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 Fourteenth Miracle

“The one who has dipped his hand into the bowl with me will betray me. The Son of Man will go just as it is written about him. But woe to that man who betrays the Son of Man! It would be better for him if he had not been born.” Matt. 26:23 (NIV)

In the early 1980’s I cared for a forty-eight year-old man with an acute subarachnoid hemorrhage from aneurysm. In those days delaying surgery for seven days after the initial bleed was thought to allow time for the brain swelling to go down making the surgery safer. The decreased surgical mortality made up for the small number of people who would re-bleed during the waiting period. One of the trickiest parameters to manage during that week was blood pressure. If the pressure went too high, the aneurysm would rupture; if the pressure went too low, the patient would suffer a stroke.

This man’s high blood pressure was difficult to control on several medicines. Fearing a rupture any moment, I ordered a seldom-used IV alpha-blocker at a low test dosage of 0.5mg, not wanting to over-treat. Normal doses would be 1 to 2 mg. An hour after the phone call, I got a call from the nurse that the patient had gone into shock and the ICU staff had already begun resuscitation. I arrived at the hospital a few minutes later to help with the unsuccessful code.

The fatal blood pressure drop had occurred shortly after the “test” dose. The nurse held out the empty 5.0 mg. glass vial. She had given ten times the ordered dose, a lethal mistake.

They don’t make that drug anymore, and pharmaceutical companies now take care to avoid packaging medicines in ways that make such mistakes easy. But the changes came too late for that patient, too late for that nurse.

She was inconsolable.

We make mistakes. She read a drug label wrong. Judas Iscariot read the Messiah wrong, and no one has ever forgotten the betrayal with a kiss. I know I’ve made big mistakes. A drill plunging into the all-important speech and language areas as I tried to drain a subdural hematoma. An injury to the carotid artery leading to a fatal stroke while I tried to get control of the blood flow to a giant aneurysm. A wrong-sided scalp incision. A bruised spinal cord.

The consequences of the big mistake are not limited to the victim. Yes, the nurse’s patient died. But what happened to the nurse? She was a good nurse–smart, hard-working, and compassionate. When we lost the patient, did we lose the nurse too? What happened to me?

Yes, Jesus died. But what happened to Judas?

When Judas, who had betrayed him, saw that Jesus was condemned, he was seized with remorse and returned the thirty silver coins to the chief priests and elders. “I have sinned,” he said, “for I have betrayed innocent blood.”

“What is that to us?” they replied. “That’s your responsibility.”

So Judas threw the money into the temple and left. Then he went away and hanged himself. Matt. 27:3-5 (NIV)

Remorse leads to despair. Returning the money was not enough. Despair led to suicide.

The nurse underwent a review and received a cautionary letter in her permanent file. She took a course in error prevention. The drug company changed the way they packaged the medicine and the hospital changed risky methods of ordering and dispensing medicines. She could have returned to working in the ICU, but she did not. Because she needed one more thing to be fully restored.

I know. There are times when the word Sorry is too small. I’ve paid for the consequences of my own mistakes, struggled with my own self-confidence, wondered if I should go back the next day to take care of the next sick person.

The passion story of Jesus carries a parallel story of betrayal. Judas wasn’t the only one to lose hope. Peter, in spite of his bluster of faithfulness on the night of the arrest (quote: “Even if I have to die with you I will never disown you”) by morning had indeed publicly denied knowing Jesus three times. When the cock crowed at the break of dawn, Peter remember his vow and wept.

Matthew doesn’t mention Peter again in his Gospel. Neither does Mark. Luke and John both tell us Peter ran to the tomb after two women had found it empty. Then we don’t hear anything about Peter until another episode recounted in the Gospel of John that occurred a few weeks later.

Peter had given up Jerusalem, returned to his home and his old job. I imagine him severely depressed. He had stood at the threshold of the Kingdom of Heaven, looked in, saw the endless beauty, and met the king. Then someone asked if he knew Him, and Peter said No, no, no. Not me! Then, three days later, his own eyes told him that he was wrong. Jesus was who he said he was, and Peter had failed his very first trial.

Three years before, when Jesus had sent them out on their own for the first time, in his guidance had said, “Whoever disowns me before others, I will disown before my Father in heaven.”

