The master design, the divine creator the gives and sustain life and all-encompassing sovereignty, is something I did not know or believe as deeply in until these past few years of working in the medical field. The world of science is fascinating, there is so much undiscovered, so much to be learned. While my knowledge and understanding of science, of anatomy and physiology continually expands it is but a grain of sand. However, what grows deeper and faster each day is a belief, irresistible and compelling, that there is something greater, someone Greater.
The Scenario
Arriving a little earlier to work than usual, I was greeted with the news that I would be talking the first admission of the day. The patient I would be receiving had just undergone a liver transplant and was in critical condition due to a series of complicating events that had occurred during the case.. We prepared the room and equipment, received report from the OR team and soon enough transitioned the patient into our care.
It was a team effort from the nurses, doctors, and residents on the unit. We spent hours trying to stabilize this patient, titrating drips of vasoactive drugs, hanging unit after unit of blood and platelets, adjusting ventilator settings to maintain adequate oxygenation, reinforcing saturated surgical dressings, drawing blood for lab work, modifying our plan of care with each new test result or each change in heart rate, blood pressure, or respiration.
It had been a particularly exhausting shift and I began to sort through the events and happenings of the day on my drive home. What I hadn’t it realized until I turned onto our street that, throughout the day, I never felt like I had taken care of an actual human being.
It sounds so hollow, so terribly sardonic for a bedside nurse to say, as it is not uncommon that we have the greatest amount of physical contact and emotional contact with a patient in a day’s time. But I left feeling none of that, no connection, no real sense of vitality existing outside of the titrating of drips, units of blood and monitoring what these lines on the screens and pressures were telling us.
The Complications
This transplant surgery was complicated by a thirty-minute bout of cardiac arrest. While the OR team successfully resuscitated the patient, the lack of oxygen to the brain for that amount of time is capable of doing extensive and irreversible damage. There’s no real way to know the extent of damage in the initial period right after, though very aware of the potential outcomes, we worked feverishly trying to stabilize the patient hoping and praying for good outcomes, hoping and praying that the patient would wake up.
The clinical signs were very poor, very discouraging initially. But it’s interesting the hope that grows so quickly and strongly inside our hearts. It’s easy to find yourself more deeply invested than you might have ever imagined in situations like these. And I was invested in this one, just like many others, more invested and more hopeful than I was even aware of in the moment.
I went home that night, still thinking about this patient, hoping and praying for some kind of miracle given the grim situation and prognosis. We received report in the morning that the neurological status of the patient had not improved. Brain scans were done early that morning and revealed what most of us had feared. Massive amounts of swelling of the brain had led to herniation.
The Dreaded Call
The team of doctors called in the family. Some family from out of town and out of state had a sense that something was terribly wrong and had already begun their journeys to the hospital to gather with the rest. In an empty ICU room with desk chairs pulled into a circle the family assembled, the mother and father, sisters, brothers, sons, daughters, grandchildren and the patients spouse. A few of us who had cared most directly for the patient filed in as a neurologist and transplant surgeon entered and took a seat.
It’s the situation most dreaded, most feared by many. You can play it out in your head vividly, the setting, the impending news, the anxiety, fear, and overwhelming emotion of the situation.
One doctor began, as gracefully as that type of news can be given to a desperate family, he gave the report was given of what the scans had revealed. Sincerest apologies were extended on behalf of a team of highly educated and excellent practicing physicians for what they were unable to do. Tears fell as the reality sank in for this family, tears from a mother and father, though well advanced in age, for the grief and sorrow over the loss of a child. Tears from sons and daughters over the loss of a dearly loved, and tears of a spouse for the deep void that is felt when you lose the one your soul loves most.
Though we as a healthcare team knew nothing of this patient or families existence twenty-four hours before, grief transcends in a way that binds the human hearts of even complete strangers together and we too cried with them over this death.
We cried for the empty spaces dying inevitably leaves, for the sting, sadness, and pain that don’t ever go away no matter how old or young, how near or how distant.
When You Can’t Explain it but You Feel it
It’s tough to explain it but you can just feel it. I realized it after I left work that night in a different way. I’ve felt if before in caring hospice patients, as I would walk into their rooms a hundred times to check on them and many times. I would stand there for stretches of time just holding their hands as they slipped closer and closer to eternity. I don’t know what its like but I think I would want someone there holding my hand as my time drew nearer, to feel the comfort human presence and touch can bring.
But you feel it the second you walk in the room, once they have breathed their last and their lifeless body is all that’s left lying in the bed, you just know. You know it before you’re close enough to see whether there’s a rise and fall of chest, you know before you feel for a pulse or softly place your stethoscope on their chest to listen for the sound of life. You feel it because their soul isn’t there. And in a similar way that’s how it felt in this situation.
It sounds like complete madness, really I know it sounds crazy, but when I finally got the guts to bring up this seeming nonsense for first time at the breakfast table one morning after work, Justin attested that he had felt the same thing, that he had that same sense. He said he’d first felt it one night after receiving a level one trauma patient from Lifeflight. He worked frantically with the emergency and trauma team to stabilize this person, but all the while this person was fading, life is slipping away though the monitor reflected a beating heart and the ventilator shows lungs receiving and perfusing oxygen. He said he has felt it; standing in the empty trauma bay after the patient had been sent on to the OR, with the warm thick metallic smell in the air from the blood covering the table and floors, their soul wasn’t there. So either there’s something here or were both nut cases.
What I do know
I’m for sure not a theologian, I only took two bible classes and college and that’s because they were required for me to graduate, I can’t read Greek or Hebrew and some days I don’t even read my English bible. I’m for sure not a scientist either, I can barely even pronounce half of the diagnoses or surgeries my patients have, and thank goodness for iPhone apps that tell me the essentials about drug dosages and rates, lab values, and hemodynamic measurements because I can’t remember them all, much less begin to thoroughly understand them.
But I know, and have felt more powerfully and profoundly than I ever have, that there is a divine Creator, a master design behind each atom and cell that has been set into motion, and that there is a sovereign sustainer that holds of fragile bodies and lives in his very hand.
Some believe it is foolishness because there is so much of science that can be explained by algorithms and formulas, some think it is a cop-out for doctors and nurses involved directly in patient care because it negates us of responsibility we hold to save lives on our own measure through understanding, interventions, and treatments.
And if it is foolishness then so be it. But I’ve learned to listen to the things you feel, the things you sense, even if you can’t understand, make sense, or explain them fully, because they telling you something if you just listen closely.
What I do know though, is how surely I feel in the innermost parts of my soul, in the every fiber of my body, this unshakable assurance that there is a One who is all-powerful, all-knowing, preeminent, sovereign, holy, and supreme. One who tenderly holds our delicate lives, who precisely numbers our days, minutes and seconds. One who heals and binds, restores and redeems, who breathes life into us, and if we trust, He softly carries us over the threshold of eternity into his everlasting arms.