Denise was nineteen and had been married for two weeks. Her husband said they had been together that afternoon when she suddenly complained of a headache and lost consciousness. He called rescue who resuscitated and intubated her at the scene and transported her to the hospital. A CT scan demonstrated hemorrhage in an area of the brain that was both critical and inoperable, the brainstem. She was placed on a respirator sent to the ICU.
I saw her there, a tiny black woman, not more than five feet tall, weighing no more than a hundred pounds, beautiful still in spite of the distortion from the endotracheal tube and other lines and monitors. An EEG had just finished, and the technician was leaving. An official reading would take a few hours, but I saw the flat lines consistent with no brain activity. Her neurological exam was also consistent with brain death.
She met all the criteria for a diagnosis of brain death except a repeat confirmatory examination to be performed eight to twenty-four hours later. Once the diagnosis was confirmed she could be removed from the respirator without any further ethical concerns, either before or after her organs were harvested to be donated.
The family entered as I finished my exam. Denise lay between us like a sarcophagus. I replaced the gauze pads that covered her eyes. The cardiac monitor beat out a steady string of slow beeps. Every five seconds the respirator made a clunk-wheeze sound and Denise’s chest rises and falls beneath the thin, white sheet.
Her husband, not much older than she, is so diminished by shock that he stands like a mute child with large, fearful eyes. Her mother, a formidable looking woman flanked by a small army of family and friends, takes charge.
Color separates us: my white coat and white skin, her dark dress and dark skin. Language separates us: my Midwest accent, her Southern drawl. I see in her eyes the sins of generations of white men and know that trust would not be earned easily, and my authority would be recognized only grudgingly.
“Doctor?” she says.
I ask what happened, although I already knew. I ask about her prior health, though it mattered little now. I ask because I want to listen to their voices and I need to earn their trust.
And I don’t want to talk. I don’t want to tell her that her daughter is dead in every sense except that her heart beats on. I listen to the story of her short life, her childhood illnesses, her graduation from high school, her recent marriage. I hear, as she describes Denise’s plans for the future, the hopes and dreams of her whole family.
Finally there is silence, and they look at me. I tell them that she likely had been born with something that now caused bleeding in her head. This is nobody’s fault; it could not have been prevented. An act of God.
“She’s in a coma,” I say.
Mother’s face steels. “She going to get better?”
The monitor beeps, the respirator wheezes, and Denise’s chest rises and fells. I shake my head.
Mother’s face almost crumbles before it steels again. “We a praying people, Doctor,” she says. Soft voices behind her murmur assent.
“I pray, too,” I say. I pray for forgiveness, I pray for comfort for Denise’s family, I pray I can leave this tragedy and go home to my wife and children.
I tell Mother about coma and brain death, how brain death is not only a diagnosis; it is the end of hope. I speak about transplantation, how life and hope can be salvaged from death and despair. I am met with stony looks.
“We be praying for a miracle, Doctor.”
I nod and look down at Denise, small enough to be a child, then explained about repeating her EEG and exam the following day. We set a time to review the results.
The following day her exam is unchanged. The EEG is still flat. Her vitals signs are normal and her labs are normal. She is brain dead, I tell her family.
“What now?” Mother asks.
I explain how transplantation works, how she can remain on the respirator until her organs are harvested then the body is released to the undertaker.
“No,” she says, “No transplants.”
I want to explain again but the steel has returned to her face, and I am forced to agree. Denise is my patient; I am responsible only to her, and by extension, her family, not the unknown recipient of a transplant. I nod. “Then we can remove the respirator.”
“My son is a preacher up in Georgia. We need him to lay on hands and pray over Denise.”
Technically, Denise is dead. A death certificate could legally be filled out now, but I am in no hurry. Death and grief are hard enough without inflicting more wounds with technicalities. “When?” I ask.
“Tomorrow morning. Ten o’clock.”
I wonder what happens when you pray with such certainty for something that is so impossible. Do you give up God? Do you give up prayer?
And I wonder what happens if you pray for the impossible, and your prayer is answered. Do you give up your faith in the expected? Is the science of medicine so frail? Does reality and experience know no boundary?
The next morning I enter the ICU and feel like I am in the wrong church. Twenty souls are gathered in their Sunday best, including Denise’s brother. Her mother introduces him, and we shake hands over the bed. I examine her, self-conscious of the audience. No change, brain dead, I tell them, and step back into a corner, uncertain what to do with my hands. I cross one over the other and stand with my head slightly bowed but eyes open. Respectful, but I feel like an alien.
Her brother lays a hand on her forehead. He begins murmuring a prayer and the room fills with others praying out loud or saying amen. A babbling hum fills the room and competes with the heart monitor and the respirator. His prayers become louder with the cadence of a practiced orator.
“We love our sister,” he calls out, one hand on her forehead and one raised to the heavens. “Now, in the name of Jesus, rise and walk.”
The room falls silent except for the monitor and respirator. He begins again, the small congregation joining with encouraging words. Again he cries for his sister to rise and walk, and again she does not. A third time he cries out in the name of Jesus for his sister to rise.
I find myself praying with him. I find myself willing to sacrifice all the certainty of the medical science for the life of this young woman.
The monitor beeps, the respirator wheezes, and no one moves, least of all Denise. A tear streaks down her mother’s cheek. Her brother’s hand rests still on her forehead. A minute passes, maybe two, maybe three.
This is the moment, I think. This is when we admit that God doesn’t answer prayers, at least not this one, at least not now. And if not now, when? Surely He must care. But if He cares, does He not act because the power that raised the only son of the widow of Nain was for that time, those people? Not now, not us. Is now the time for bitterness and grief?
Her brother whispers something. Then repeats himself, now loud enough that I can just make out the words. I hear, “Thank you, Jesus.”
But why? For what?
“Thank you, Jesus,” he says again, louder, the words unmistakeable now. And again, even louder. Murmurs of assent and soft amens from the family rise like a chorus to his solo as I stand to the side, puzzled and dumb.
“Thank you, Jesus,” he says one more time. “For we loved our sister.”
I hear the chorus of amens.
“But You loved her more. Thank you, Jesus.”
He lifts his hand from her head and steps away. Family members file by, touching Denise, hugging her mother, shaking the brother’s hand, then leaving one by one until only the brother and his mother remain. He nods to me as he turns to leave, surrendering the ground.
I shook his hand as he passed. “I’m sorry,” I said. Sorry your sister died. Sorry your prayers weren’t answered. Sorry that I, in spite all my scientific knowledge and skill, am completely helpless.
“Thank you,” he said.
Then I am alone with Denise and the ICU nurse. We disconnect the lines and turn off the respirator and the clunk-wheeze stops. The heart monitor beeps on. I secretly hope that she will breathe and we will call back the family and celebrate a miracle. But her chest no longer rises. The beeps slow, then become irregular, then stop.
I sign the death certificate and go to church, joining my wife and children in a quiet Methodist congregation where all the men wear suits, all the women wear dresses, and we all pray for the will of God to be done, but never for the dead to be raised. We are safe from disappointment that way.
But I wonder if we don’t ask for too little. Though Denise did not rise from the dead, at least not in this world, I feel that because her family had prayed for something I wouldn’t have risked, we witnessed some kind of miracle.
Before their prayers, her family was lost in grief. Her family asked God for more time with Denise in this world of suffering and sorrow; God assured them that Denise was living a perfect life now and they would see her again someday. Because they prayed for a miracle in the hear-and-now, they witnessed a miracle in eternity.