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The Best Thing

Being cured and being healed are usually the same thing.  But not always.

A few years ago I was already driving home at the end of a long day when I got a call from the ER.  A thirty-something year-old mother of two had been driving home from work when her car was struck broadside from someone running a red light. She had been briefly unconscious at the scene, but was alert and able to give a coherent history on arrival at the ER. Then she unexpectedly lapsed into a coma, the right pupil dilating.

By the time I arrived, a CT scan had confirmed my suspicions of an intracranial hemorrhage, specifically an acute subdural hematoma.  If the clot could be removed before she suffered permanent damage to the critical life-support and consciousness areas of her brainstem, she could live.  But the window of opportunity was narrow.  She had less than two hours.

An emergency OR team was called and the patient resuscitated with assisted breathing through a mechanical airway and medications to minimize brain swelling.  Blood for transfusion was reserved, labs were processed.  The clock continued to tick.  I shaved her hair in the ER while waiting for the OR to be ready.

Finally, she got to surgery.  I made a big incision and cut a big window in her skull to allow room to evacuate the blood clot and find the source of bleeding.  A large surface vein had been torn due to the accident, but the brain itself looked normal.  Once the clot was out and the bleeding controlled, the tension level in the OR dropped and the surgery finished without any problems.  I bandaged her head in a classic turban dressing.

Her post-op scan showed complete resolution of the intracranial bleed, and she quickly regained consciousness.  Early in the morning of the second post-op day I visited her in her ICU room surrounded by her celebrating family.  She had made a full neurologic recovery and, other than a black eye and a bandage, looked perfectly normal.

I needed to change her bandage.  Although it looked pristine on the outside, undoubtably the inner layers of gauze had blood and serum from the incision, and I wanted it clean there, too.  I cut away the old bandage and reached for the new gauze wraps when she quickly put her hand to her head and grabbed a mirror.

“My hair,” she wailed. “What happened to my hair?”  Tears welled up.

I re-bandaged her head and assured her that her hair would grow back.  Her family comforted her and told her how glad they were to have her alive and how little they cared about her hair.  But she was inconsolable.

I was disappointed.  She had a perfect medical result.  Yet, she would need many months of psychiatric treatment for post traumatic stress disorder (PTSD).  She had been cured by her surgery, but not healed.

A few months later I received a consult to see a patient that I knew I couldn’t help.  This patient had suffered paralysis due to a gunshot wound to the thoracic spine several weeks before and had been treated at another hospital before transfer to the rehabilitation facility in my neighborhood.  The question on the consult was whether or not she needed to continue to wear a brace (she did not).

All I had to do was talk to the patient, do a brief exam to confirm my findings and write a note explaining what I already knew from looking at her hospital records and x-rays.

“Can you tell me what happened?” I said.

“The best thing in my whole life,” she replied.

I stared at her, a thirty-something year-old woman who looked older than her stated age.  Her hair was prematurely gray, disheveled and greasy from too many weeks in the hospital.  She must have misunderstood me.

“No, no,” I said.  “I meant about the spinal cord injury, the gunshot wound.”

“Yes, of course,” she said. “It was the best thing that ever happened to me.”

I realized that I was not going to have a normal conversation with this new paraplegic.  “Okay, I’ll bite,” I said. “I’ve seen lots of people with spinal cord injuries. Some adjust better than others, some adjust quicker, but I have never heard anybody say it was the best thing that ever happened to them.”

“I was an addict working as a prostitute to support my habit,” she said.  “A family of Christians lived in my neighborhood.  They knew what I was doing.  Every day I would walk by their house, and these little children would say something like, ‘Miss JoAnn, won’t you come in?’ or ‘Miss JoAnn, Jesus loves you.’  The last time it was the little boy. He said, ‘Miss JoAnn, Jesus loves you and we are praying for you.’

“I remember thinking I’d come and visit the next day, after one more high.  But that’s what I told myself every day.  A couple hours later I got shot in a drug deal gone bad.  I woke up three days later in the hospital unable to move my legs.”

She paused, collecting her thoughts and trying to form an explanation.

“But three great things happened to me that day.  The first–I was delivered from 20 years of addiction to crack cocaine. The second–I was delivered from 18 years of prostitution. The third–I found Jesus Christ as my Lord and Savior.  I have joy in my heart for the first time since I was a child.  So if never walk again, which is what they are telling me, it’s a pretty good trade.”

I couldn’t offer her a cure.  But then, she didn’t need it.  She had already been healed.

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One thought on “The Best Thing”

  1. Two appropriate and parallel stories where the opposite behavior expected occurred in each prognosis . Great stories to pair for reflection on where people are in their personal journey

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