side. He understood. He felt restless and unsettled at best, maybe full-bore psychotic at times. His face must give him away. He would never be a good enough actor to disguise his insanity.

Josh found a seat on the edge of the bunks and unlaced his boots, slipping his feet into a pair of sandals. He pulled his food bag from his pack and lit a stove. He looked at Luke’s hollow cheeks and asked, “Eat yet, Luke?”

Luke thought for a moment. “No.  I guess not. Mighta forgotten.” He looked at his pack.  “I already hung up my food bag, out there on the bear cables.”

“Well,” said Josh, “that’s good bear management, but it truly sucks as a nutrition plan.  You may be the first hiker I ever met that plum forgot to eat. Hell, that’s half the reason to hike–so you can eat as much as you can get your hands on. I consider forgetting to eat a sign of just plain craziness.”

“Yeah, well. Maybe so. Craziness.” He got that part right. Luke may have been starving but he hadn’t been hungry until Josh spoke.

Josh put on a pot of boiling water. He looked again at Luke who had resumed his seat by the fire. He seemed to be weighing and measuring something beyond the ingredients in the pot.  Finally he said, “I have enough for two. No sense you going out in the rain one more time to retrieve your food bag. We’ll split this, half and half.”

“Thanks,” Luke replied, “but it’s too big a gift.”

Josh nodded. Food was precious on wilderness trails, traded frequently but rarely given away. Food had value not only as intrinsic needed energy, but from the work required to pack it in over hard trail miles. Hikers earned what they ate, and ate what they earned, and did not expect to feed, or be fed, by other hikers.

“Uh huh. Which way you going tomorrow?  North or south?” asked Josh.

“North,” Luke replied.

“Me too. Let’s do this. We share my food tonight, we walk together tomorrow, we eat your food tomorrow. Deal?”

Luke hesitated. It was a fair deal, one he could live with, but he was deeply sunken into his solitude. Hiking with someone else meant hiding his anger and grief for a whole day, something he hadn’t been successful at without heavy doses of drugs and/or alcohol. Escaping human contact had been the only way he’d been able to escape substance-induced oblivion.

On the other hand, he really was hungry. “Deal.”

“Deal it is then,” said Josh, pouring boiling water into a foil envelope of freeze-dried food. “And, as a special treat, I have a bottle of wine, which I’m not planning to carry one more step, and a loaf of fresh-baked bread.”

“It’s been a while since I’ve had fresh bread,” Luke said, really worrying more about the wine. “Sounds good.”

“So, who’s Jane?” asked Josh.

“She was my wife.”

“Ah,” Josh said. “Was.” He fished in his pack, brought out a couple of metal Sierra cups, emptied a packet of cocoa mix into each one, and stirred in the remainder of his heated water. He handed one cup to Luke.

Luke took it and stared into the dark liquid. He knew he should elaborate, but where could he even begin? And he sure as hell didn’t know where to end.

“Past tense,” Josh said. “But you’re still talking to her.” He looked around the shelter. “Kind of.”

“Yes. I loved her from the day I met her until the day she put a bullet in her brain.”

“Ah,” said Josh.  “I’m sorry.”

“Our relationship is a bit more complicated now,” Luke said. Shut up. Shut up now. “But I can’t seem to get out of the habit of talking to her.”

The darkness encroached on the halo of light around the dying fire. The rain tattooed the shelter roof, as death and betrayal twisted into Luke’s memories.

Josh put another log on the fire, and opened the foil envelope, giving the contents a stir before sealing it up again. “Five more minutes.”

They sipped the cocoa in silence. Luke figured Josh was already regretting the shared meal and the promise of the shared walk. Finally he said, “You don’t have to do this, you know.”

Josh laughed. “Yeah, I kinda do. I can’t eat all this myself, I don’t want to carry it on my back tomorrow, and I am not going out in the rain to bury it tonight. So yes, hell yes, we’re gonna do this.”

The laugh startled Luke. He hadn’t heard anyone laugh for a long time. He shrugged. “I wanted to give you an out. It’s not like I don’t know I’m crazy.”

Josh gave the packet contents one more stir, this time leaving it open. An aroma of rice, cashews and chicken filled the shelter. “They say if you know you’re crazy, you’re not.”

“They say lots of stuff. Most of it total bullshit.”

“Can’t say I disagree.” He produced two plastic bowls and emptied the contents of the foil packet into them, handing one to Luke. He pulled a loaf of French bread and a bottle of screw-top red wine out of the packet.

