Friday, July 22, 2011

FIRST ON FRIDAY WITH DAVID LEVY, MD AND GRAY MATTER

David Levy, MD
What We Are Saying: 
It's our pleasure to welcome David Levy MD to our blog.
What Happens When Surgery and Prayer Mix?
 Neurosurgeon, Dr. David Levy shares his personal stories of faith, forgiveness, and the power of prayer in his neurosurgery practice.
Science and religion don’t typically mix well. David Levy says the role of prayer in healthcare is itself a gray matter. So when he, a  highly-respected neurosurgeon,  decided to ask his patients if he could pray with them prior to surgery, he had no idea what to expect.
What if the surgery went poorly? Who would be to blame? What if it went well? Would science or God get the credit? And how would introducing prayer into the surgical process change his patients’ and colleagues’ opinion of him as a surgeon?
Discover more and get a fascinating glimpse into the elite field of neurosurgery.
and leave your name and email address for a chance at winning  a free copy of his book.
 About the Authors 
 David Levy, MD practices neurosurgery in San Diego, California. His articles have been published in a variety of neurosurgical journals, and he is an accomplished and engaging speaker and presenter. In his off time, David enjoys helping those less fortunate who live in California and in other parts of the world.

Joel Kilpatrick is an award-winning journalist and author whose work has been featured in Time magazine, the Washington Post, USA Today, CBS Radio, the Dallas Morning News and many other newspapers and magazines. He lives in southern California with his wife and children 

 What David Levy, MD  is Saying... 

 I wanted to have it both ways-to pray for people and see the power and comfort that it brought them, but not be thought of as someone who prayed for people or believed that God is relevant to medical care. To stop living that lie would take courage, but it would also provide relief if I could do it-no more waiting around for nurses to leave, no more agonizing or hiding my actions. I saw before me tantalizing freedom that would come from being bold and single-minded. I also saw the risks to my reputation and my pride. I had a choice to make.” ~



Chapter One-Risk Factors

 Maria, the well-dressed businesswoman sitting in my office, had a brain aneurysm.

One of the blood vessels in her brain had weakened, causing the vessel wall to balloon out in one place like a snake that

has swallowed an egg. From the size and irregular shape of the aneurysm I had concluded that if not dealt with relatively

quickly it might burst and kill her.

She was employed in high-level management and looked the part: she wore a black suit and heels, and an attaché case

that appeared to be full of paperwork, presentations, and might be here on a lunch break between important meetings.

I half expected her to say something like, “I’ve got ten minutes until my face-to-face with clients, Doc. Make it

snappy.” But I could see that this sudden and unexpected diagnosis was causing her concern—a brain aneurysm isn’t
exactly one of those things you put on your calendar and schedule into your life.

It was our first meeting. She had been referred to me  week earlier by the neurologist who had picked up on the
aneurysm, an unexpected “catch” that might very well save Maria’s life. Many brain problems don’t announce themselves.

Aneurysms, notoriously, give no warning; they hide in the brain until one day, when the blood pressure proves
too great for the strength of the artery wall, they rupture and bleed, causing a tremendous headache, loss of
consciousness—and eventual death. Sometimes, in the fortunate cases, the aneurysm will push against a nerve or brain
structure and prompt some odd symptoms that might alert someone before a catastrophic rupture. In Maria’s case, there
hadn’t even been a suspicion of an aneurysm. The MRI scan had been ordered for a completely different, minor concern.

But like a video security system that happens to catch images of a wanted killer lurking in the background, the scan had
detected this menace inside her skull. My job was to fix it before it could do any real damage.

If you have a brain aneurysm less than seven millimeters in size, a quarter inch in diameter, the chance of it bleeding
is relatively low, less than 2 percent per year. That means the chance of it not bleeding is greater than 98 percent every
year, which is not a large risk. However, if it does bleed, the risk of death is high—30 percent of those whose aneurysms
burst don’t even reach the hospital alive. They die from the trauma of blood flooding the skull and having nowhere to
exit. Of those who make it to the hospital, 30 percent end up with a major cognitive deficit of some sort, losing their
ability to talk or walk or recall information or even recognize loved ones. They are not able to resume their previous
lifestyles. These are the kinds of facts I have to lay out for patients when discussing whether or not to treat them. I have
to tell them whether I think that aneurysm or other malformation we see on the scan has a good chance of bursting or
harming them and, if so, how to fix it before it does. As for Maria, I felt she had no choice. The nine-millimeter
aneurysm had multiple weak spots, or “daughter sacks,” and was large, unstable, and unpredictable. It had to be treated.

