Ultimate Reality

I showed up at the Student Health ENT Clinic fresh from my second-year lectures about the anatomy and physiology of pain.  Since my undergraduate degree had been in psychology, I also felt that I had an edge in understanding the emotional component to pain.  Though pain was on my mind, the reason for my ENT visit was the aggravating but nearly painless problem of persistent otitis externa–swimmer’s ear.

Interns and residents, bright, knowledgeable young men and women lacking only experience, staffed the Student Health Service.  Being all of twenty-three myself, I was convinced experience was highly overrated, and happy to accept the free and convenient care.

“No problem,” the resident said.  “You just sit here and I’ll curette out that wax and debris.  You’ll feel better in no time.”

I relaxed.  He curetted.  And in ten seconds I experienced the most intense pain of my life.  I jerked away and stifled a scream.

The resident told me to stay still.  I relaxed.  Pain is a state of mind, I told myself.  Mind over matter.  I willed myself into an immobile zen-like state.

He curetted again.  I jerked away again.  We repeated the scenario multiple times.  In the end, I still had otitis externa, and now a whole new understanding of pain.  There is no mind-over-matter.  There is no zen-like state.  Pain is pain.

A few years later I took care of an old man with a compression fracture of his thoracic spine.  His fall had been minor, and osteoporosis had made him susceptible to such fractures.  The important thing, I kept telling him, was that his spinal cord was in no danger and these injures always healed with time and rest.  But it hurts bad, he told me.  So I gave him a generous prescription for narcotics before he went home from the hospital.

A few weeks later I saw him in the office.  “It hurts bad,” he said.  I asked if the pain medicine was working.

“Not taking it,” he said.  “It’s narcotics.  I don’t want to be no dope addict.”

I assured him that he would not get addicted using the medicine only while he was healing.

He looked doubtful.  “How long?” he asked.

“Six to twelve weeks,” I said.  “From the time of injury.  Another month or two.  No more.”

He gave me the same skeptical look, but this time shaded with something darker.  “I don’t know if I can take it,” he said.

“Take the pain medicines,” I told him.  “Rest.  Be patient.  You’ll be fine.”

I wasn’t worried.  In a few weeks he would be back to normal, which for him involved caring for his rural cabin where he spent his life hunting and fishing.  I had no reason to think this would not be his future.

A few weeks later, his wife called to tell me he was now in great distress.  She was afraid for him.  I got him on the phone.  “The pain’s so bad,” he said.  “I don’t think I can take it.”

I asked about the pain medicines.  He wasn’t taking them.  I reassured him and asked if he wanted to come back to the hospital.  He didn’t.  I got his wife back on the phone and told her to bring him in if it got too bad.  She told me that I didn’t know what he was like.

“He will be okay,” I told her.  “The pain is temporary.  He will heal.”

Two hours later Rescue called from the patient’s kitchen.  He had shot himself in the chest with a shotgun, aiming for the painful fracture site which was located immediately behind his heart and aorta.  He was dead within minutes.

He possibly would have been okay if he had taken his narcotics.  He possibly would have been okay if he had come back to the hospital.  He certainly would have been okay if he had been patient, if he would have–could have– given himself the time to heal.  If only he could have stepped outside of time and stepped back in a few weeks later.  But instead he was dead, a victim of the white-hot obliteration of rational thought and panic induced by uncontrolled pain.

Pain is the ultimate reality, psychiatrist Jordan Peterson stated.  None of our philosophies or religions or meditation strategies can completely take us out of our physical state in this time-space-matter continuum, and nothing drives that point home more poignantly than pain.

Often a patient with a concussion experiences something like stepping out of time for a day.  This concussion patient suffers an injury then a quick return to consciousness but with amnesia for the traumatic event and events several hours before.  He then loses the ability to retain any new information for the next twenty-four hours.  He repeatedly asks where he is, what happened to him, how long he’s been there.  After their questions are answered, almost immediately he will repeat the same questions.  It is as if time now stands still in his mind.  He remembers everything up to one moment, then nothing new.  Nearly always he will return to normal the next day.

The curious thing is that patients with this type of concussion rarely complain of pain, even if they have suffered a broken bone or worse during the traumatic event.  But the next day, when memory returns, pain returns.

Pain, therefore, seems to require us to be conscious of our place in time.

Which brings us to Jesus.

If God is God, and created the universe, one hundred billion galaxies with one hundred billion stars each, and God is all-knowing, and He exists in eternity, that is, not simply forever but outside the limits of time, then God knows of pain but does not experience it.  Yet, He made a decision to not let one species on one tiny planet circling one middling star in one middling galaxy, destroy itself, even if it cost Him some mystical transformation into flesh and time, and, yes, pain like that white-hot thought-obliterating, panic-inducing pain that would cause one to blow their heart away with a shotgun.

