Forgiving the Sick

Healing Miracle, Part 5

The Sins of the Sick

Jesus stepped into a boat, crossed over and came to his own town. Some men brought to him a paralyzed man, lying on a mat. When Jesus saw their faith, he said to the man, “Take heart, son; your sins are forgiven.” Matt. 9:1-2. (NIV)

The boy’s mother was in her mid-thirties, but not likely to see her forties without a miracle. She had been a hard drinker and user of multiple non-prescription drugs, and now, though her demons were at bay, her bone marrow and liver were failing rapidly. Her four girlfriends were her strength, a liver transplant was her hope, and her son was her joy.

But that day her time had run out. Due to lack of platelets from her depleted bone marrow and lack of coagulation factors from her diseased liver, she suffered spontaneous intracranial bleeding and hovered in coma nearing death. An operation and another miracle would be needed to get her to that liver transplant.

A former nurse, now administrator in charge of risk management and miscellaneous tasks, called me and told me about the situation. Since the patient had no next-of-kin of legal age, an administrative consent had been obtained for surgery. Though I didn’t legally have to do it, the administrator asked if I would speak with the son, a fourteen-year-old who had been in foster care for most of his life. Only in the past year had he and his mother been able to re-unite.

I explained the situation to him as well as I could, trying to cushion him for more bad news that would likely follow. I finished, and for a moment the three of us stood silently in the ICU hallway outside his unconscious mother’s room.

Then he looked me square in the eye and said, “Are you any good?”

The nurse-administrator gasped, and started to say something. I stopped her. He was only asking what everybody wanted to know but didn’t dare ask.

I was good, but I wasn’t God. “I think so,” I said, holding his gaze. “But the problem is bigger than my skills. No matter how well her surgery goes, she needs to stop bleeding and heal, and that may not happen.”

He nodded once, looked into his mother’s room, nodded one more time and walked away. I felt neither blessed nor cursed, only inadequate.

I saw him two more times, once a few hours later to tell him the surgery went well, and again a few days later when, from liver failure and re-bleeding, she died.

I wished I could do for his mother what Jesus could do: forgive sins, absolve her of all consequences of her sins, and give her back life.

Accountability

At this, some of the teachers of the law said to themselves, “This fellow is blaspheming!” Matt. 9:3 (NIV)

Someone always objects to the forgiveness of sins. We demand accountability. Actions have consequences. This is how the world works and it is what we teach our children.

We like to think our sins are choices. But most of us adults know that it is more complicated than that. Often the initial sin is trivial. Maybe the woman in my story was a teen-ager with a friend who wanted to try whiskey just to find out what the big deal was, and one drink was all it took to start an addiction impossible to beat. We make decisions because of our addictions and compulsions and our allegiances to friends and family. Consequently, our decision to sin doesn’t seem like a choice at all. We do what we have to do.

A few years ago, a car pulled up to the ER and someone shoved the passenger out onto the pavement and sped away. The deserted friend was dirty, bruised all over, and a little drunk. But not drunk enough to explain the depth of his coma. Labs showed the liver profile and suppressed bone marrow of chronic alcoholism, and a CT scan showed an acute subdural hematoma.

The hospital staff replaced coagulation factors and platelets with blood bank plasma, and I rushed him to the operating room. The depth of his coma was such that I did not really expect survival, especially with the liver and bone marrow issues, but without any family to give or deny permission to proceed, I wanted to err on the side of the most aggressive treatment.

As soon as the scalp was shaved I could see evidence of previous brain surgery, perhaps for another alcohol-related head injury. This made me even more pessimistic about a good neurologic recovery even if he did survive.

The surgery went as well as could be expected. The hematoma was removed and the bleeding stopped. I closed the wound, sent him to the ICU on a respirator, and went to the surgical waiting room to see if any family had materialized.

His mother was waiting alone. Far from distressed, she took in my account stoically, told me he had indeed had another serious head injury related to alcohol use several years before in Baltimore, and that he had left her house four days before without leaving a note or calling.

I told her that her son remained in coma, on a respirator, and survival chances were less than 50-50. She nodded once, visited her son for less than five minutes and went home.