We sat across from each other in my exam room at the San Diego hospital where I practice. The room is nothing
special, your typical ten-by-ten medical box with a sink, cabinet, and window looking out on the trees in the parking
lot. Nothing about it bespeaks comfort. Only my own nature photography hanging on the walls sets it apart from
any other room in any other medical facility in America. Lining one wall are seats for the patient and family, though
there was nobody here today but Maria and me. Just off to one side is a rolling computer stand into which I enter data
and can review a patient’s scans. Now I turned the computer screen around and showed Maria a 3-D rotational picture
of the aneurysm from the CT angiogram. The multilobed, balloon-shaped aneurysm arose from her smooth brain artery
like a phantom from a drainpipe.

“Let me lay out how I would approach this technically,”I said.

On the wall behind me was a whiteboard on which I drew a picture of her aneurysm and then detailed the treatment
plan, to help her understand what would be taking place inside her skull while she was asleep. After a moment,

I swiveled gently away from the board to face her. This was an important moment for both of us. In spite of her
professional demeanor, Maria was now giving all the visible signals of agitation: arms and legs held uncomfortably tight
against her body, eyes and facial muscles tense and alert. She keptmaking quick motions with her head and unconscious
repetitive movements with her fingers. If she was trying to hold the anxiety in, it wasn’t working; the tension was spilling
out.

Maria seemed to be wondering if her life, so full of the things she had hoped and planned for, was coming to an end. It was
as if someone had slammed on the brakes and turned sharply into a blind alley called brain surgery.

As the neurosurgeon walking her through this difficult news, I had a complex set of tasks to perform. I had to ease
her mind about the upcoming procedure, giving her the confidence that it could be successful and that she could come
out of it without any loss of function. I also had to be honest with her about the level of risk it involved—of blindness
coma, paralysis, or death—so that she could properly set her own expectations and those of her family. We could not
avoid the possibility that, as with any surgery in so delicate an area, things could go terribly wrong. I had to convey all
this in a calm, honest, and straightforward way—to someone who really didn’t want to hear it.

So much of a doctor’s job is in not just diagnosis but in demeanor and presentation as well—the way you come across
as you speak, the way you comport yourself, the way you relate to patients. Are your eyes steady, or are they shifty? Do
you look into their eyes or over their shoulders or around the room? What does this subtly tell them about their
prognosis? What can they read into your body language, your hand motions, your almost imperceptible movements of
facial muscles, your ease or lack of ease, and your willingness to engage with them as persons, not just medical problems?

Pre-surgical consultation is a dance. You have to practice it, becoming light on your feet and making the right moves in
sequence, for it to seem graceful to you and to your patients. Fortunately, I have a calm manner that seems to set people at
ease. Still, it takes a great deal of experience to make bedside manner seem effortless and ultimately that is what you want
to achieve: a sense of peace and confidence in spite of a bad diagnosis. I explained the risks and benefits of intervention,
and the risks and benefits of doing nothing. She nodded and followed along, taking it all in. As she looked at me, her eyes
pleading for good news, I knew she was waiting for me to tell her that there was a pill or an easy treatment—something
quick and painless that would solve her problem. Most patients believe, or at least hope, that a doctor can do anything.

We are the modern medical high priests, called upon in almost spiritual fashion to rid people of the inconveniences of
illness and to heal on demand. At least, that’s how people treat us and how, especially in my field of neurosurgery, we
often want to be treated. But I had made a decision to give up the role of high priest, even if I still looked like one in my
white coat and light blue scrubs—the standard, intimidating outfit that helps to signal the surgeon’s separation from and,
technically speaking, superiority to the people around us. Yes,I am a highly trained medical professional, but I am not my
patients’ ultimate healer, and I certainly am not their god. I believe that position is already taken.

