Charlene Charles had always been a woman with a tough personality, never mincing words, and often times having ‘choice ones’ for people or situations that irritated her.
In many ways this demeanor served her well, since she had a difficult life to say the least. She survived the diagnosis and treatment for breast cancer almost twenty years ago and more recently had to undergo chemotherapy for a second cancer, lymphoma and was currently in remission.
Though she had periods of time when she saw the glass more empty than full, she managed to fight through it all.
Given this history one might feel she had been through enough, but unfortunately she had one more trial to endure.
This time, however, things progressed more rapidly and the outlook was darker than it had ever been before. One day she had been fine, and the next day, the words that came from her mouth were a jumbled mess. Speaking with her you could tell by the look in her eyes that her brain knew what it wanted to say but she just couldn’t get the words out so they made any sense.
As a result she visibly became frustrated and because of her personality she became extremely angry as well.
At times like these I kind of feel like an interpreter attempting to translate a foreign language. Because I have seen so many people with aphasia, or difficulty speaking I can almost tell what the patient wants to say just by listening to their fragmented speech even when the actual words are completely wrong.
Shortly after she was admitted an MRI scan was performed and revealed what she and her family had dreaded and I suspected…she had a brain tumor. Only it was not a metastasis from her breast cancer or the lymphoma but she had developed a third type of cancer, a malignant astrocytoma.
The following Monday I took Charlene to surgery to remove the tumor. That morning before the nurse took her back to the operating room I went and ‘spoke’ with her. Since she had been receiving a steroid medication for the brain swelling caused by the tumor, her speech was actually more clear, though still not normal. Unfortunately, because of the tumor’s location (left temporal lobe) I realized her speech might not get any better and could even be much worse.
She knew that too.
Surgery went well.
Though I knew I could not completely removed this type of cancer, I hoped that removing as much as I did would decrease the pressure on the surrounding brain enough that her speech would improve, and that her prognosis would be better as well.
I was crushed to discover that following surgery, Charlene could not speak at all. At first I believed this was probably due to my manipulation of her brain as well as the anesthesia and once these effects wore off after two or three days, she would be better. Unfortunately she still was unable to speak, and in fact she seemed to regress to the point where she would not even open her eyes or respond.
Two days after surgery I ordered an MRI scan to be performed. When I reviewed it, I had indeed removed a majority of the tumor but I clearly avoided her speech area so I was even more puzzled as to why her condition was so much worse than before surgery.
I quickly became concerned that now, she might not even make it out of the hospital alive, let alone survive for 12 – 18 months.
Her sister had arrived a few days after surgery and when I spoke to her she revealed how Charlene had on more than one occasion expressed her desire to give up fighting and just join her husband who had long since passed away.
I continued to treat her for whatever brain swelling might still be present in the hopes she would recover but after 5 days, there was no change. When I spoke with her sons later in the day, I expressed my concerns that her recovery was in doubt, as I too, began to accept the inevitable.
At the suggestion of the neurologist who had seen her I started mannitol, which is a diuretic of sorts for the brain. Surprisingly, Charlene began to awaken and become more responsive. This didn’t make sense to me from either a medical or scientific standpoint because this medication shouldn’t have had any significant effect this far out from her surgery.
What is more is that we only administered this medication for a couple of days, then stopped it, yet her improvement continued.
When I saw Charlene 9 days out from her surgery, I was dumbfounded. She was sitting up in bed speaking clearly! Not only was her speech better than before surgery, it was perfectly normal.
She then began to relate to me the ‘dreams’ she was having in the days following her surgery. The images she described sounded more like demons and monsters that were out to get her and in that moment I was reminded of a child hiding under the covers in her bedroom to escape them.
Looking back, it seemed like, to her, just a bad nightmare.
Now, how much of this was the due to the short-circuiting of the complex wiring of her brain caused by the tumor and the surgery, and how much was due to something more inexplicable, I can’t be sure.
But what is clearly miraculous is the degree to which her speech completely normalized… and I this is exactly what I told her.
At this point I am unable predict her prognosis since the post-operative MRI revealed there was residual tumor and the diagnosis was that of the worst possible primary brain tumor, a Glioblastoma Multiforme. But what is clear, is that at least for now, she has been blessed with more time to enjoy her family, and they both have the opportunity, perhaps, to say and understand the things they have been meaning to say to one another for quite some time.