Peter was disowned before the Father in heaven. Life could offer him nothing more than return to fishing in the obscure province of Galilee. He had turned away from the kingdom of heaven at the critical moment. He had made the big mistake.

Now he worked all night and caught not one fish. He was no longer good at fishing. Total and complete failure. And this time of day was the worst, the graying of the sky before dawn, the time the cock crows. Tired, depressed, and hungry, he felt like throwing himself overboard.

In a few minutes he would do just that. But for a reason he did not expect.

He smelled something. Smoke. And fried fish and warm bread. It tickled his hunger and made him lift his head. A hundred yards away a small fire flickered on shore. Some early riser getting ready to make breakfast. Some early riser who was apparently a better fisherman.

“Friend,” the stranger called out to them, “haven’t you any fish?”

Was their failure that obvious? Even from a hundred yards away?

Peter’s companions shouted back, “No.”

“Throw your net on the right side of the boat and you will find some.”

Just what he needed. A know-it-all. Like the water on one side was different than the water on the other. An idiot bent on making them all look like idiots. Before he could say a word, though, their nets were up and tossed out again over the opposite gunwale.

The net filled quickly and the boat tipped dangerously toward the starboard. They couldn’t pull in the seine of squiggling fish. Peter’s crew kept the ropes tight and started rowing for shore, dragging their catch.

Peter squinted now through the mist and the pre-dawn gray at the flame and the figure on the shore. It sounded like, looked like…but it couldn’t be. Then his cousin John whispered loud enough that Peter heard, “The Lord.”

He looked back into the boat. James and Andrew struggled with the oars, John kept the net tight. Peter should help. The boat barely made headway and Peter was clearly the strongest rower. John lifted his eyes from his struggles long enough to meet his gaze. The Lord, he mouthed.

Peter leapt over the side, the cold water shocking his tired mind bright and clear. He swam hard and fast, keeping his eyes on the small flame. Dripping across the beach he came to the banks of flaming coals, fish already cooking and bread being warmed.

Jesus (it had to be Jesus), said nothing at first, only squatted by the fire and turned the fish. Peter, too, said nothing. What could he say to the the man who had talked with Moses and Elijah, who had walked out of his own tomb?

The words Whoever disowns me echoed again in Peter’s head, as they had for the last three weeks. Why was he here giving them fishing instruction and cooking breakfast? Is this the final farewell? The final I warned you, but you wouldn’t listen. Better luck next time message? He deserved the message, he knew he did. What he didn’t deserve was a record-breaking catch and breakfast.

The boat’s keel crunched into the gravel beach behind him. He heard the bang of the oars on the gunwales and the splash of men struggling with a full net of live fish.

Finally Jesus stood up. Their eyes met, and Peter waited for his dismissal. But he said, “Bring some of the fish you have just caught.”

Peter turned and ran to the boat, scrabbling over the side, grabbing the net from the exhausted crew and dragging it up the beach. Then the four stood before the fire, Jesus on the other side with a griddle and a basket of bread. Had the heavens opened and choirs of angels begun to sing, they would have been less surprised when he simply said, “Come and have breakfast.”

Words failed them. They ate in silent wonder. When they could eat no more, Jesus spoke to Peter. “Do you love me?” he asked.

“Yes, Lord,” Peter answered.

Jesus repeated the question two more times; Peter repeated his answer two more times.

Three times Peter denied knowing Jesus, three times Peter affirmed loving Jesus. The balance was restored. Jesus went on to say a few more things, saving the most important for last: “Follow me.”

After the big mistake, you can throw the coins back into the temple, you can take your letters of reprimand and remedial education courses and pay your fines. You can say you’re sorry.

But if the mistake is big enough, you still live in the cloud of despair.

I hope you haven’t made any big mistakes. Some of us have divorced someone that didn’t deserve it, some of us have abandoned children, some of us have had abortions. Some of us have robbed people legally or illegally. Some of us have killed people for no good reason, and some for a good reason only to discover there are no good reasons.

Remorse, depression, and despair pull us into a deep, dark place, and if you are there right now remember that little light you see a long distance off in the mist is Jesus cooking breakfast for you.