In defiance of night and rain and death and betrayal and insanity, Luke’s body reacted to the sight and smell of this feast with visceral joy. His mouth watered so hard he nearly drooled. He pulled his titanium spork from his shirt pocket and poised it above the bowl of cashew chicken and rice. But just before the spork dropped, Josh spoke.

“Father, thanks for food, shelter, and company. Amen.”

So Josh was one of them, a grown-up religious nut. Harmless usually. And not too annoying if they could manage to keep their religion to themselves. Luke wondered if tomorrow’s hike would be a day-long lecture in obscure theology. But his worry was brief, his hunger great, and the food good. They both fell to eating. Josh broke the loaf in two and handed half to Luke. Then opened the wine, took a swig, and passed the bottle to Luke.

“Body and blood,” he said with a wink.

Luke had just enough religious training to realize this was some kind of inside joke about communion or mass or whatever it was they called that ritual.

As they mopped the last morsels of food from the bowls with the last crusts of bread, emptied the cocoa cups, and took the last swig from the wine bottle, Josh added another log to the fire and stirred the coals into an encore of heat and light.

“It’s not crazy to grieve,” Josh said.

“It feels crazy.”

“Sure it does. Because nobody ever tells you that the day will come when you will lose everything you ever loved. No one tells you that you will fail, someone will betray you, your best friends will disappear, and everything you thought you were working toward disappears in a puff of smoke.”

No, Luke knew, he hadn’t cornered the market on suffering. Bad things happened to good people. But in his heart he knew that his own decisions had pushed Jane over the edge. He was at least partly the cause of his own misery. But Josh sounded like he was talking about himself now.

“Sounds tough,” said Luke, hoping that would end the discussion. He wasn’t really interested in anybody else’s problems.

“I could see it coming and I spent a night sweating blood, hoping it would all go away. And it didn’t.”  

“You think you were like me?” Luke asked.

Josh turned away from Luke and looked into the darkness. He said, “I think I was–maybe still am–like Jane.”

“Jane was desperate.” A gust of wind swept into the fire. Sparks flew and the smoke came back at him. Luke stood and rubbed his eyes. “Ethan was so miserable. And I was so stupid I thought it would be better after he was gone. I thought she would be better after he was gone.  Stupid.”

Luke paced around the fire, rubbing his eyes.

“Ethan?” asked Josh, kneeling by the fire under the smoke.

“Yeah. Ethan, our son. He got leukemia when he was four. The kind that doesn’t go away with four-drug chemotherapy. The kind that doesn’t go away with bone marrow transplants. The kind that isn’t kind. He was dead by the time he was six. Two years of misery for the poor kid, and a lifetime of heartbreak for us.”

Josh said nothing.

“Then he was gone and there was this big emptiness. He wasn’t there to love.  He wasn’t there to comfort. He wasn’t there to talk about, worry about and cry about. We couldn’t get together and rack our brains for a better treatment plan. He wasn’t there, and we looked at each other and didn’t know what to say.” Luke continued to pace and clench and unclench his hands, but the smoke seemed to follow him.

“You couldn’t comfort each other?” Josh asked.

“Not very good at it, I guess. Partly ‘cause I was gone a lot. I was a neurosurgery resident, so I wasn’t home much. But also because we had the same despair.” Luke resumed his seat, knuckles clearing the tears from his cheeks.

“No hope?”

“No goddamn hope. No god, no heaven, no reason for the misery, no purpose. I mean, it’s hard not to come to the conclusion: life’s a bitch, then you die.”

Luke paused to look into the fire. “I coped by working. As long as I kept moving, I didn’t have to think. As long as I concentrated on other people’s pain, I didn’t have to deal with mine.  That worked for about six weeks, until I came home and found Jane dead.”

“Seems like it’s all still raw,” said Josh.

“Yeah. It was about three months ago. I’ve been mourning, I’ve been drinking, now I’m just walking. Trying to figure out the next step, one step at a time.” Luke stood up suddenly and covered his face with his hands. “This goddamn smoke.”

Josh stood next to him and lightly placed his arm across Luke’s quivering shoulders. “You’re a brave man, Luke.”

“I don’t feel brave,” he said, keeping his face down. The stranger’s gentle hug shocked him before it comforted him. No one had hugged him since the funeral.

“We are held to this earth only by tethers of love, and fear of what lays beyond. Just to keep breathing after the tethers are cut is an act of courage.”

They stood together until the quivering stopped, standing in a shelter on a long trail that starts on a mountain and ends on a mountain. Some say the trail starts in the middle of nowhere and ends in the middle of nowhere; some say it starts and ends on holy ground.