Posted in Brain Tumor, Miracles | Tagged Aphasia, Astrocytoma, Blessed, Brain Tumor, Cancer, Cerebral Edema, Faith, Family, Glioblastoma Multiforme, Inexplicable, Language, Lymphoma, miracle, MRI, Neurosurgery, Prayer, Remission, Speech, Trial, Words | 4 Comments »
Years ago, a big part of my life was lifting weights. I was obsessed, you might say. I worked out at least three days a week for 2 – 3 hours at a time.
One day as I was moving from the bench press to the dumbbell rack I thought, ‘I spend so much time chiseling my physical self, if I only spent half as much time on my spiritual life how much better a person I might be!’ But, the thought vanished as quickly as it came to me and I went about with my ‘bicep curls’.
It has taken me many years to get to the point where my spiritual health has taken on a more important role than my physical appearance. Although with my responsibilities at work and the time I devote to my family, helping out with homework assignments and shuttling here and there after school, exercise had been pushed way down on the list of priorities anyway.
Of course as a result my overall health has suffered. Hypertension is something I have had since medical school but diabetes is something I have acquired within the last five years or so and it has gotten worse. So clearly, my health is something I must refocus my efforts on.
But balance is the key. It is important to take care of our bodies and to be the healthiest physical version we can be, but it is equally important to be the healthiest spiritual version of ourselves as well.
Do you not know that you are God’s temple and
that God’s spirit dwells in you? If any one
destroys God’s temple, God will destroy him.
For God’s temple is holy, and that temple you are.
1 Corinthians 3:16-17
Unfortunately, it is not because we inherently want to be the healthiest version of ourselves although that may be in part, or perhaps completely, the excuse; but because we have a narcissistic desire to look better than the next guy, or girl and to be sure the world knows it.
The irony is that to be the best spiritual self we can be is more difficult to achieve. It takes a tremendous amount of humility and ‘strength’ of character; and when we become prime physical specimens it often brings out in us an attitude that is the exact opposite. After-all being in a state of perfection requires us to crush the opposition, does it not?
In reality, I believe we can be both spiritually and physically strong at the same time as long as we keep things in perspective, but it takes work… and more than bench pressing 275 lbs!
Recently I read in the book, The Measure of a Man, the importance of being meek without being weak! How is this possible?
This is an interesting concept because it would imply that our faith can be strong and when necessary forceful but without being puffed up with pride. After all Jesus warned us about showing off how ‘holy’ we are to others but rather we should keep it to ourselves so that only God knows. (Matthew 6:1-6)
Of course we are human and by our nature we often fail.
Recently, a friend of mine mentioned the workout routine P90X and how it was really effective but that the workouts were intense and that the diet was something you had to stick to. So I decided I would try it out. Besides you could do the workout as intensely with resistance bands instead of weights, which appealed to me because I had injured myself in the past with weights.
I admit the food is not always a gastronomic delight but I have lost weight and in fact my diabetes has been impacted tremendously. And at this point in time, practically speaking, I am not taking any diabetes medication at all! So this has been the greatest motivator for me and my appearance becomes a by-product of my health, and not the other way around.
However…just the other day as I left my Friday morning men’s group I was focused on getting home and performing my workout for the day. But the parish school where my children attended was about to go to morning mass and in the back of my mind I thought I should go too. But that workout loomed large over me.
That’s when I stopped and began to listen to ‘God’s’ voice in my head… ‘Here you are being somewhat critical of those who are obsessed with THEIR workouts and now you are becoming the same way about YOURS!’
I knew He was right, and besides I had nowhere special to be that morning and I could exercise afterwards… so I turned my truck around and returned to the church parking lot. Of course it was a wonderful mass and I was so glad I went. To think I could have lost that important moment in my life and that of my children.
The other day I joked with my wife Stacy that not only was I doing the P90X workout but also one that was more important, the Alpha and Omega X workout! She looked at me a bit perplexed, as I reminded her…
“I am the Alpha and the Omega,”
says the Lord God, who is and who was
and who is to come, the Almighty.
For me, making Christ, a part of my daily ‘workout’ is what helps me achieve this balance… although as with anything that is worth having, it takes hard work.
