Resurrection

Healing is the great intersection of faith and science, the eternal and the incarnate, where hope and truth are inextricably entwined.  Names and identifying details have been changed to protect patient confidentiality, but the stories are true and deserve to be shared.  Here’s the first:

I stood at the bedside in the ICU of a patient I’ll call Sandra.  I had run out of options, knowing the battle was lost and wondering why.  I wondered who would mourn her death, why a capable, attractive young woman would disappear, a death notice in the local paper, a vacancy to fill at work, an abandoned apartment somewhere.  I wanted to weep for a life lost before it appeared to have been lived.  I wanted to shout in frustration over the operation that had seemed perfect yet turned out to be lethal.

I had met her two weeks before.  She was thirty-seven, single, without children, and worked as a manager at a dental office in a nearby city.  Recently she had a severe headache at work followed by collapse and evacuation to the nearest emergency room.  A CT scan and subsequent MRI confirmed a colloid cyst of the third ventricle.  She appeared in my office the next day with the scans and a world of questions.

A colloid cyst is uncommon but benign in terms of malignancy.  Yet for some, like her, the cyst causes a potentially lethal obstruction to cerebrospinal fluid (CSF) circulation, leading to headache, loss of conciousness, and frequently sudden death.  As we talked she described headaches that were becoming increasingly frequent with two other episodes involving a brief collapse and loss of consciousness.

I recommended surgery.

A few days later she underwent an operation that seemed to go smoothly.  She awoke with minimal headache and transferred to the ICU with a ventricular drainage tube to monitor her intracranial pressure (ICP) and drain CSF if necessary, a common post-op precaution.

Eight hours later her, ICPs went up.  Initial treatment with CSF drainage brought the pressure back to normal for a few hours.  Then the ICP rose again to dangerous levels.  Post-op CT scans showed an inexplicably swollen brain.

The swollen brain caused a severe headache, then confusion.  Without dramatic treatment she would soon lapse into a coma and die, exactly the thing the operation was expected to prevent.  Anesthetic levels of sedation, control of her breathing, medications to reduce brain swelling were all used with only temporary benefit.  Artificial coma by use of high-dose barbiturates and hypothermia (lowering her body temperature) were used as desperate measures–again with only temporary benefit.

Now, as I stood by her bedside, she was in coma on a respirator and, by the only measurable criteria, brain dead.  Brain death is usually diagnosed by a clinical examination that shows no sign of brain function coupled with an EEG showing no activity.  For the diagnosis to be accurate, the patient must be free of sedative drugs and have a normal body temperature.  Since Sandra was sedated and cooled, the brain death diagnosis could not be made by the usual means.

But neurosurgeons and those who care for patients in coma from increased ICP know that when the ICP is equal to the systemic blood pressure, the blood cannot circulate in the brain and the brain cells die rapidly from lack of oxygen and nutrition.  A clear record of ICP equal to blood pressure for several hours also demonstrates brain death.  This was Sandra’s situation.

In despair, I laid my hand on her bandaged forehead.  I talked to Jesus.  I told Him how I couldn’t see this death as a good thing, how that even if He has a bigger plan, her life now couldn’t exactly be a bad thing.  I confessed that I lack any proximity to perfection and may have messed up my life, and may even have messed up the operation.  But as far as I can tell, I did the best operation I knew how to do without a known error and gave her the best post-op care available.  Why take out divine retribution on this innocent woman?

I reminded Him that once He raised the dead, like Lazarus.  Maybe He still did.  I told Him that this one didn’t even have to be a big publicity stunt; I was the only one who knew she was dead.

I stood there for another moment, one hand on her forehead, another on her arm, hoping to hear from heaven, but expecting nothing.  I raised my eyes to the monitors.  They beeped the same lethal numbers.   I turned to leave the room.

Her nurse stood at the door, chart and clipboard in hand.  She tilted her head, curious, as if seeing something she had never seen before.  “Were you praying?” she asks.

I wanted to say no.  Because I’m a doctor, a scientist.  But I said, “Yes.”

I left the ICU and saw hospital patients with more mundane problems, then went to the office to see more patients, all of whom were suffering to one degree or another but were still blessed with the illusion of their own immortality.  For the next several hours I expected to be interrupted at any moment by a call from the ICU telling me that Sandra’s ICP was out of control again.  The ICPs had to be out of control, and the nurse should be calling to ask what else to do.  I had no answers, but I still expected the questions.  Finally, I phoned the ICU to speak to the nurse.

“The ICPs are normal,” she said.

I didn’t believe her.  Prayers don’t reverse brain death.

Not trusting the nurse, I left my office and returned to the ICU to see for myself.  I checked lines and re-calibrated the ICP monitor.  Still normal.  Blood flow to the brain was now restored.  Her pupils were constricted due to the barbiturates, but they were reactive to light, a sign of life.

The lethally uncontrolled ICP was now controlled.  Still, whether the ICP would remain normal as her body temperature returned to normal and the barbiturates were discontinued remained unknown.  More importantly, had irreversible brain damage already occurred?

I left orders to discontinue the cooling measures.  By the following morning, the ICPs had remained normal and I discontinued the barbiturates.  Next, she was weaned from the respirator.  Finally, the ventricular drainage catheter was no longer necessary to monitor the ICP.  I hesitated to remove it, having spent ten days worrying over each pressure reading.

But she had awoken.  Weak and confused, she could speak and move all her extremities purposefully.  Her vision was normal.  Her wounds from the original surgery seemed healed.  I pulled the ventricular catheter.  A few hours later she started out of bed for the first time in two weeks.

In a few days she was transferred to a rehabilitation hospital, and three weeks later she went home, aware of her life, but unaware of her resurrection.

I have a scientific theory on what post-op complication led to the uncontrollable brain swelling.  Possibly a large vein had a thrombus that formed at the time of surgery and resolved spontaneously a week later, the morning I prayed for her.  Perhaps she did not suffer extensive brain damage because of the protection offered by barbiturate coma and body cooling.  Perhaps the important faith was not in God but in the power of medicine.

But then again, if you ask God for a miracle and it occurs at the very moment you ask, can you honestly tell yourself it was a coincidence?