So this is the miracle of Christmas: the Creator of the Universe chose to experience pain like yours so that you could experience love like His, and someday you, too, can step into eternity, outside of time and outside of pain.  And into great joy.

Broken

 

The patient had just murdered his wife.  A single shot from his handgun had sent her straight to the morgue.  Then, with a sudden loss of basic marksmanship, he failed to kill himself.  He placed the gun in his mouth, allowed an awkward angle, fired, and the bullet lodged in the right temporal lobe of his brain, narrowly missing the structures that would have led to his immediate death.

Frankly, I lacked enthusiasm for treating him.  He wanted to die.  He deserved to die.  I wanted him judged by the standard of an eye for an eye, a tooth for a tooth, and a life for a life.  But the discipline of medicine allows no such judgements, and I found myself in the operating room removing the bullet, debriding damaged brain, and sealing the cranial cavity from potential contamination from the tract through the mouth and sinuses.  Miraculously, and somewhat to my disappointment, he survived.

And he survived well.  On day one, I changed his bandage.  On day three, he regained consciousness with no loss of vision or paralysis.  On day five, I removed his stitches.  He suffered no complications despite the high risk of infection.  Physical therapy supervised his return to normal balance and ambulation.  For two weeks he wore a patch over his right eye because he saw double, but then that symptom also went away.  By the third week he could read again.

His discharge was delayed, however, because he had no place to go except jail, and he couldn’t go there until he reached sufficient physical and mental capacity to be competent and self-reliant.  For several weeks he lingered in the hospital with a sheriff’s deputy stationed at his door.

Each day I would come to see him.  Always he was courteous and cooperative with myself and the staff, and in my mind I tried to reconcile the gentle person before me with the raging lunatic who had killed his young wife.

I asked what would happen to my patient after he was transferred to jail.  The deputy shrugged.  “It’ll be up to the judge,” he said.  “But I think probably nothing.”

“But he murdered his wife,” I said.

“Yeah, but the judge is going to see that scar on his head and send him to a psychiatrist who will say he’s not competent to stand trial, and maybe he’ll go to a state mental hospital, or maybe he’ll just go home.”

I stared at him.  He shrugged again as if to say What are ya gonna do?

The next day I found the patient reading his Bible.  I wondered if he even remembered what he had done.  So I asked.

A cloud passed over his face.  “I killed my wife,” he said.

“Do you remember why?” I asked.

“I was angry.”

His memory was intact, but sometimes patients with temporal and frontal lobe damage will be incapable of remorse.  “How do you feel about that now?” I asked.

The cloud came back.  “I feel bad,” he said.  “I loved her.”  He paused for a moment,  then continued, “I’m not that person anymore.”

In his last statement, he was entirely correct.  Due to his self-inflicted wound, his temporal lobe and frontal lobe were significantly damaged, and changes to his emotional responses and intellectual capabilities were undeniable.  He may be incapable of anger.  In a way, he was broken.  Yet the changes left no outward signs.  Even the scar became hidden as his hair grew back.

I once watched a man in Wyoming break a horse.  The horse was dangerous and useless, but expensive with good breeding and therefore worth saving if at all possible.  As a last resort the horse had been sent to the trainer from New Mexico.  Unless the horse could become trainable and safe, it would be euthanized.

The horse bucked and snorted in his stall before being released to a circular corral about forty feet in diameter.  The man stood in the middle of the corral with only a light six-foot flexible rod and let the horse run around him, seemingly oblivious to the threat of crashing hooves and sharp teeth.  He then described his own life, full of passion and rage and despair, and stated he and the horse were alike until, on the eve of his own self-destruction, he was broken and began a redeemed life.  Over the next hour he talked to us about redemption as he let the horse run, made himself vulnerable to the horse, thereby building trust, and then gave the horse the opportunity to submit.  He never touched the horse with his rod or his hand until near the end of the hour when he faced the now calm animal, stroked his muzzle, and placed a halter on his head.  Then he mounted and rode around the ring.  The horse was no longer the dangerous bucking bronco that had entered the ring.  The changes left no outward sign, but the horse was “broken.”

I know that within myself is a streak that is wild and self-serving and ultimately destructive.  It is the voice that tells me that only I know what is best for myself, that life is short and I need to get what I want now, that I need to free myself from the people and the rules that restrain me.  This voice echoes the wild spirit of the stallion, the spirit that would have led to its destruction, and I expect that it echoes the demon voices that drove my patient to murder.