Posted in Exercise, Health, Jesus Christ | Tagged Alpha, Appearance, Balance, Diabetes, Dumbbells, Exercise, Faith, Family, God, Health, Humble, Irony, Jesus Christ, Lifting Weights, Meek, Narcissism, Obsessed, Omega, P90X, Perfection, Physical, Priorities, Responsibilities, spiritual, Strength, Workout | 1 Comment »
I had just finished my second case of the day, a cervical fusion, when Chad, my PA got a consult to see a patient at Countryside Hospital.
Aaron Cook, 81 had been diagnosed with multiple myeloma, which is cancer of cells in the blood that accumulate in and weaken the bones of the body.
Chad had spoken to the nurse and was told, Mr. Cook was paralyzed in his legs.
An MRI of his spine revealed that the cancer had replaced most of the bones of his spine. In his mid back, the cancer had weakened so much of one of the vertebra that it crushed upon itself. As a result the bone and cancer cells were pushed back into Mr. Cook’s spinal cord causing his paralysis.
Given Mr. Cook’s age, his paralysis, and the appearance of his MRI my initial reaction was that there wasn’t much that could be done. I spoke to his physician, Dr. Reynolds, who told me Mr. Cook had initially presented with severe back pain.
But because the cancer was so widespread it was concluded by the oncologist and radiation specialist that any treatment would be palliative, which basically meant the cancer could perhaps be slowed down but not cured.
Dr. Reynolds informed me Mr. Cook had been in the hospital about ten days receiving radiation treatments to his spine. ‘The excruciating back pain that he had on admission had subsided’, he continued, ‘but now he was unable to get out of bed because his legs were paralyzed’.
I told Dr. Reynolds that it was unlikely anything could be done surgically to help Mr. Cook but that I would go by and evaluate him if he wished. He said that would not be necessary. He just wanted me to look at the films and let him know if there was anything that should be done.
As soon as I hung up I was called back to OR room #4 for my next surgical case of the day. I finished up operating at about 6pm, and after I dictated my surgical note and checked on my post-ops I thought about Mr. Cook. I knew I wasn’t expected to see him but I felt compelled to drive over to Countryside Hospital and see him nonetheless.
As it turned out I had performed surgery on Mr. Cook’s wife many years earlier so he knew me, and in fact, he was expecting me. As I talked to him about how he wound up in the hospital he told me that up until about 4 weeks ago he was just fine. He and his wife had gone over to the Florida east coast but because he ‘just didn’t feel right’ he told his wife they needed to cut their trip short and return home.
When I was given his history earlier in the day I just assumed he had been diagnosed with multiple myeloma several years ago and that now his MRI revealed the end stages of the disease. But he had just been diagnosed 10 days ago.
When I examined him, I discovered he was ‘paralyzed’ in his right leg but that the strength in his left leg was only mildly weak. I then discussed with him options and prognosis. ‘In most circumstances such as yours I would remove the crushed vertebra and replace it with a metal or plastic cage filled with bone’, I told him. ‘Then I would place screws and rods in the spine above and below the fractured vertebra to stabilize it’, I continued.
‘But because the cancer had affected so much of your spine, I can’t do any of that. And because of your age, I’m not sure you would survive such an extensive surgery anyway’, I concluded.
‘So, what does that mean’, he asked. ‘Well’, I said hesitantly, ‘I’m not sure you will ever walk again’.
Choked up, Mr. Cook said, ‘Oh my God, my wife is too ill to take care of me…’ Looking down at him lying in his bed, still in pain and unable to get up and walk, I was sorrowful, wishing there was something I could do, yet realizing surgery was too risky.
I told him I was sorry and that perhaps with continued radiation treatments, he still might get better, although I knew this was not likely.
As I stood at the nurse’s station writing my progress note in Mr. Cook’s chart, I felt compelled to look at his MRI scan again. As I flipped through the images I thought to myself, ‘there’s got to be something I could do that might help’.
I called Chris, one of my colleagues to discuss his case. He too, agreed that Mr. Cook at 81 years-of-age would never survive a major surgery. But perhaps if I removed some of the bone from the back part of the spine, he suggested, this would free up enough of the pressure on the spinal cord so that his strength might improve to the point where he could walk again.
I thanked him, hung up the phone and walked back into Mr. Cook’s room.