I glanced over her scans one more time, knowing full well that, with her, there was only one way to go.
“Maria, I recommend we take care of that aneurysm,”I said. “It is the type we call a berry aneurysm because it has
a small ‘neck’ holding it to the parent vessel. The aneurysm itself is round like a berry. Unfortunately, this kind has thin
walls, and your thin walls have thinner walls called ‘daughter sacks,’ which I believe make it more likely to burst.”

She didn’t even exhale when I said this. It was as though she were holding her breath, waiting for the good part. She
wanted me to tell her that she would be fine, but I could not promise that. Looking at this woman in the prime of her
ife and career, I was struck yet again by the fact that people with nothing outwardly wrong can have a ticking time bomb
inside their heads.I felt compassion and a familiar sense of peace. It would be tricky, but I had the skills to help her, and I
loved using those skills; we were going to mend this thing so she could get on with the rest of her life. I wanted nothing
more than to help put this incident firmly in her past. Ideally, she wouldn’t see the inside of a hospital again until we did
follow-up scans several months later to monitor her progress. Unlike other relationships, most surgeon-patient
relationships should be temporary. We come together, solve the problem, and then go our separate ways.

“Can it wait?” she finally asked.

Statistically, it could; an aneurysm of that size had been there a long time. But those who have been in the business
long enough have seen people bleed before they can get into surgery.

“If your aneurysm were perfectly round or smaller, I would have no problem waiting,” I said. “We could wait
a month—but I don’t feel good about the size and shape.”


She nodded slightly. “Then I guess that’s what I have to do,” she said. “I’m sure I’ll have more questions when I’ve
had a chance to digest this and research it a little more, and after I tell my family.”


We both sat quietly as she considered again what I had said. After a moment, I leaned forward slightly and did what
had become customary for me, something that I had never seen another doctor do, something that in a single moment
stripped me of any semblance of godlike status.

“I know that I have given you a lot to think about. Would it be okay if I said a prayer with you?” I asked in a tone that
made it safe for her to say no if she wished.

 I had asked earlier about her spiritual history and learned that her parents were Catholic but that she did not attend
services.

She tilted her head to one side and looked at me curiously, as if reading a financial report she didn’t understand. She
relaxed slightly and nodded.

“Uh, okay,” she said, a little confused. “Fine.”

I slid my rolling chair over to her and slowly reached out my hand. As surprised as she was, she instinctively reached
out with both of her hands and grabbed it as if grabbing a lifeline. I bowed my head to give her privacy. Then I began
to pray.

“God, thank you for Maria and for allowing us to find this problem,” I said. “This is a surprise to us but no surprise
to you. I am asking that this aneurysm not cause her any problems until we can fix it. Please give her peace and good
sleep leading up to this surgery. God, we are asking you for success for this surgery. Give her the sense that you are with
her. In Jesus’ name, Amen.”

I opened my eyes after the short prayer. Maria’s chin was on her chest and she was crying softly. Tears had made water
marks on her skirt. Peace seemed to blanket her, and she was tranquil and centered, like a visitor in a church or other
sacred place. Gone were the extraneous movements born of high stress. She breathed deeply and seemed to exhale the
concerns that had nearly overtaken her. This sudden change might have surprised me if I hadn’t seen it happen so many
times with so many other people.

After a few moments she looked up at me. Tears were blending with her mascara and running down her cheeks in
gray streaks. She nodded her affirmation of the prayer and dabbed her nose with a tissue that I handed her from the box
I keep on my computer stand.

“Thank you, Dr. Levy,” she said with a sparkle in her eyes that spoke of calm and hope. “I’ve never prayed with a doctor
before.”

I smiled. I’d heard that many times. This simple act had done what no conversation, no psychological analysis, no
recitation of the medical facts had ever done, in my experience. She had received something no insurance company,
medical provider, surgeon, or drug could offer: confidence and peace from a simple prayer.
And even, I believe, a welcome touch from God.Maria’s surgery went flawlessly—until the very end. Then a tear in the
aneurysm caused blood to flow  into the spaces of her brain with every heartbeat. I feared the worst; we might not be able
to save her.