Head for shore. Sorry will be enough. You are forgiven.

The Bad Year and the Good Friday

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.

Mountains and Mustard Seeds

Number Thirteen in the Healing Miracle Series

When they came to the crowd, a man approached Jesus and knelt before him. Lord, have mercy on my son,” he said. “He has seizures and is suffering greatly. He often falls into the fire or into the water. I brought him to your disciples, but they could not heal him.”

“You unbelieving and perverse generation,” Jesus replied, “how long shall I stay with you? How long shall I put up with you? Bring the boy here to me.” Jesus rebuked the demon and it came out of the boy, and he was healed at that moment. (Matt. 17:14-18, NIV)

Jesus had been coy with patients before, taking his time before responding to their requests, calling them out when they touched his robe, forgiving sins instead of commanding healing, casting out demons from the violent men of the Gadarenes without being asked–all unexpected responses to human suffering. But never had he been impatient, even rude, as he was now to a father with an epileptic son.

Or maybe his comments about the “unbelieving and perverse generation” had been directed elsewhere. Maybe to the disciples, because of their failure to cure the child in his absence? But even this seems unfair, and out of character, for the Jesus we have come to know in the previous chapters. Or maybe he’s human–not just human, but still human like you and me.

He had just come down from the mountain. He had been in the presence of Moses and Elijah, the great leaders and prophets, both of whom the world thought to be long dead. And God Himself spoke to them, and Jesus, in the presence of three witnesses: This is my Son, whom I love; with him I am well pleased. Listen to him! (Matt. 17:5, NIV)

How many of us wouldn’t love to hear those same words from our earthly fathers! Or if we were lucky enough to hear them, don’t we treasure those moments among the best in our lives? Imagine hearing the clear voice of God the Father while communing with the saints of the past. This had to be the pinnacle of his life on earth so far–what he had meant when he talked about “The Kingdom of God,” a place he knew in faith and in hope but had yet to experience in earthly life.

Then he came down from the mountain and found the same kind of problems he had left behind the day before, along with disciples that couldn’t seem make any headway without his presence. No doubt the disciples looked sheepish. After Jesus had his little outburst, he did what Jesus does; he cast out the demon.

“How long shall I stay with you?” he cried out, but maybe he was really questioning his Father whom he had just left: How long until I can come home? How long until every soul has unity with You? How long will our created world be filled with diseases and demons?

The Kingdom to Come

Our internship class inherited a man named Archibald, or “Archie” as everyone quickly came to know him. About a week before our internship started, he had suffered a shotgun wound to the abdomen when a heroin deal went south, and had his first of many operations to save his life. Any abdominal wound can be fatal, but a shotgun is particularly nasty because of the multiple intestinal perforations each of which can be the source of infection–peritonitis–and potentially life-threatening sepsis. Some of the intestine can be sacrificed, but if too much intestine is taken, the body cannot absorb adequate nutrition to survive.

Archie survived his first operation, but had recurring bouts of peritonitis and sepsis. At one point his respirations failed and he needed a ventilator for nearly a month. To “rest” his intestine and minimize further infection he required total parenteral nutrition, TPN, through central intravenous lines. Over the next few months, he underwent several more operations to find and repair damaged intestines or drain abscesses. Every one of our surgical interns rotating through general surgery took care of Archie.

He was a likable guy. We–all eighteen interns–suffered with him, and never lost hope for his eventual healing, even though every week seemed to bring a new complication, and the months dragged on. In all those months, no friends or family members visited. We had the feeling that he had become part of our family at the hospital–the pseudo-family that comes together when dedicated people work together for a common purpose.

Finally, one day in early Spring, word spread throughout the interns scattered through the hospital: after nine months, Archie had made it out of the ICU! Then a few days later–miracle of miracles–he was released from the hospital. The interns and ICU nurses actually had a party for him. With cake!

Three days later, he was back in the ER with a new abdominal problem. This time he had been stabbed.

He actually looked sheepish. He knew how much literal blood, sweat, and tears had poured into his care. Then we did what we do; we took care of him. But we were deeply disappointed.