We all needed that spirit to be broken before we could become whole–at least whole in the sense of fulfilling our best destiny.  In other words, we needed to be broken to be healed.

But I don’t think we can break ourselves.  My patient may have come close by trying to destroy himself.  But the horse needed a gentle trainer.  And I also have a gentle trainer; His name is Jesus.

When we are broken, we can be redeemed from the wild and self-serving spirit that leads to rage and lust and alcohol and drugs and despair, the things that hold us in back from our best selves.  The best of us are broken.

Sorry

Christina throws a piece of debris far over her head into the already overloaded, over-sized dumpster then screams in pain, clutching at her right shoulder.  Even from twenty yards away I know the shoulder is dislocated.

She is a young woman from Michigan, an EMT and firefighter–an angel really–who had volunteered to come to Middleburg, Florida and coordinate relief efforts for flood victims.  Earlier that day, we met Christina when our motley crew from Crossroad Church arrived at the Middleburg United Methodist Church, and before we divided into teams to go muck out homes.  Strong and beautiful, and she gave us our safety lecture.  She reminded me of my wife and daughter and daughters-in-law: mostly kind but a little fierce.  I wanted to adopt her.

Now I run toward her with no plan.  It has been over forty years since I graduated from medical school, nearly seven since I practiced neurosurgery, and I have never treated a dislocated shoulder.  I could only support her and immobilize the arm.  Between her cries I learned that she had suffered the dislocations before but she had no clue how to fix it.  We both collapse into the mud, kneeling face-to-face, both clutching her right arm.

I suggest the emergency room, but she cries No!  She tells me the longer it stays out, the worse it will be.  I need somebody to put it back it, she says.  Tears streak her cheeks and fall between us.

She doesn’t know me.  To her I am an old man kneeling in the mud with her.  Vague memories of shoulder anatomy float to consciousness as I see her arm where it shouldn’t be, forward with her biceps pointed at a bizarre angle across her chest.  I take her forearm and press down, then rotate her wrist toward me.  She utters another short gasp.  I feel a little click; I hope it is a tendon sliding into place.  Then the arm audibly thunks back into the joint and it is over.

For a few moments neither of us moves.  Greg lays hands on Christina’s shoulder and prays.  Her tears still fall into the mud.  Then she says what I don’t expect: I’m sorry.  I’m so sorry.

And I want to hug her and tell her a thousand things–but only one important thing–because I know exactly what she means.

I am like her.  As she runs toward fires, I ran to ERs.  As she resuscitates as an EMT, I operated as a surgeon.  As she volunteers to serve in disaster areas, I volunteered for medical missions.  We want to serve; we want to be heroic.

But there is a thin line between service and self-affirmation.  We become what we do, and when we can’t do it we are lost.  We are ashamed.  We are sorry.

We are “Marthas.”  Martha is the women who, when Jesus is coming to dinner and everybody (including her sister, for crying-out-loud) sits at his feet and listens, is in the kitchen cooking the meal.  Somebody has to do it, Martha thinks, and she is the one who shoulders the responsibility.  Martha wants to get dinner on the table; Christina and I want to muck out that flood-damaged house.  We are doing it for Jesus.  But when we fail, we forget that we are not loved for what we do but for who we are.

Jesus didn’t exactly criticize Martha for her service, but He did tell her that it was more than okay for her sister not to help.  In his gentle rebuke is a reminder: I can feed five thousand people with food out of thin air and turn water into wine.  Your sister knows she is loved; so are you.  You are a child of God.

A few days later, my ninety-eight-year-old mother complains of “indigestion” and general malaise.  My wife, Mary, sits with her for a few hours and realizes this is more than indigestion and calls me and her doctor.  I arrive and take Mom to the emergency care center.  For ten minutes she gasps for breath and clutches her chest as I drive her to the ER.  I know it is the aortic valve disease that has finally thrown her into congestive heart failure, and I fear this is the beginning of the end for her.  In between gasps, she says, I’m sorry.  I’m so sorry.

I know exactly what she means.

Mom is okay now.  She’s back in her assisted-living facility, taking care of herself and, in many ways, happier than I have ever seen her.  But her words on the way to the hospital reveal to me how persistent is the feeling that the love we receive is conditional.

God has a different message, one about unconditional love

We must know that this is true.  But when we cannot be who we want to be, when our shoulder is on fire and we collapse on our knees in the mud with tears streaming down our cheeks, or when our chest hurts and we can’t breathe, we forget.

