Tuesday, May 27, 2014

Catholicism: It's About Jesus, not Architecture.

I went to daily Mass yesterday at the tiny Polish parish, which is my geographical parish even though I know exactly three words of Polish.

One of the other parishioners had brought a non-Catholic friend to Mass. She happily introduced me to her guest. We went into the church together, and sat in the same pew. Because there is Eucharistic Adoration just before daily Mass at this parish, the parishioner pointed to the monstrance and whispered simply and confidently to her friend, "That's Jesus...."

I thought about the newcomer all throughout the Mass; I saw everything through her eyes. And I had so many questions. Why are there pictures of popes everywhere? Why are you praying for Mary's help in front of that "Jesus"? What is that forboding-looking picture (the Black Madonna), and why is it in the middle of the wall instead of "Jesus"? Why are some of these women wearing veils? Are all these candles really necessary?

If I'd been to my first Mass in a less old-fashioned parish (like the one where I grew up), I would have had a different set of questions. Why are these statues so ugly? Do all your churches look like warehouses? If that's the 'presence' of Jesus, why does everyone chat in here? And are all these candles really necessary?

But regardless of the parish, the biggest challenge would come as the faithful knelt and bowed low at the consecration. I imagined a visitor saying to me, "You are an intelligent person in a first-world country. You are going to be a physician, and you are bowing in front of a piece of bread. This is backwards. It's indecent."

I wish I could have had a word with the visitor before she left, but they left right after Mass and I was going to stay for Evening Prayer and meditation. I would have said to her, "don't be distracted by all the candles and statues and pictures."

In all my moves, and even the single diocese where I live now, I've seen parishes all over the spectrum between Spartan and Baroque. Some Catholics (like my Cistercian spiritual director) love rough-hewn blocks of stone, representative or primitive statuary, and unfinished wood. Others (like my mother) love filigreed altar rails, marble altars, and stained glass.

But those are all accidents, and the only purpose of all that stuff is to help our stubborn hearts bow to that impossible shock of the Eucharist. "Focus on that little Host," I wanted to tell that visitor, "Everything else in here is for our sake. You could go to another parish if you their architecture or their community helps you more. Or you could just be detached about it. But all this stuff is just to help you fall in love with God. And that," I'd say, pointing to the Host, "is God."

Source: www.lifeisaprayer.com
This post is titled with the highest respect to Catholic architects, especially Duncan G. Stroik, who are eloquently, quietly teaching the truth though beauty.

Friday, May 23, 2014

Abortion Hurts Women: I've seen It.

This post conforms to the blog rules.
I witnessed emergency surgery on a woman with complications after abortion. Someone had perforated her uterus, and she was rushed to our hospital.

I only heard about the case incidentally. I was on a different service (not the gynecology service, and not even on my OB/GYN rotation). I happened to be down in the main OR, and I was just leaving when I saw one of the OB/GYN chief residents I knew. I’d been trying to arrange a meeting with him about residency program selection. I was eager to hear what he had to say, because I happened to know that this chief had interviewed specifically to avoid performing abortions, or “terminations” as OB/GYNs often say. We’d never gotten to talk because he was out of town for vacation, I was out of town for the cardiothoracic surgery rotation, etc. When he saw me, he seized the moment to sit down in the physicians’ lounge and give me a list of programs he liked and a list of programs he didn’t like.

As we were talking, I noticed that not only was he there, but so was the third-year GYN resident, their attending, and the medical student on gynecology. This meant they had a pretty intense case. (The rarer the case, the more likely the upper-levels are involved. And to have two residents in on a case is rare indeed.)

The third year resident (R3) noticed that I was counting and surmising. “Something's coming up from the ER,” the third-year said, to explain why they were all there.

“A perf’d uterus from an abortion,” the chief said. The attending sat wordlessly by, watching the television.

“Your dream case, right?” the R3 said to the chief, smiling. From his comment and tone, I surmised that the R3 was probably pro-choice, and was joking with the chief, who had never done an abortion but who (I guess?) needed to log one. “Are you going to count this as an abortion?” the R3 joked.

The chief smiled back good-naturedly. “Yeah,” he said quietly, “ ‘open abortion,’ ” he said, referring to how he would make his incision. What must it be like to be pro-life among pro-choice colleagues for four years of training?

I asked to observe the case, even though I knew I couldn't scrub in (because there was already a med student and two residents, and because I wasn't even on the gynecology service). The attending gave her permission, and I went to see the patient in preop. She lay there on the ER cot she'd come in on; next to her was her significant other. She looked like a woman in pain—physically and emotionally. The other medical student (the one actually on the gynecology service) was scrubbing, so I took my place at the foot of the table, behind a machine and next to the kick bucket (where the used/bloody sponges are tossed).

There were a dozen people in the OR. This is a stock photo.
Once the patient was asleep, the chief resident made a large midline incision. Blood and clots came out as he reached the peritoneal cavity. The anesthesiologist ordered two units of red blood cells. I literally had to be careful not to get splashed as bloody sponges were tossed into the kick bucket in rapid succession.

The chief and the attending opposite him pulled the incision open like an emergency C-section, and then the chief reached in to explore the patient’s body with their hands. The chief resident emerged and passed something to the scrub tech, who placed it on her mayo stand, just a foot away from me. It was the head and shoulders of a fetus—a tiny, perfect bust the size of a plum. Next, they found the uterus and pulled it up. I could see it: part of it was a healthy pink, but one corner was mangled, raw, purple, and bleeding. They then explored the surrounding organs, and found the sigmoid colon nearly transected, the proximal and distal limbs held together by a pencil-sized strand of mucosa or mesentery (I couldn’t tell). When they pulled that up, there was an instant of silence as everyone in the room mentally said something between “oh my gosh” and an explicit oath.