The care was simpler this time. Knife wounds are ever so much easier than shotgun wounds. A few weeks later, Archie was discharged again and we never saw him again. Maybe he mended his ways. Or maybe he moved, or maybe he died after the next injury. I don’t know.

What I know is the change in us, his caregivers. We lost a certain enthusiasm for our unbridled altruism, recognizing that sometimes we care more and work harder at fixing our patient’s injuries than they work at saving their own lives.

Or that’s the way it seems. Another way of saying this is that we could fix complicated abdominal injuries, but we couldn’t fix addictions and broken neighborhoods and broken relationships, and if those things don’t get fixed, all our other efforts are in vain.

Maybe that’s something like what Jesus felt. Every effort falls short unless “the Kingdom comes.”

A few months ago I went hiking in the Smoky Mountains with my friend Gee. We experienced wilderness solitude and a healing miracle. We tested our physical endurance and renewed our appreciation for simple things like food, water, shelter, and rest, and explored a fast from all the other things we liked but didn’t need: TV, electricity, cars, hot showers, cell phones…No, wait, maybe we did need cell phones.

The fourth and last day should have been the easiest, and it started out that way. We got up, ate breakfast, and walked about five miles on mostly flat trails. The several stream crossings were very doable, and we reached a campsite at the edge of Lake Fontana around 2pm, well ahead of schedule. I had arranged for a motor launch to meet us there at 4pm and bring us to the marina where the truck was parked. If all went according to plan, by 5pm we should be on the road home.

We ate the last of our food, took off our boots, and stretched out–resting, meditating, enjoying the sunshine and blue sky under the shade of a giant sycamore tree at the edge of a calm lake. We prayed thanks for a great trip, and for guidance in our future steps. This seemed like the perfect end to a renewal in the wilderness–a real “mountain top experience.”

Around 4PM, I put on my boots and packed away the sleeping pad that had given me comfort. I started listening for the sound of a boat motor. Around 4:15, I decided I had misunderstood, and the pick up time was really 4:30. Around 4:45, I realized the boat wasn’t coming. In other places, a cell phone call would fix the problem in a minute, but Fontana Lake, we discovered, is a blessed and cursed by cellular silence. We would have to walk out.

The Lakeside trail to the top of the Fontana dam has no net elevation gain or loss, but the five plus miles from Eagle Creek are marked by steep ups and downs. Fast hiking would be impossible for two senior citizens with packs. Sunset would be at 6:45, but here on the east side of the ridge, darkness in the forest would come earlier.

We walked the last thirty minutes in complete darkness, our headlights giving us just enough illumination to stay on the trail. Antique auto body shells, crashed in the woods ninety years ago when the trail was still a road, eerily appeared in the shadows. At last we made it to the parking lot that marks the junction to the Appalachian Trail and the gravel road spur to the Fontana dam. We stashed our packs off the road behind a tree, hiding them from opportunistic thieves, but we needn’t have troubled. The parking lot was deserted, as was the gravel road, the Fontana dam, and the remaining three miles of paved road to the marina parking lot. Not one person, not one moving vehicle. And, except for the streetlights on the dam, the night remained pitch black.

We made it to the truck and returned to retrieved our packs, then started driving toward home. By now we were about three hours overdue check-in with our families. We knew they would worry, and soon the Park Service would be called to report us as missing hikers. But the cell phone black hole continued for nearly an hour after we left Fontana.

Finally, around 10 PM we reported ourselves to be alive and well. Shortly afterward we found a reputable chain hotel with a vacancy, and immediately after that started looking for food.

I’m always hungry after four days of hiking, and especially so after missing dinner and hiking an extra eight miles or so in the dark. The only place open was the local Waffle House.

A Waffle House at a rural crossroads in eastern Carolina around midnight on a Friday can be a scary place, a dive with unhealthy food and dangerous people, and nothing like how the day started–walking along a sunny stream in the Smokies. We found a rusted pick-up truck in the parking lot with a caged and howling hunting dog, an Elvis impersonator at the counter inside, a middle-aged couple dressed like teenagers and carrying motorcycle helmets, and a very short and very round elderly waitress with a short pencil and shorter attention span. Nobody we met lacked visible tattoos.