It’s okay to cry because we hurt.  Jesus wept, too.  But we never have to cry because we have failed.  I try to tell Christina, and I try to tell Mom: Jesus loves you, just like you are, in sickness or health, injured or whole, strong or weak, serving or listening.

Then every day I try to remind myself.

Forgiving the Innocent

Dean
Adam

 

 

 

 

 

Adam got well.

After a long, hard winter of radiation, infections, a second operation, antibiotics, his hair started growing back–first with wispy strands, finally morphing into a confident mop.  He let it get long; I didn’t object.  He finished his junior year in high school, and we celebrated by going cycling in Europe as a family.  The following year he finished high school and started his first year at a prestigious college in Atlanta.

But I found myself emotionally distanced from him.  A little voice in the back of my mind told me I should be more grateful, more joyful.  I hope I disguised my emotional desert well and did the right things as a father.  It was depression, I told myself, and I’m sure that’s part of it, but the emotional distance from Adam was specific and held a thinly veiled streak of anger.

Many months, perhaps years, passed before I realized my anger was in response to his illness.  He quite unintentionally terrorized me with the specter of grief that came from nearly losing him. And he also held the power to terrorize me again.  I feared to get too close.

But if I were to have an authentic father-son relationship, I had to get over my fear and my anger.  I had to forgive my son for having a brain tumor.  The tumor wasn’t his fault, obviously, and it wasn’t his choice to make me vulnerable or to hurt me.  But emotionally, I somehow held him responsible.

Once I understood that neither Adam, nor his tumor, caused my fear, my anger dissolved easily.  My fear of loss came from something within me, something beyond my ability to give up: the power of love.  And that love is without choice; he was born, I held him, I loved him.

Love is always a risk.  Give your heart away, and it can get weighed down so that it can drag you to the depths and destroy you.  If I were to continue to love him, I had to forgive him–even though he was innocent–and I had to accept the consequences of love.

Forgiving Adam for his tumor is not so much granting absolution as it is granting permission to hurt me again.  It is saying Go ahead, get sick if need be, because I will be there and I will not flinch, I will not distance myself, I will not walk away.  Because fear of loss is the cost of love, the dark side of the coin whose other side is shining joy.  And Adam gives me great joy.

I am awed now by the infinitely better love of our heavenly Father who loves me and forgives me–and I am not innocent.  He gives me permission to get sick, to sin, to live like a prodigal son–not encouragement, but permission–even though what I do may break His heart, cause angels to weep, and the world to become more like hell than heaven.  Yet He promises to be home waiting, ready to get up and run to meet me.  What I now understand in a small way is the cost of that great love, the dark side of the coin He is willing to pay because in some unimaginable way I must give Him great joy.

If this sounds like I am special in the eyes of God, I am.  So is Adam.  But the good news is, so are you.  You give Him great joy.

Stuff It Down

Dean

One Friday afternoon in August of 1991, Adam, Mary and I sat waiting for his MRI to begin.  I had scheduled the scan myself a week before when his opthalmologist couldn’t explain his double vision and referred him to a neuro-opthalmologist.  I had already become secretly concerned.  Then that morning the neuro-ophthalmologist called me to tell me he had a condition that was nearly always associated with a tumor.  I knew then what the scan would show, yet I hid my anxiety from Adam and Mary and held onto the slim hope that I would be wrong.  Mary was a mere six months from surgery for her breast cancer and had one more chemotherapy session to go.  We weren’t ready for more bad news.

Then my junior partner called from the operation room.  His patient had a rare and life-threatening complication in the middle of an operation, and he asked me to come and help.  No other neurosurgeons were nearby; it was me or nobody.  I left Adam and Mary blithely ignorant of the pending disastrous results of the MRI and went to the operating room.

The next three hours challenged my ability to segregate my feelings from my thoughts and actions, but that was nothing new.  For two decades I had learned that when you’re the one involved in direct patient care, everything else gets stuffed down.  You’re hungry or tired or sick?  You just had a fight with your wife?  Your mother and father are coming to visit?

Nobody cares.  Stuff it down.

Dr. Harvey Cushing, widely considered the father of neurosurgery, once did an appendectomy on one of his own children.  Another time he received the news of his son’s death in a car accident and took fifteen minutes of solitude.  Then he went directly to the operating room and performed the previously scheduled operation.

Stuff it down.  Deal with it later.  Even when your kid is sick.

After the crisis abated I left the OR and received the expected message that the radiologist wanted to review the MRI.  The images had been transferred to the hospital.  All I had to do was walk across the hall to radiology.  The images hung on the view boxes–crisp, clean lines of black and white on film representing the dark, uncertain future of a boy with a brain tumor.  The reality stunned me.  The words “evil incarnate” came unbidden to my mind.

