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Credo VII

“…He suffered under Pontius Pilate, was crucified, died, and was buried…”

God is dead. Not only is He dead, but there is a specific historical marker (Pilate) of the event and crucifixion by Mosaic law that puts Jesus under God’s curse. There is no mistake because He is buried.

It was true then, and there are times now, that it seems like He is dead. I don’t see Him, I don’t hear Him, I don’t feel Him. I go on day after day, week after week, month after month, doing the best I can, but the world is a dreary place. One of those times occurred while I was a neurosurgery resident during a particularly difficult season.

I remember being called to the ER at Yale-New Haven Hospital by stat page and finding the trauma room full of nurses, x-ray techs, ER doctors, the general surgery resident, all resuscitating a twenty-something-year-old kid from a motorcycle accident. Details filtered in as his stomach was pumped (remains of a recently consumed Italian dinner and much alcohol), an endotracheal tube placed, x-rays of his chest and skull were taken, and we waited for the CT scanner to be available. He had ridden his motorcycle at full speed down a hill in West Haven, gone through the T-intersection, directly striking the telephone pole on the other side. No helmet, little hope.

All the residents at our hospital did rotations at the West Haven VA. We had all driven that same road dozens of times on our way from here to there; we all knew exactly what hill he had accelerated down, what telephone pole he had hit. We all envisioned it; we all knew it was insane, even beyond the usual testosterone and alcohol-induced risk-taking behavior of young men.

The name was familiar to old hands in the ER and they called for records. Another motorcycle accident had occurred at the same place exactly on the same date two years before, and the victim had the same last name. Again, then the victim had arrived in the ER and died shortly thereafter. That victim was tonight’s victim’s brother. From this I created a narrative in my mind. Maybe we all did, but nobody talked about it. It was too sad.

A troubled young man, depressed over something–a lost girlfriend, a lost job, a failed test–decided to self-medicate with alcohol. Perhaps he had an underlying mental health disorder. He had a mom, maybe a dad, and a younger brother, but it wasn’t enough. The future was too dark. He rode into the night, accelerating his motorcycle to maximum speed on a downhill stretch and ended it all on a telephone pole. Two years later, the little brother faces a loss that seems big and sees his brother’s solution. So he takes his motorcycle on the same path to the same pole. There’s a mom left behind still washing the dishes from the spaghetti dinner. Maybe a dad.

After the resuscitation in the ER we took him to the Neuro ICU on a respirator with an intracranial pressure monitor. When we got him settled there I noticed the tattoo on his left biceps: “Born to Lose.” I few hours later, he was dead.

A couple of weeks later, a sixteen-year-old girl on her way home from school, suddenly cries out in pain, clutches her head and collapses. Rescue brings her to the ER in a coma, a CT scan shows a large hemorrhage in her left hemisphere, the part of the brain that controls speech, language, and movement of the right face, arm and leg. The bleed had been caused by something called an arterio-venous malformation, an AVM for short, something that would have been a formidable challenge for an experienced neurosurgical team with weeks of preparation. But she needed immediate surgery. So she got me, a resident, and a junior staff neurosurgeon named Charlie Duncan.

The operation was long and difficult. Though we knew a lot about AVMs, we both had minimal surgical experience for this condition. The urgently gathered OR staff was also inexperienced. For every clot removed, an artery bled. Whether this artery could be cauterized without permanent loss of speech, coordination, or intellect, we had no way of knowing. If abnormal blood vessels were left un-cauterized, the girl would re-bleed and die. Held breaths alternated with hyperventilation. Hours passed.

Finally, all the clots were out, the AVM resected, and the brain appeared normal. We closed. After surgery, she awoke without speech or comprehension and paralyzed on her right side. A life saved but at the cost of probable severe lifelong disability. We didn’t celebrate. Two weeks later, her condition unchanged, she transferred to a rehabilitation facility to recover with people three and four times her age.

A few weeks later, an eight-year-old boy is playing on the sidewalk waiting for his school bus on the busy Whitney Avenue. He trips and falls into the street in front of a garbage truck. Brakes screech, horns blow, but still there is a sickening thump. Traffic stops. An ambulance arrives and the boy is transported to the ER on a respirator in deep coma from the head injury. He got hit in front of the preschool where my son attended. I called Charlie Duncan and described the case. He asked my assessment, and I told him it looked hopeless. Well, almost hopeless. We gambled with the almost and ignored the hopeless.

I placed an intracranial pressure (ICP) monitor to guide treatment, optimized the respirator rate and administered various medications to control brain swelling. By two PM, these measures had failed. Another CT again showed diffuse brain swelling. At three PM we took him to surgery to remove a large part of his skull so that even as the swelling increased his brain would not be compressed and the damage would be limited. But even as the skin sutures were placed, his brain continued to swell. The ICP went up again to dangerous levels, and then to levels incompatible with life. By six PM, the battle was clearly lost. The child would die.

It felt like God was dead. I had been part of surgeries that had failed, and this was not the first person I had seen die, nor even the first child. But this was hard. Maybe because this time the victim looked too much like one of my own children.

Maybe everyone has times that it feels like God is dead. I imagine how Jesus’ family and disciples felt on the Saturday following Good Friday. It not only seemed like God was dead; He was dead. And buried. The future held nothing except futile struggle and inevitable despair.

That’s how I felt. So I hid behind the paperwork in a corner of the ICU until Duncan came and stood across the desk from me. “There’s someone to see you,” he said.

I shook my head; if I tried to speak I might cry. Besides, no one ever came to see me; I was just the resident. Or worse, maybe Duncan wanted me to talk to the parents. I couldn’t face them. Not yet.

“Come on,” he said.

“No,” I managed to say.

He stared me down, long enough that he knew I was in pain, and I knew he wasn’t going away. “Come on,” he said again.

I got up and followed him. After all, he was my boss.

In the hallway outside the ICU stood a teen-age girl in a cowboy hat. Long, dark hair spilled out from under the right side of the hat, but no hair on the left, and maybe a hint of a scar in front of her left ear.  She smiled a crooked smile and leaned on an aluminum four-poster cane.

Then I recognized her. The teen-ager with the AVM. Not in a coma, not a vegetable. Walking and…could she be talking?

Her words were slow and overly round like her tongue was too big. “Thank you,” she said.

I don’t know what I said, and yeah, I might have shed a few well-disguised tears of joy.

Maybe it was a coincidence that this thoughtful teenager took this particular moment, when Duncan and I were into the depths of futility and despair, to say thank you. But coincidence is just another way of saying miracle. God sent a messenger to remind me He wasn’t dead.

The disciples would have to wait until Easter morning.

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6 thoughts on “Credo VII”

  1. What a tough situation !
    The average person just doesn’t realize what the medical people experience.
    I was a medic in the army but did not have a lot of bad experience.
    The world owes the medical field a lot of respect.

    1. Thanks, Ralph. There’s a lot of jobs that put people in foxholes–medics are one of them. Thank you for your service.

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