“Just sleep,” said Josh.  “When you wake up in the morning, we’ll walk and talk. You are not alone.”

Sleep had eluded Luke for months, maybe years. His restless nights had been filled with excruciating memories and nightmares. “Sleep would be great.”

Josh withdrew his arm from the embrace and put his hand on Luke’s forehead, almost like he was checking for a fever. The smoke cleared and Luke inhaled the scents of fresh rain, pine and wet grass. He felt his muscles start to relax–first his shoulders, then his hands, back, legs. He realized his muscles were sore, his joints ached. His body became heavy. When Josh lifted his hand, Luke crawled into his bag and immediately slept. In the morning, he knew he must have dreamed because he remembered Jane’s face. She was laughing with her head thrown back, crazy blonde curls flying in the sunlight.

Imagine that. Laughing.

The Bad Year and the Good Friday

Evil Incarnate. Those were the words that came into my mind as I looked at the MRI image of a giant tumor of irregular borders and varying densities spreading near the geometric center of the brain. The natural history of this tumor would be progressive disability, loss of intellect, coma, and death within a few weeks.

Treatment plans were nearly as different as the number of neurosurgical centers, since at that time the long-term outcome studies for the various treatments had not established the best therapy. Outcome was guarded, depending not only on treatment plan, but also on the pathology of the tumor cells, which could only be determined by biopsy and spinal fluid analysis.

Evil Incarnate is a pineal area tumor. The most common variation in a patient like this teen-age boy would be a germinoma, something familiar to me. But germinoma was not the first word that came to my mind.

Because this time the MRI imaged Adam, my 16 year-old handsome son with the blond crewcut and the gymnast’s body, and the poet’s heart and mind.

Evil Incarnate.

The words had been forming in my unconscious for the previous five months. My wife, Mary, and I still dealt with the aftermath of the abnormal mammogram, the needle biopsy that diagnosed the cancer, the bilateral mastectomy with node dissection, and the subsequent chemotherapy every two weeks. There was still one more scheduled chemotherapy session at the time of our son’s MRI.

Oh yes, she had a good prognosis. But the estimated 90% five-year survival for this size and type of tumor was the kind of statistic that sounded so much better when it was about someone else. 90% sounds so good when it rolls off our doctor tongue. But the first thought I had as the patient’s husband was: That’s not good enough. I did not want to see my wife with a 10% mortality of the next five years. She would have been safer in the front lines in Viet Nam. And what about the next five years, and the five after that?

No, cancer with a good prognosis is not good. It is better than cancer with a bad prognosis, but it is not life simply going forward. It is facing mortality. It is Mary bargaining with life and death at stake: I’ll trade the violence of surgery and the poison of chemotherapy for more days in this time-space continuum on this planet. I do it for the sake of those I love, and who love me—for my children and husband—so that they will not miss me when I am gone, at least not for a long time. By then they will be older, and it won’t be so painful. And I know how painful it is from my father’s death when I was 12, and how I learned that, heaven or no heaven, dead is dead and he was not there and is not here, and I do not wish my children to know what it is like to have a parent die while they are still children. So bring it on. Bring on the scalpel and the scars, good-bye to those symbols of my sexuality. Bring on the drugs and the nausea and the hair loss. I will do what I need to do to fight for life, because I am not fighting only for my life; I am fighting for my children.

Mary and I hung onto our teddy bear called Good Prognosis, pushing down our fears, re-assuring our children. We fought for normality, pretending that life simply went on, and we were doing a pretty good job of it. Then I saw Evil Incarnate.

Looking at that image, I wished for the first time that I was not a neurosurgeon. I wished that I did not know what that image represented. I wished that I did not know what pain surgery caused. I wished that I did not know the risks: visual loss, intellectual impairment, paralysis. I wished that I did not know what it looked like to die from pineal tumors. And most of all, at that moment, I wished that I did not have to be the one to tell my son and my wife.

The next week, Adam had surgery. The following week, Mary had her last chemotherapy. the subsequent week, Adam started radiation therapy. The next month Adam started having pain in his abdomen. The next month he had another operation to remove an infected shunt. Each day his temperature would spike to 104⁰ F, and twice daily a nurse would come to the house to administer an IV infusion of antibiotics. I thought he would die.

Then, the bad year was over. By January we were done with treatments. Mary and Adam started recovering physically, but had been left with hard consequences. Mary had lost her figure, and Adam had gone from being a gymnast to a kid who couldn’t jump high enough to get his feet off the ground.