The mountain top experience was gone. I got the cheeseburger with fries and a malt, and cleaned my plate. Gee got the “Big Breakfast”–eggs, bacon, pancakes, grits–and at least had the good sense to leave some of it uneaten. We could have been mugged in the parking lot, or died of coronaries before we got back to our hotel. But this time, the Waffle House wasn’t scary. It was a place filled with people who, like us, a little dirty, a little desperate, and a little lonely, found food and fellowship and light in the darkness. An outpost for the Kingdom to Come. 

A Little Faith

Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?”

He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.” (Matt. 17:19-20, NIV)

Jesus had previously commissioned the disciples to “Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons.” (Matt. 10:5, NIV). When Jesus returned, they couldn’t understand their failure. They had to know.

One of the most common spinal conditions I cared for was a herniated lumbar disc. The results in a typical case were gratifying–90% of patients felt improved and returned to normal activities. But 10% didn’t, descending into a nightmare of chronic pain and disability, and the reasons for failure were often obscure. Sometimes I felt the failures were my own–misdiagnosis, clumsy handling of the delicate nerve, failure to remove enough of the disc, or even removing too much disk or too much bone during the exposure. More often, I could tell no difference between the operation I would do on a successful case from the operation on a failed case. Nevertheless, failure was always personal. I wanted desperately to know why this time I couldn’t drive out the demons of pain and disability.

Jesus gave the disciples a cryptic answer: Because you have such little faith.

Whatever could that mean? They had apparently faced similar problems before quite successfully. They had given up their jobs and homes to follow Jesus. What did more faith look like?

I don’t know. But I think the mountain he was talking about was the mountain he has just come from–the Kingdom of God mountaintop experience of being united with our Father and the saints. If you have faith like a mustard seed, you can move this mountain of misery to the mountain of the Kingdom.

One of the most difficult things for a surgeon to do after a failure is to see the next patient. When I walk out of the room of one patient still in pain weeks after what should have been a successful operation and go to the next room of a patient in pain after weeks of non-operative treatment for the same condition, sometimes it’s hard to turn the doorknob. I know what is most likely to give the patient relief and I know it is an operation that I am trained to do–as well as anyone in the world–and I know what the patient wants and what medical science recommends and what I am going to say. But sometimes it’s hard. Because after the doorknob is turned, and I step into the room, everything else will happen, and the results will be on me, and at those moments I have little faith, no bigger than a mustard seed, and I don’t want to do it.

Then I turn the knob, take a step into the room, hold out my hand to theirs, and listen. We do the examination and look at the images, and we work out a plan together. And, most of the time, the mountain of pain and disability moves from here to there. Then, to one more little corner of creation, the Kingdom comes.

Demons, Lost Sheep, and Hungry Dogs

Healing Miracle Series, #12

Leaving that place, Jesus withdrew to the region of Tyre and Sidon. Matt. 15:21 (NIV).

The religious leaders of Jesus’ home country plotted to kill him. His family thought he had lost his mind, and tried to interrupt his preaching. His hometown shunned him. And his cousin, friend, and partner in ministry, John the Baptist, had just been executed by the local political authority. Yet crowds pressed on him wherever he went. Everybody wanted something. Some wanted to be healed; some wanted him to be quiet; some wanted him dead.

The demands of the crowd and the persecution from those in power drove him out of the country. He retreated to the coastal plain in what is now Lebanon where he would be relatively unknown. Remember when the devil tempted Jesus in the wilderness? When the devil left finished all this tempting, he left him until a more opportune time. (Luke 4:13, NIV). Maybe this was “the more opportune time,” and maybe the doubt sown by the devil was for Jesus to wonder if he had really heard the voice of His Father, and, if so, why was it so hard?

Jesus wasn’t the first to be thrown into doubt and chased away from his mission. Moses fled to Midian, David fled to the wilderness of Judea, Elijah fled to Mount Horeb–all of them experiencing early success and strength before falling into fear and uncertainty. They all had something more to learn before they went on to the great final acts on their lives. Jesus, like the great leaders from the past, had good reason to flee the country and seek some peace.

But peace eluded him. A Canaanite woman, a descendent of the people Israel displaced when they took over the Promised Land, pestered him to drive out a demon. She had the bulldog tenacity of a sick child’s mother.