The following morning I was pleasantly surprised to find the man had improved dramatically from his pre-op status. He breathed weakly on his own, moved all his extremities purposefully, all his brainstem reflexes had returned. Although he did not respond to voice requests or commands, and therefore would technically still be in coma, this was a level of coma from which patients often recovered. Feeling optimistic, I looked over the rest of his labs and found the only immediate life-threatening condition to be severe anemia–a not unexpected finding given the surgical blood loss and the state of his bone marrow. I ordered a transfusion and went to look for his mother to tell her the good news.

She wasn’t in the waiting room, so I decided I’d check back and call her later if she hadn’t shown up by the time I planned to leave the hospital.

Just then I got a page from the nurse. We couldn’t proceed with the transfusion because the mother refused permission.

I told the nurse not to worry; I would talk to the mother. She undoubtably thought the situation was still as grim as it had seemed the night before and didn’t want unnecessary transfusions if he wasn’t going to survive anyway.

I met the mother outside the ICU and gave her the good news. Her son, who we thought was dead, looked like he would survive, and early signs pointed to a good quality of life. This is the kind of news neurosurgeons like to give.

Much to my surprise, she told me she understood perfectly. She explained, “I told him that if he drank again I would do nothing to help him.”

“But it’s only a transfusion,” I said, still not understanding.

“Not only will I not consent to the transfusion, I want him off the respirator.”

“But he’ll die,” I said.

“Exactly,” she said. “He’s been trying to kill himself for years. He has been in and out of rehab–four inpatient stays for a month each time–and one major head injury. What happened this time was inevitable. If he survives, he’ll do it again.”

Her mind was made up, and she had power of attorney and next-of-kin authority to decide her son’s fate. Yet, it seemed wrong. I contacted the intensive care specialist in charge of the respirator and told him the situation. He met with the mother, but point-blank refused to discontinue the respirator. The compromise was an emergency meeting of the Ethics Committee. This bought a few more hours of respirator support for our patient.

The committee is made up of the hospital chaplain, the risk-management administrator, the director of the ICU, and a couple more doctors experienced in end-of-life decisions. The next morning she faced them down. I’ll never forget what she said.

After explaining in graphic detail the twenty-plus year battle with alcoholism, and all the treatment failures she said, “He has a terminal disease. If he had cancer instead of alcoholism, you wouldn’t hesitate to honor my request. His alcoholism is his terminal disease.”

Her logic was irrefutable. I didn’t want to do what she wanted, but she had the legal authority, and I didn’t have to live with the son through his recovery. We discontinued the respirator, and he never got the blood transfusion or any other extraordinary treatments beyond fluids, nutrition, and comfort medications.

But by then he had woken from his coma and recovered sufficiently to survive off the respirator. The transfusion would have certainly made his recovery quicker, but he survived without it. A few days later he went home. With his mother.

Forgiveness…and Going Home

Which is easier: to say, ‘Your sins are forgiven,’ or to say, ‘Get up and walk’? But I want you to know that the Son of Man has authority on earth to forgive sins.” So he said to the paralyzed man, “Get up, take your mat and go home.” Then the man got up and went home.” When the crowd saw this, they were filled with awe; and they praised God, who had given such authority to man. Matt. 9:4-8 (NIV)

The people at Peter’s house saw the paralyzed man get up and go home. But what awed them was not the recovery of his physical ability, but that his sins had been forgiven. They praised God, because if there was mercy for this paralyzed man, maybe there was mercy for them, too. Maybe they could be freed from what sin had done to them. God had come down and given such authority to man.

My patient didn’t return for post-op appointments. I never learned the end of the story. I like to imagine that the young man was finally freed from his alcoholism and that he and his mother lived happily ever after. Maybe. That would be awesome.

What I do know is that it is possible. Because I know that while my particular habitual sin hadn’t ruined my liver and bone marrow, it had wrecked the most precious relationships in my life. I couldn’t fix it by just trying to be better. I had tried–four times, forty times, four hundred times?–I lost count. But when I was helpless, Jesus talked to me, told me to trust Him, and sent me home. He removed from me the burden of habitual sin, and he fixed the relationships that I had so nearly destroyed. This is the power of the forgiveness of sins.

Jesus doesn’t care if you’ve been through rehab four times or forty times or four hundred times. He is always willing to forgive your sins, whatever they are, and you can take up your mat and follow Him. He will take you home.

That is awesome.