The Hand of God? IV

HandOfGodP4

Part IV: The Hand of God?—The Will To Die

By Edison McDaniels, MD | surgeonwriter.com
You might want to read the other articles in this nonfiction series first. [Click Here]

Keywords: nonfiction, brain death, coma, miracle

The will to live is strong in us all. Every physician with more than a handful of years under their belt has stories of patients who defied the odds and thrived.

The twenty-seven year old woman I met as a surgical intern who was operated emergently for a burst ectopic pregnancy and turned out to have widely metastatic hepatoblastoma with a ruptured liver. She should have bled out that day, or died many times over in the months that ensued, but lived long enough—over a year—to appear as matron of honor at her best friend’s wedding. She looked positively radiant when I saw her the week of that wedding, a week before her own death.

The seven year old boy who ran through a plate glass window on his way back to the pool after going to the bathroom, eviscerating himself. He also tore his kidney off it’s vein and ruptured his spleen. He came into the trauma unit with no heart rate and bleeding clear saline—a result of the massive IV fluids given him in the field by the paramedics, who, as luck would have it, lived in the firehouse next door to his home. They were on scene in less than a minute. That boy spent a month in a coma before he walked out of the hospital.

A nineteen year old youth who survived five years and seven operations on his highly malignant brain tumor, a form of cancer that usually kills in months, before finally succumbing within twenty-four hours after he announced to all of us—with complete lucidity—that he was done.

Sometimes the odds go the other way, that is, not in the patient’s favor. I treated a young woman once, just eighteen, who presented with a mild head injury and a broken femur (the thigh bone). She was crying in the ER, and I made it my mission to comfort her. I told her she’d be fine, how she had only a minor concussion and a broken leg. “The leg is serious,” I said, “but not life threatening. You’ll be fine.”

Whereupon she looked me dead in the eyes and told me otherwise. She was miserable in her pain and through a clenched jaw said “I’ll never leave this hospital alive.” Those were her exact words and, so long as I myself draw breath, I will never forget her eyes. Dark and sunken, with a melancholy character I had never seen before and expect never to see again. They were dead eyes I suppose, though I didn’t know it at the time.

She was wrong in her words. She did leave that hospital alive. But she was correct in her sentiments. Before her thigh bone could be fixed, she developed something call fat emboli syndrome. Her lungs failed as a result and we transferred her to another hospital, one where they could do something called extracorporeal membrane oxygenation, which is a fancy way of saying they bypassed her lungs to oxygenate her blood. It’s like a lung bypass machine. But it didn’t work. She was young and healthy and had everything going for her but died fifteen days after our discussion in the ER.

Her death was no miracle, to be sure it was a tragedy. Tragedies are common in medicine, a dime a dozen. Luck of the draw. One person gets an abscessed tooth and is cured by pulling it, another develops bacterial meningitis for no apparent reason and is never the same again. Shit happens. People get sick. People die.

But one case in particular made me think otherwise. That occasionally, just occasionally, there’s another hand at work. The case made me question much of what I had witnessed over the years. I can’t say what I observed that night was a miracle, although it may have been. It certainly was a Believe It or Not moment though. I always knew the will to survive was strong, that a person with a strong mind and a weak body can sometimes push beyond the natural boundaries of life. But does it work the other way round as well?

Can a person with a strong mind will themselves to die?

I was working in a trauma center in Minnesota at the time. I was ever on call and that night was no exception. I remember it was after midnight when she came in. An elderly lady, I’ll call her Mabel. She was eighty-five and still lived at home with her husband of sixty plus years. Henry was his name. At ninety-three, he was more frail than she. He looked his age, she less so. They were both spry though. No walkers, no memory aids.

She had awakened thirsty and gone to the kitchen to get a glass of water. Not uncommon apparently, except when she didn’t return to bed her husband went looking for her. He found her on the kitchen floor, where she sat with a mild look of befuddlement about her. “I can’t seem to move my left leg,” she told her husband.

Henry called an ambulance and before long Mabel was sitting on a gurney in my ER with Henry ever present at her side. He wouldn’t leave her, even when she went for a CT scan. He insisted on helping her use the toilet, and when she had the slightest difficulty or hesitation answering my questions, he filled in. They were cute together, and obviously still very much in love.

Her problem wasn’t remotely life threatening. A very small hemorrhage, a form of stroke, on the right side of her brain along the midline. Too small to warrant surgery. In fact, I had to look twice to see any hint of blood at all. It was really more a case for the neurologists, the doctors who care for nonoperative strokes. I made a few phone calls, got the neurologists involved, and prepared to make my exit.

