By Faith, Not By Sight

A large man by anyone's standard, he was much more than overweight. He was tall and heavily framed, with a broad face and meaty hands. Still though, he carried probably close to 75 lbs extra with him wherever he wandered. By all accounts this mountain of a man was immovable, unconquerable, invincible.

That is, until he went to the dentist.

It was a simple extraction, nothing so involved as a root canal or other oral surgery. And it took no more than 15 minutes from needlestick to lollipop unwrapped from the cheery mug on the counter, meant to soften the blow of paying for often painful services at the payment window.

Even as he lumbered out the door, pausing to hold it open for a harried mother with three small children in tow, he had no idea.

He had no idea he was already dead.

A few weeks later, he had been ill for more than a week. He passed it off as being fatigued from the busy season at work, but his wife knew better. That was his way though, shrugging off illness like a bull swatting a horde of biting flies with his tail. But when he began talking out of his head, making incomprehensible requests and becoming severely agitated when she couldn't make heads or tails of it at all, she ran for her cell phone to call 911. Likely that saved her from injury as well, for as soon as she left he had gathered himself unsteadily to his feet and promptly collapsed onto the oak and stained glass coffee table, flattening it and sending shattered leaded glass whistling through the air like so many pieces of brightly colored shrapnel.

Arrival at the ED found him in dire straights indeed. The 12 lead EKG in the ambulance on the way in showed massive ST elevation, but his clear stroke-like symptoms described by his wife were also particularly troubling. The monitors barely registered a blood pressure. The impressive array of superficial cuts from the coffee table that seeped and oozed blood were by far and away the most visible sign of trouble, but were the least concerning. At least until the removal of the particularly large fragment in the middle of his chest began bubbling black purulent blood like black gold oil flowing out of the ground in West Texas.

The final tally of CT's and other tests read like a cheap Saturday night horror flick. An abscess in the sternum had carved out its own living quarters, eroding into the aortic arch and front face of the heart. This did little more than expose the massive biological vegetation growing throughout both ventricles and atria.

Clearly a large fragment of this vegetation is what caused the massive stroke that strangled the life from half of the cerebellum, and most of the occipital, temporal, and frontal lobes on the left side of the brain. Unmercifully the mid brain and brainstem were spared, allowing bodily function to continue. And just to make life interesting, he was in massive septic shock, which had taken out most of his gut and kidneys.

A semi truck would have caused less damage.

And that's how I met him--recovering him from the 16 hour surgery to replace his aortic arch and bypass the 5 coronary artery blockages, and to reconstruct as much of his mediastinum as possible. He was on the ventilator, IABP, CVVHD. He was maxed on 4 different pressors, barely maintaining a MAP greater than 50. Chest tubes sprouted from every possible sector of his chest, draining foul black sludge from his tortured body. His urine, less than 20 mls of it per 12 hour shift, was black as well.

No other hospital in our area would have done this operation.

And through it all his beautiful family persevered. Stealing 5 minutes at a time during lulls of activity to pray over him, and gracefully stepping back to allow us to continue our care. Remaining sweet and grateful, thanking each nurse, each physician for caring for him as they left his bedside. Speaking words of encouragement to the other three patients and their families in the pod (none of which nearly as ill as their own loved one). Undeniable, unbridled, impossible faith.

I found myself in a moral dilemma. Every ounce of my medical knowledge told me that this man would not, could not survive. This knowledge demands of my ethical standards to keep my patient's family informed, albeit with caring and sensitivity, but a *realistic* picture. I simply could not live with myself if I created a false sense of hope for someone.

But this family's faith is contagious. Do I dare hope against glimmer of hope that a miracle happens? Is it my duty to battle this unrealistic shred of sanguineness?

I carefully, lovingly even, kept the family up to date regarding his condition. I could tell they were firmly grounded. They knew and understood the severity of his condition.

After one such update to his wife, I found myself apologizing to her for not being able to fix him for her.

Resting her hand momentarily on my arm, her tired eyes sought mine and smiled a quiet, knowing smile.

"Right now," she said, "We're walking by faith, not by sight."