But we were okay. We had a good prognosis. We were healing. We would get better. We went to school, we went to work, we went to church. We ate, and slept and went to the movies and read books and had birthday parties. Life would go on. We were sure of it.

Or at least this is what I was saying. I was the cheerleader. When Mary or Adam expressed their sense of loss or concern for the future, I would grab the teddy bear named Good Prognosis. I would wave him in front of them and pet him, and hold him up high, and I would say, Everything will be okay.

But everything was not okay. Mary and Adam both experienced a profound sense of loss from who they had been to who they were. Double vision never left Adam, painful scars never left Mary and the scars were more than skin deep. We had a new household resident named Fear.  Because from that time forward, a cough was not a cough; it was metastatic cancer. A headache was not a headache; it was a recurrent brain tumor. Weariness or nausea brought the deja vu of chemotherapy.

Time does not heal all wounds, but at least it allows time for the debris of life to cover the scars and make some bad things easier to forget. Fears without foundation become more rare. A cough became just a cough, a cold became just a cold, a headache became just a headache, and double vision is just something that happens when one gets tired. The pain and stiffness in Mary’s scars eventually faded and she got clothes that accommodated her new figure. Adam’s hair grew back, and although he was never again a gymnast, he could hike the Appalachian trail and play chess and go to college. If we learned any one truth about our purpose of life it was that the most important thing was to love each other, and be loved. For without that, our lives were not worth the battles it took to live them.

Both Adam and Mary were depressed during their recovery. Adam with the resilience of youth perhaps less acutely, but Mary had periods of tears, self-imposed social isolation, feelings of hopelessness and an inability to plan for the future. I had to learn that sharing grief is more important than fixing grief. And she had a Palm Sunday experience when God directly intervened, a story she tells much better than me, and she started getting better.

Then, oddly, as she became less depressed and Adam resumed the trajectory of his life, and we all returned to something like normal, I became chronically depressed.

I had always been a fix-it guy. Why else go into medicine and surgery? Fix the problem, save lives, alleviate pain and suffering, prevent disability–that was what it was all about. But now I had just learned that all fixes were temporary, and I could not shake off the implications: we have no control, death is inevitable, and we are the dust and my accomplishments are trivial.

I survived by working, but now I never had the illusion that on a good day I saved a life; the best I could ever do was to prolong one. I distracted myself by learning to draw, trying to play the saxophone, and playing golf. I learned to be a better listener to my wife and children, and to be around more, to be a better dad. I would like to think that I was a more compassionate physician with a deeper understanding of my patients’ suffering.

But my heart was heavy, and I simply waited for the next day of darkness.

One Spring, on a Good Friday, I got home from work by mid-afternoon. No one else was home, and I went into our back yard to do nothing but feel blue. I reflected on the fact that it was the day that even Christians celebrated death. I tried to think of the things that everyone knows for sure, the things I could know for sure. There must be solid ground. Of what could I be certain?

Death and taxes, of course, but the inclusion of taxes is more a matter of humor than philosophy. Death then, for sure. And time, space, matter, and energy. But time ticks on without any end in sight. Space is infinite. Energy is simply another form of matter, and matter is mysterious, understood only by mathematical models that give us illusions sometimes of charged particles or sometimes of energy packets, or sometimes more bizarre forms predicted by quantum physics. And now we know that for any particle to be defined in our universe it passes through the Higgs field to become real.

In other words, we live for a short time in a universe as creatures without understanding of our basic make-up or destiny. We are dust.

Then I remembered a book from my youth. The title of the book was “Your God is Too Small” by J.B. Phillips. The problem now may be that I imagined God as too small. I tried to imagine Him bigger. Our human concepts of time, space, and particle physics, lead us toward infinity; is it such a jump to believe that we are surrounded by eternity?

I saw a vision of God creating a universe and writing the laws of both quantum physics and relativity theory. And furthermore, a God capable of creating other universes with other laws. I envisioned the mind of God, the unfathomable, immense mind of God the ultimate Creator whose thoughts become our reality.

And in this mind of God, I am a thought. His thought. His creation. Infinitely tiny compared to the grandeur and complexity of the universe, but still I am a purposeful thought in the mind of God. And if we are surrounded by eternity, is not existence in the mind of God a kind of heaven in itself?

That was my Good Friday vision. Life has purpose because God has created me. I am His thought now and into eternity.

That was when my depression lifted. I was ready for resurrection. I was ready for Easter morning.