I told Mr. Cook that I had given his problem more thought and there was something I could do surgically that might help him. ‘However, while I cannot promise you it will be successful, I think it may be worth the risk’. Not surprisingly he was willing to take that chance.
I spoke to Dr. Reynolds and explained my plan who then agreed to have Mr. Cook transferred to the hospital where I would perform surgery in the morning.
Surgery went well and though the cancer had destroyed most of that particular vertebra I was able to relieve the pressure on Mr. Cook’s spinal cord. Over the ensuing weeks following surgery Mr. Cook gradually regained strength in his leg and began to walk using a walker and some assistance.
For me, Mr. Cook’s case reinforced to me the importance of several things. The first is that nothing replaces talking to and examining the patient myself.
Not only does this allow me to get a real sense of the patient’s problem but also helps me to understand the true impact of the illness on the patient and his (or her) life.
In Mr. Cook’s case I initially dismissed ‘out of hand’ that anything could or should be done surgically in someone who had widespread cancer. However after speaking to him I realized he was living a normal life just 2 weeks earlier. Not only that but his wife was very ill herself and there was no way she could take care of him.
So as I stood there leaning up against the counter at the nurse’s station, I felt a change of heart. Was it merely my sense of compassion… or was it an angel, or the Holy Spirit that inspired me, reminding me I was given my gift to help others.
And so, grateful once again for be able to hear that voice in my head, I did what I could to help Mr. Cook, and his wife.
“The wind blows where it will, and you hear the sound
of it, but you do not know whence it comes or whither
it goes; so it is with every one who is born of the Spirit.”
Posted in Jesus Christ, Listening, Spiritual Experiences | Tagged Angel, Cancer, Christ, Compassion, Expectation, Gift, God, Helping, Holy Spirit, MRI, Multiple myeloma, Palliative, paralysis, Radiation, Risk, Sorrow, Sound, spinal cord, Spine, Spirit, Strength, Surgery, Too old, Voice, Widespread, Wind | 3 Comments »
Understandably, with the passing of my mother-in-law, my wife Stacy has undergone a life altering experience. And as much as I might try to comfort her and tell her I understand, the reality is… I don’t. It is more honest to say that I am trying (to understand).
On the other hand, my mother is quite elderly, 89 to be exact and though she has lived a full life and I might think I will be able to accept her passing when it is time, until it happens I really won’t know. What I have come to realize however, from witnessing my wife’s experience and speaking with others, is that losing a mother seems to be a greater loss than when a father dies.
I can’t speak for everyone but while I love and have a great appreciation for my father, I would have to say that the bond between my mother and I is stronger. In part it is because our personalities are so much more alike, but somewhere in the recesses of my brain I feel it goes deeper than that.
A father loves and provides for his children, as I have done and I would have to say without hesitation that I would lay my life down for my children.
But a mother will sacrifice everything, including herself, every day of her life if necessary, for her child. After all her child is flesh from her flesh.
Recently this occurred to me as I was making rounds in the ICU.
When Jesus saw his mother, and the disciple whom he loved
standing near, he said to his mother, “Woman behold your son!”
Bobby Waters is a 24-year-old ‘boy’ who had been complaining of a headache after having sustained what he thought was only a minor head injury. He then began having some difficulty speaking, but because he did not have insurance he avoided going to see a doctor. However when he became lethargic and his girlfriend found him lying on the floor of his apartment, she called 911.
Bobby was a tall, well-built, good-looking boy who had an equally good-looking girlfriend. Unfortunately, during his hospitalization a lot of that would change, all except one thing.
On arrival to the hospital, a CT scan was done which showed that Bobby had a large hemorrhage deep within his brain on the right side. The size and location couldn’t have been worse for this young, previous healthy boy. It extended into the top part of his brainstem resulting in paralysis of the left side of his body.
And there was nothing that could be done surgically to safely remove the hemorrhage and reverse the damage that had occurred.
The hemorrhage also blocked off the normal flow of cerebrospinal fluid within the brain causing it to back up and resulted in an elevation of the pressure within his brain to critical levels and as a result, Bobby was in a coma.
The neurosurgeon on call emergently performed a ventriculostomy, which is basically drilling a small hole in Bobby’s skull and passing a thin, soft catheter through the brain into the fluid filled ventricles within the brain to drain off the cerebrospinal fluid and thus relieving the elevated pressure.