“She’ll be alright then doc?” Henry asked.

“Right as rain,” I said, or something like it. I assured the both of them it wasn’t remotely life-threatening. Her blood pressure and other vitals were normal and there was nothing of concern on the few lab tests we’d run that night. She was about as healthy an eighty-five year old woman as I’d ever seen or expect to see. “I hope I’m as healthy as she is when I’m eighty-five,” I said.

“Thanks doc, you’ve made my day. I can’t lose her. Without her, I’d be nothing but an old fool. She’s keeps my lights on.”

On the gurney, his wife actually blushed. Married over sixty years and they still touched each other like that. Down deep, where the air is rare and the fire is hot. Something my mom used to say.

I smiled through my fatigue and spoke in a voice a bit too colloquial, as I have a tendency to do at times. “You ain’t gotta worry about nothing tonight, mister. It seems somebody’s looking out for you two.”

Henry seemed to visibly relax. “Ain’t that the truth. Praise God, we’ve had a good life, Mabel and I. Nothing to complain about.”

“Nothing at all,” Mabel seconded.

Exiting the cubicle, I saw them kiss out of the corner of my vision.

An hour later, I was back in the ER. I’ve forgotten why after all these years. Something mundane but necessary. It was two in the morning and if it could have kept until morning I’d have been sleeping. It wasn’t surgery though, that I would have remembered.

I passed the cubicle with Henry and Mabel. Henry was seated on a chair beside the gurney; he might have been sleeping. Mabel smiled as I passed.

I was in the back somewhere, maybe talking to a patient, when I heard the overhead call for a code blue in the ER. That’s a cardiac arrest, an all hands onboard sort of evolution. I was close, so I heeded it.

I stepped into the hallway and saw the commotion at the other end of the emergency room. As I got closer I realized it was Mabel’s cubicle. Oh no, I thought, wondering if maybe she was having a seizure. A small crowd was already gathering.

That crowd wasn’t assembled around the gurney though. They knelt on the floor. They knelt over Henry.

An orderly was doing CPR while one of the ER docs was giving instructions to the nurses. Somebody brought over a crash cart. I watched as they opened Henry’s shirt and put leads across his front. The monitor was a mess of indecipherable squiggles.

“V tach!” the ER doc announced. “Paddles now. Charge to 400!”

He put the paddles to Henry’s chest, said “Clear!” and triggered the pulse.

I realized in that moment that Mabel was witnessing all of this. Her eyes were wide and pensive.

Henry jumped slightly when the charge was triggered. There was no animation behind it, a quick lift of his chest off the floor and back again, an inch or two at most.

“Again!” the ER doc shouted.

The look on Mabel’s face was now less pensive and more horror. “No, no please.”

Henry jumped again. The monitor had gone from squiggles to flat line. Not an improvement.

“Resume CPR. Recharge. Get me some epi and bicarb.”

“Please stop,” Mabel said.

The ER doc either didn’t hear her, didn’t realized who she was, or didn’t care. But I knew who she was, who Henry was, and—most importantly—who they were to each other.

I put a hand on the ER doctor’s shoulder. “It’s enough,” I said.

He looked up, perhaps only then realizing the man’s wife was present in the midst of all this horror. He called it. Henry was dead. It was just after 2:00 am.

I stuck around to speak with Mabel. I guess I tried to comfort her. She seemed…distant. Perhaps that was an effect of her stroke, not sure. They had no family members, none that came that night anyway, and I didn’t want her to be alone. I spent about half an hour with her, not nearly long enough as it turned out, before a chaplain arrived to take over.

“Thank you doctor,” she said, “for your kindness to Henry and me.”

I remember thinking how composed she was all things considered. “He was a good man. I’m sorry.”

“He liked you. He said as much.”

I thanked her again and said my goodbyes. I told her I would visit her upstairs later, though that may have just been lip service. Physicians are too busy for social visits to patient’s rooms, or so we tell ourselves. I had been growing antsy just waiting for the chaplain.

I never saw her alive again. She died before the sun rose that morning. She had been among the healthiest eighty-five year olds I had every seen. Her injuries were not remotely life-threatening. And she was dead.

An autopsy failed to disclose any particular cause of death. A little heart disease and of course the small stroke. Neither of these had killed her.

I believe she willed her own death, that she simply lost the will to live after her husband died in front of her.

A miracle? A hand of God moment? I don’t know. You decide. I’ve made my piece with it. Thanks for reading.

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