A Canaanite woman from that vicinity came to him, crying out, “Lord, Son of David, have mercy on me! My daughter is demon-possessed and suffering terrible.”

Jesus did not answer a word. So his disciples came to him and urged him, “Send her away, for she keeps crying out after us.” Matt. 15:22-23 (NIV).

“Demon possession” implies mental illness or epilepsy. This Canaanite girl likely had some form of epilepsy. The ancient Greeks called epilepsy “The Sacred Disease.” Hippocrates wrote an essay about it 400 years before Jesus was born. There were no cures. The mother’s perseverance is totally understandable.

But Jesus, already forced to be a stranger in a strange land, and now beset by a woman in the tribe of his people’s ancient enemy, didn’t say a word. He didn’t agree to heal the girl, but much to his disciples’ dismay, he wouldn’t send the her away either. You can hear the disciples saying, “Not our problem,” then turning to Jesus for confirmation.

He answered, “I was sent only to the lost sheep of Israel.” Matt. 15:24 (NIV). 

Understanding Jesus in his human form is so much more difficult than understanding him as God incarnate. Because as God incarnate, he already has the right answers and already knows the future. But the little windows we have–his hesitancy to turn solve the wine problem at the wedding in chapter 2 of John’s gospel, the temptation in the wilderness, the prayer in the Garden of Gethsemane–all tell us that he didn’t have all the answers. But he did have that peculiar faith that listens to the Father’s voice even when the Father hasn’t been saying much recently.

Jesus was keeping a low profile, hoarding his energy, restoring his sense of direction. I don’t know what it cost him personally to heal somebody, but my experience with life and the principles of economics and physics tells me that nothing is free. Each healing experience cost Jesus something we don’t understand. He needed a little space, and now this woman kneeled in his space. He had to tell her something.

The woman came and knelt before him. “Lord, help me!” she said.

He replied, “It is not right to take the children’s bread and toss it to the dogs.” Matt. 15:25-26 (NIV).

In 2003, in a roadless village on a muddy riverbank in Central America, a mother brought her nine-year-old daughter to our makeshift, one-day mission clinic with a similar story to the one told by the mother who pestered Jesus.

The house where we held the clinic sat on a mud embankment a dozen feet above a dock at the edge of a fast flowing stream. The house had a solid concrete foundation, a good roof, and generous windows for circulation and light. Electricity and indoor plumbing had yet to reach this small community. The the air hung damp and heavy with the barest breeze, a vague suggestion that rain would bring relief from the heat. But the rain never came, and the house became hotter and hotter under the afternoon sun.

Two college kids served as my assistants. One translated Spanish and the other served as my pharmacist. We had been dropped off at this house by a motorized dugout canoe that morning with a promise of an afternoon pick-up that would get us back to the mission base camp before dark.

The patients had the usual ailments: parasites, water-borne illnesses, fatigue, and pain. We carried with us the usual temporary fixes: anti-parasitics, antibiotics, adult vitamins with iron, children’s vitamins without, and many bottles of ibuprofen and acetaminophen. I freely dispensed advice about water purification, hand washing, and to avoid sleeping on the ground to prevent parasites–advice soundly based in the principles of medicine and regularly ignored in the reality of tropical subsistence farming, hunting-gathering, and irregular migrant labor work. Our goals were modest: temporary relief of pain and suffering, a blip of preventative health measures, and a witness to the love of Jesus.

By mid-afternoon the heat and humidity weigh on me like a damp, wool blanket. My butt aches from sitting, my joints stiffen, and a weariness crawls over whatever good intentions I had started with. And, after a few days in a country where almost nobody peaks your language, the feeling of alienation is inevitable–the literal experience of being a stranger in a strange land. I begin to wonder why I am here. This is what a crisis of faith feels like. I look at my watch and wish the boat to come soon.

Then our last patients came, a mother and her nine-year-old-daughter. Like many of the people in that area, they were refugees from the violence of the socialist regime in the nation across the river. The mother demanded to know what was wrong with her child.

I looked her over and found nothing wrong. If anything, the child was better nourished with less evidence of parasites than the other children I had seen that day. I told the mother my opinion.