With my crew waiting for instructions, I called for the specific tools I would need to repair the breach. Everything
seemed to happen in slow motion, and I felt my frustration rise. There is nothing surgeons hate more than surprises,
especially the kind that could rob this family of a wife and mother. I guided my instruments up the carotid artery just below
the bleeding aneurysm and tried another method to stop the bleeding from the potentially fatal tear in the vessel wall.
After five minutes of intensely focused work, I injected dye to see if I had succeeded. My heart sank as I watched the
screen and saw the dye leak from the top of the aneurysm as she continued to bleed.

She had been bleeding into the brain for more than five minutes. Would she survive? And if she did, what would she be

like?

It took several more minutes of delicate, painstaking work and periods of agonizing waiting, but finally the bleeding
stopped. It took another hour to determine that Maria would survive the bleed and had not suffered a major stroke; she
was moving her arms and legs and was talking.

As she went into the intensive care unit and continued to improve over the next few days, I thanked God for answering the
prayer that Maria and I had prayed together in my exam room. I believe it made the difference for Maria—and for me.
Because in neurosurgery, you never know what might happen.

• • •

I have no way of knowing exactly how many nurses, doctors, surgeons, or even other neurosurgeons take the spiritual
lives of their patients seriously or pray with their patients as I do. It’s certainly not a subject that comes up at medical
conferences or with coworkers in the elevator or hospital cafeteria. In fact, if spirituality is not introduced in a way that
honors the patient and his or her faith, it can lead to ostracism by the medical community or worse—discipline of some
kind.

The role of prayer in health care is itself a gray matter.

~~~~~~~~~~~~~~
Copyright 2011 by David Levy. Used with permission from Tyndale House Publishers, Inc. All rights reserved.  Dr. Levy's book may be purchased at any major book seller.


Dr Levy is giving away one copy of his book to a lucky winner. Please leave your  name and email address so that we may contact you if you win the book. Thank you so much for taking time out of  your day to spend with us.

6 comments:

Dejah said...

I'm sure his responses have been varied. Personally, I hate being prayed over. I don't mind people praying for me. It can't hurt, even if I am unsure of its ability to help. If I feel the need for prayer, I pray privately. But put in a situation like the one he describes, where life is at stake and the alternative is scary brain surgery, perhaps I would feel differently. Who knows. But frankly, my usual reaction would be even more discomfort. Living in the south, I have learned how to deflect such well meaning offers, but it never seems to be as graceful as i'd like. The person offering always seems to be offended that I don't want their "gift," when to my thinking, the offer to pray with someone SHOULD be something you can refuse.

susansheehey said...

That's an incredible story, Dr. Levy. Thank you for sharing this experience. It was extremely touching. I don't know of any doctor who prays with their patients and the more I think about it the more it makes sense. Where else could prayer make such a difference if in no other way the way we feel?
Thanks again!
susiesheehey (at) verizon (dot) net

Anonymous said...

Speaking from a personal viewpoint, if a surgeon wanted to pray with me, I'd think my situation was worse than he described and it would frighten me. I can't say I've ever seen a doctor pray with anyone, so this is an unusual man.
Tamara

Richard Mabry said...

I've prayed many times in my 36 years of practice, but almost always in private. I prayed for wisdom and skill for myself as I prepared for surgery or sought the best course of treatment. I prayed for grace and comfort for the patient and family. And last of all, I prayed for all concerned to be able to accept God's will in the matter.
Thanks for sharing your own experience.

Anonymous said...

I had a doctor who used leave the room and say, "Have a Blessed day." A nice gesture but not necessary.
Annie

Ruby Johnson said...

I work in obstetrics and I held a patient's hand while she was having an emergency c-section under epidural anesthesia. I talked to her in a soothing voice to try and help her relax. I saw her again two years later and she said, "Oh, you're the one who held my hand and talked me through my emergency c-section. It meant so much to me." I believe in the power of touch in connecting to patients. I've never prayed with a patient but I'm sure it can't hurt.

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