Unfortunately this only prevented other problems from developing, because Bobby still remained paralyzed and in a coma, and on the ventilator.
Over the next several weeks, Bobby would develop a collapsed lung, pneumonia, an infection in his blood stream and a suspected infection in his brain. And though he survived it all he remained dependent upon the ventilator to breathe for him. And while his brain condition improved to the point where he would open his eyes, if you were to look at him you would hardly consider him ‘awake and responsive’.
Ultimately the CT scan revealed that the hemorrhage resolved although whether Bobby would recover was uncertain at best. The catheter which stuck out from the top of his head that drained into a bag on the side of his bed was removed. In its place was an internalized shunt with a valve that would regulate the pressure within Bobby’s brain so that it would be normal.
He also became less dependent on the ventilator but nonetheless the tube coming from his mouth was converted to a tracheostomy coming from the front of his neck.
Through it all, Bobby became a shell of the vibrant young man he was going from almost 170 to 115 lbs.
One day after about 4 weeks into his hospitalization, as I happened to walk by his room in the ICU I looked on to see a solitary person sitting by his bedside, as she had from morning till night each and every day since his admission a month ago…his mother.
Gone was his brother. Gone were the friends. Gone was his father who as near as I could tell only came to town briefly mid-way through Bobby’s stay in the hospital. Now, she was the only person there, as if keeping a vigil awaiting her baby boy’s first words.
He still has not spoken though he has shown some movement on his paralyzed side. He does know when his mother comes into the room and he tracks her with his eyes as she moves from the door to her usual chair by his bedside.
To me, this epitomizes the devotion and complete self-sacrifice of a mother, which as I think about it mirrors the depth of love that Jesus has for each and every one of us.
So, as a child when you lose this person, your mother, there can be no loss that equals the pain that you must feel. I suppose the only consolation is to know that one day you will once again be reunited with her, although the pain persists nonetheless, taking time to lessen. Of course, we still have the ever-present person of Jesus Christ who is always there to console us.
Peace I leave with you; my peace I give to you; not as the
world gives do I give to you. Let not your hearts be troubled,
neither let them be afraid.
Posted in Human Emotions, Jesus Christ, Miracles | Tagged Bible, Brain Hemorrhage, Child, Christ, Coma, Consolation, death, Devotion, Gospel, Hydrocephalus, Jesus, John, Loss, Love, Mother, paralysis, Passing, Peace, Sacrifice, Scripture, Shunt, Ventilator, Ventriculostomy, Vigil | 2 Comments »
Jesus said to him, “Rise, take up your pallet and walk.”
And at once the man was healed, and
he took up his pallet and walked.
Afterward Jesus found him in the temple, and said to him,
“See you are well! Sin no more, that nothing worse befall you.”
John 5:8-9, 14
In my last post I included a passage from Luke’s gospel that told the story about Jesus giving sight to a blind man. The key statement by Jesus was: “Receive your sight; your faith has made you well”. Here, Jesus heals a paralytic but the implication, to me, is not just that the man was able to physically walk, which certainly was a miracle, but that he should also walk in the footsteps of Jesus. And just to be sure the man ‘got it’; Jesus finds him later and clarifies what is really important in his new life by saying, “Sin no more, that nothing worse befall you”.
Recently, my wife’s mother Janice, who had been ill, past way. Because we had been on Cape Cod at the time we had a funeral service there. She was then cremated and when we returned to Florida we had a funeral mass here.
At both services I was asked to deliver a eulogy celebrating her life and the person she was. In contemplating what this was, I kept being reminded that the single most important characteristic of her life was the love she had for her children and later in life, her grandchildren.
A passage from John’s gospel clearly spoke of this to me; It was when Jesus gives his apostles a new commandment that they love one another as He loved them. He then tells them, “by this all men will know you are my disciples, if you have love for one another”.
And this is what Janice tried to become in her life… a true disciple of Jesus Christ.
After we got home to Florida, my wife, Stacy found a journal that her mother had kept. In one particular entry from several years ago, she spoke over and over about walking with Jesus. And how she regretted earlier in life not ‘seeing’ that this is what she should have been doing all along. Yet, she was grateful for finally realizing that this was the path she should be on.
I guess I knew she was close to God; after all He used her to touch and change my heart many years ago when cynicism and selfishness threatened to derail me off my path to help others using the gift God gave me.