But there is something wrong with her, she said. She cannot do her schoolwork. Two or three times each week her body stiffens and she falls to the ground and urinates on herself. Then she must come home. Other times, several times each day, she stares off in space without speaking. No one can talk to her for a minute, or two or three. Then she will be confused and know nothing. The teachers tell me to stop bringing her to school because she cannot learn.

The diagnosis became clear to me. The girl had a seizure disorder, generalized, or gran mal, episodes with frequent minor seizures, absence spells. A variety of anticonvulsant medications exist that can control these symptoms in the great majority of cases. But I have none of these with me, nor would I be able to do the long-term monitoring and medication changes that would optimize her care.

I explained to the mother what I felt certain was the problem, and suggested we make a referral to a doctor at a town a few miles up the river. Then the mother explained to me that she had already been there, and even taken her daughter to a public health clinic in the capital city. No one believed her story, no medicines had been prescribed, no more tests had been performed.

Other times when I had worked in this country, I had local medical contacts where I could make referrals. But this was the first time I had been in this province and, at the moment, I had no solution. I hoped that Anna, the permanent missionary in the area, would know the necessary local medical network enough to make the right referral.

Just then I heard the puttering of an outboard motor. Our canoe had come. It was time to pack up and go home. I looked out the glassless window to see Anna in the oversized canoe approach the dock.

She was middle-aged, strong and stout, and outspoken to the point of being rude, seemingly an odd choice for Jesus’ local representative. She lacked the gentle demeanor usually associated with the Savior. But she did have his courage, and his heart for the poor and the lost.

Anna marched from the dock to the house and demanded to know if we were ready to go. I told her my frustration with my last patient. “We’ve got nothing to offer her,” I said.

“Nothing to offer?” she spouted. “Of course we have something to offer. Where is that little girl?”

I thought she had some additional medical resources, or meant she knew where to refer the child.

When I indicated the girl and her mother, Anna grabbed my arm and pulled me toward them. She spoke a few words in Spanish then put her hand, and my hand, on the girl’s head. She bowed her head and spoke in a torrent of Spanish, then said a brief prayer in English for my benefit. “In the Name of Jesus, be healed!”

Then she spoke a few gentle words to the mother before stomping away muttering under her breath something about, “nothing to offer, indeed.” She bullied us all, along with our supplies, into the canoe, muttering more things like, “Time’s a-wasting,” and “You don’t want to be on this river after dark,” and in a few minutes we puttered away.

He replied, “It is not right to take the children’s bread and toss it to the dogs.”

“Yes it is, Lord,” she said. “Even the dogs eat the crumbs that fall from their master’s table.”

Then Jesus said to her, “Woman, you have great faith! Your request is granted.” And her daughter was healed at that moment.  Matt. 15:25-28 (NIV)

I’d like to report, as Matthew did, that my patient was “healed from that moment.” Matthew lived most of his life only a few miles away in Galilee; he probably did know for certain that the Canaanite girl was healed. But did the little refugee girl in Central America have continued seizures, or was she miraculously healed? Or did she finally find a sympathetic and skilled doctor, and respond well to medical treatment? I don’t know. I can only hope. What I do understand after Anna’s prayer is that Jesus still brings hope to mothers of children possessed by demons.

God sent Moses a burning bush, He sent David an army, and He sent Elijah a “still, small voice.” 

Then God the Father sent Jesus a messenger in the form of a desperate mother, someone who needed him and had faith in him, to beg that Jesus could bring hope to a child without hope. Take one more step, the Father said. Even is it is beyond what you thought your ministry was about, even if it is out of your comfort zone.

To our eternal benefit, Jesus took one more step, healed a strange girl in a strange land from a strange illness. Then he took another step, and another. In a few days he had returned to the shores of the Sea of Galilee where “Great crowds came to him, bringing the lame, the blind, the crippled, the mute and many others, and laid them at his feet; and he healed them.” (Matt. 15:29, NIV)

I experience times when I feel that I have been obedient to the voice of the Father and I experience nothing but criticism, and feel that whatever I am doing is no more than feeding crumbs to the dogs. Then God sends someone who needs Jesus, like the little girl with the seizure disorder, and someone, like Anna, guides me, and I take one more step.