I was particularly overwhelmed because I’d ordered the scan myself.  Now I had to deliver the news myself without the buffer of an outside authority figure, a professional in a white coat.

I felt terror.  I didn’t want to be the doctor; I wanted to be the dad.  But I couldn’t be dad.  Not yet.  I stuffed my feelings down again, and we did our family conference at home.  I remember only a little about that night.  Mary and Adam and I talked.  Then we included my parents and Jay and Brieanna.  Then we prayed.

The next morning I cancelled my appointments and spent the morning on the phone with neurosurgeons across the country searching for the best answer for Adam.  At the time, therapeutic options for his type of tumor were hotly debated.  Which surgical approach was the best?  What was the role of radiation therapy?  How to deal with tumor-associated hydrocephalus?  I had my own opinions, but had at least enough sense to realize my judgement was clouded.  I needed someone else to be his doctor.  Two days later we checked him into Shands Hospital at the University of Florida in Gainesville, and I could be the dad again.  Only then could I cry.

The ability to “stuff it down” is important.  No one wants a surgeon, a policeman, a fireman or an EMT dealing with their own emotions when they are dealing with your needs.  But this ability also has its own consequences, its own scars.  Once you’ve stuffed down your own fear and grief, it doesn’t easily resurface.  Then if I am insensitive to my own emotions, I could be nothing but insensitive to Adam and Mary.

I was a good cheerleader, but a bad listener.  “You have a good prognosis,” I would say.  “A ninety-percent cure rate.  I looked it up.”

They would stare back at me, sometimes blankly (Adam), sometimes with frustration (Mary).  And I would stuff down the fact that ninety-percent now terrified me.  A cure rate that sounded so good to me when I told patients now sounded way too low.  We had a ten-percent chance of repeating the current nightmare, and the next time would hold no chance of salvation this side of eternity.

Over the next few months Adam underwent two operations, one spinal tap, several weeks of radiation therapy, two weeks of antibiotics.  He lost his hair and he lost his strength.  I told him the prognosis was good.

The day after we returned from Gainesville Mary went in for her last chemotherapy treatment.  Her eyelashes fell out and she couldn’t eat.  I told her the prognosis was good.

It was a hard four months.  Then the active medical interventions were over for both of their cancers.  It was time to get better.

Adam tried to resume normal activities.  Chemistry was hard.  Sports were impossible–anything requiring hand-eye coordination was downright dangerous.  Mary tried to find clothes to fit her new shape.  They would tell me it was hard; I would tell them they had a ninety-percent cure rate.

Soon we stopped talking about illness and recovery as each of us drifted into our private world of terror and grief.  On the outside we looked like a normal family going about work, school, and community activities like anyone else.  Scratch the surface, and any one of us could fall apart.

Then, in the Spring of 1991, I bought a self-help book–not for me, you understand; I thought it would help me provide direction to my other son, Jay.  One chapter dealt with the skill of listening.  Some people don’t need instruction in this, but I did.  Don’t think of your response while the other person is talking.  Repeat what they say as a question to 1) make sure you understand, and 2) give them permission to keep talking.  This is instruction so simple it borders on stupid to repeat, but there it was.  I tried it out on Mary the next time she spoke about her cancer treatment, her scars, her fears.  She kept talking; I kept listening.

Her depression started to lift.  (She has an amazing testimony about a dramatic moment of recovery, but that is her story to tell.)  On the other hand, all the fears and grief I had stuffed down now floated up.  I had to start dealing with the fact that I and everyone I loved was going to get sick and die, and that fact terrorized me.  I could no longer be the cheerleader with “the ninety-percent cure rate,” since I was now quite conscious that the cure rate was a temporary illusion, a distraction from the fact that life has a one-hundred-percent mortality.

But I became a much better listener.

Listening, I learned, has a cost.  If you listen to those who have suffered loss and fear for the future, you will mourn.  So I mourned the scars of Adam and Mary, the loss of their hopes, and the fears of what the future would inevitably bring to all of us.  But if I mourned with them, we were no longer alone, and if we were no longer alone, we were comforted, and if comforted, loved.  And if we had love, we had hope.

Jesus knew this.  His first public declaration in his ministry was that the kingdom of God was near.  His second was that the poor in spirit are blessed because they would receive the kingdom of heaven.  But his third was that those who mourn are blessed because they would be comforted.

There are times to stuff it down, those griefs about things lost and the fears of future sufferings and separations.  But do not fear listening, do not fear mourning.  Because we are blessed to mourn.  Then we shall know comfort.  And love.  And hope.