But, and I am embarrassed to say so, because she wouldn’t come to church with us on Sunday I merely assumed God was not playing a big role in her life. It is ironic that in our efforts to be ‘good Christians’ we allow the evil one to cause us to be judgmental of others when they do not ‘appear’ to be the same ‘God-fearing’ people we perceive ourselves to be.
Of course she had very real health reasons that kept her homebound but I felt she should have made a better effort to be there. Jesus, I suspect would have been more loving and understanding than I. As it turned out she was walking closer to Christ than I was…
When she was 16, she had a vision while she was hospitalized. She recalled that God appeared to her surrounded by the brightest of lights with a child at His feet. She then heard Him say ‘Do not fear, I am here’. At the time it seemed to me she was more confused rather than inspired by what she had ‘seen’.
Later in life as she looked back on this experience, she regretted not allowing it to influence her decisions in life more. I guess we all have our demons that constantly struggle with the good inside of us. Jan worried a lot and as a result became very anxious. Often she found herself being critical and judging others which led to what she called ‘tears of frustration’.
She realized that often she was not always able to forgive others for what they may have done to her. Quite eloquently she wrote that because of this particular failing she had deprived herself of the gift of God’s love and forgiveness.
The one thing that Jan did excel at all her life though, was her love for all her ‘children’. Very much like Jesus, Jan did cherish the innocence and hope that is embodied in every child.
And calling to him a child, he put him in the midst of them
and said, “Truly I say to you, unless you turn and become
like children, you will never enter the kingdom of heaven.
Whoever humbles himself like this child, he is the greatest
in the kingdom of heaven.”
Later in life though, through much prayer Jan reached out to God in the ‘truest form’ and as result came to truly know Him and as a result was able to not only walk in the footsteps of Christ but ‘with’ Him. Of course she realized her first steps had to begin with forgiveness and in this she found such peace and love.
About 10 years ago, Jan’s husband Don or as he was called by his grandchildren, ‘Pa’ was diagnosed with Alzheimer’s. Throughout this time, Jan devoted every waking moment to him right up until his last day three years ago. She missed him dearly but she continued her journey with Christ. Not that it was always easy…
Two years ago she was diagnosed with lung cancer. Initially it was thought because the tumor was so small it could be successfully treated and perhaps cured with a specialized form of radiation. And for a while she did well and continued to live her life to the fullest traveling to Cape Cod with Stacy and with our family to the cabin in North Carolina.
But earlier this year the cancer recurred and so we all were forced to face the reality that she would die, although the end came more quickly than we had anticipated.
As the summer approached she had wanted to make one more trip back to her home on Cape Cod. A repeat PET scan showed the cancer still had not spread so we felt she would be able to make the trip and we fully expected her to make it back to Florida before the end would come.
In fact she was so happy and gleeful to be heading back to Cape Cod that she seemed to have new-found strength that overcame the weakness of her illness. And as she crossed the Sagamore Bridge she had a sparkle in her eye and a smile ‘ear to ear’.
Sadly, as soon as she got home, she weakened quickly and practically before we could realize what had happened, she passed away on the 4th of July with her family and friends surrounding her, as a final tear rolled down her cheek.
Watching and helping my wife take care of her in the last several months, as she became more and more dependent on Stacy for her care, it seemed as though she became more and more like the child that Christ wanted her to become that day in the hospital 60 years earlier.
Just this past week, Stacy lay to rest the ashes of Jan (or Mimi as the grandchildren called her) and Pa at home in Sandwich, Massachusetts. Together again, they are surrounded by the love of her Lord, Jesus Christ.
‘When a woman is in labor she has pain, because her hour has come;
but when she is delivered of the child, she no longer remembers
the anguish, for joy that a child is born into the world. So you
have sorrow now, but I will see you again and your hearts will rejoice,
and no one will take your joy from you.’
Posted in Faith, Jesus Christ, Miracles | Tagged Anxiety, Cancer, Cape Cod, Children, Christian, Critical, death, Disciples, Footsteps, Forgiveness, Frustration, God, Gospel, Happiness, Jesus, Joy, Judging, Light, Love, miracle, Paralytic, Peace, Rise, Sagamore Bridge, Seeing, Sight, Sin, Strength, Tears, Understanding, Walk | 4 Comments »