“We need colorectal,” the attending said commandingly.

“Colorectal?” repeated the circulator, lifting the phone.

“Stat,” replied the chief resident.

The other medical student, who had already been on the trauma service, turned to me and said, “that’s worse than I ever saw on trauma.”

Again, stock photo. The OB/GYNs didn't need
headlights or loupes (or that sternotomy
retractor), but the rest is accurate.
Then began the fastest and bloodiest hysterectomy I’ve ever seen (and the only supracervical hysterectomy I’ve ever seen). As they cut away the fallopian tubes and ovaries, I heard the anesthesiologist say, “can we get two units stat?” The OB/GYNS continued to work like machines, clamping vessels and cutting uterine muscle, while the anesthesiologist updated them: the patient’s blood pressure was dropping, and he couldn’t get it up. “We need a trauma tray,” he finished.

“Trauma tray!” confirmed the circulator.

The anesthesiologist was starting an arterial line at the patient’s wrist. Beneath the sterile towels he’d draped over her arm, I saw that her fingers and fingernails were white, like the bodies we’d dissected in gross anatomy. The patient had started as a beautiful shade of bronze—she must have lost a lot of blood to be sheet-white like that! I started to pray.

Colorectal arrived—an attending and two fellows. Because I was the only one in the room without a job, I gave them the one-liner presentation. “This is an **-year-old female with perforated uterus and sigmoid after therapeutic abortion earlier today.”

“I heard,” the attending said grimly. He and one of the fellow got gloves and gowns. The OB/GYN attending looked up at them, her bloodied gloves holding two enormous clamps that disappeared into the patient’s pelvis. Her expression was remarkably calm. “We’re almost done,” she said. “We’re taking out the uterus.”

At that moment, my pager went off. I thanked the attending and went to see the patient I was paged about. It was a very boring “trauma,” for which I did nothing and the patient was wheeled (completely stable) to the CT scanner. As soon as I was free again, I went back up to the OR. The case had just ended, and the chief was writing the post-op note in the physician’s lounge.

I only had one question for him: did she make it?

“Yeah,” he said. He told me about the remainder of the case, most of which I don’t remember. I talked with the medical student the next day and he had more information.

“It was a cornual pregnancy,” he said. “So whoever was doing the abortion was going to perforate the uterus no matter what.” He knew I was against abortion, and I expected he said this so that I didn’t go on an abortionists-are-so-incompetent march. What he said fit with the appearance of the uterus—one corner destroyed.

“She also got a colostomy,” the med student went on. “And she didn’t know that. So when I went to round on her this morning and asked her how she was doing with a colostomy, she didn’t know what I was talking about. And she was pretty upset when she found out.”

This woman lost her baby, her uterus, and part of her colon. Although her colon would probably be reanastomosed later, she currently had a colostomy and unexpected time away from work, plus a long new scar and postop pain. Add to this that she was not safe during this surgery: her blood pressure was very low during it, and I was afraid for her life.

*SIGH* Stock again; her baby would have been much
smaller, less developed, and in the horn of the uterus.
I was very unhappy for her. Laws were recently enacted in my area to require preop ultrasound. Would preop ultransound have shown the location of her fetus? Had it been done? Had it been done carefully and well? Did they rule out cornual pregnancy? Did they see it but think they could do it anyway? Did they tell her she had a cornual pregnancy? Did they really give good informed consent?

I left with the overwhelming feeling that abortion clinics don’t provide best medicine to patients. And I already this, but now it was impressed on me forever: abortion hurts women.

Tuesday, May 13, 2014

Miracle in the Operating Room

This post conforms to the blog rules. Recently I witnessed a miracle. I was on the Acute Care / Trauma surgical team. When someone comes into the emergency room and the ER doctor thinks they need a surgeon, an AC/T resident is consulted. During the day and even overnight, we operate: taking out inflamed appendices and gallbladders, draining abcesses, debriding necrotizing infections, and repairing trauma patients. Whenever someone comes in with a gunshot or stab wound, or after a car accident, the AC/T team is paged and responds. It can be a very dramatic scene: a dozen people crowding around a person with nasty wounds, urgently managing serious injuries. The role of the medical student in our institution is: A) don't get in the way and B) look like you're trying to help. I usually end up getting the warm blankets and C-collar, putting in a Foley, and then standing around stupidly. Most of the traumas I've been paged for haven't exactly been movie-quality. In fact, some are downright boring: the patient is stable, just has a few fractures, and we roll them to the CT machine and stand around while the images populate with (surprise) the fractures we already knew were there.

But one day, someone came in from a bad, bad accident. He'd been hit by a car as a pedestrian. I got the page while sitting with the residents right outside the door of our last trauma. "Another autoped," I overheard a nurse say. "But this time a head lac; exposed brain."

I raised an eyebrow. "Lac" is short for "laceration," And a cut so bad that the brain was exposed sounded awful. The other day, we had a motor cycle crash, which gave the man a twenty-centimeter head laceration down to the skull. But exposed brain? That was a new level. They wheeled the unfortunate man in, and I couldn't see brain, but I could see lots of blood.

To make a long story short, he crashed in the trauma bay. "Crashed" means "died" in medical slang. He "desatted" (had very little oxygen delivery to his tissues) to 54% (you're at 99-100% reading this) at one point, had a difficult airway to manage, lost blood pressure, we couldn't find a pulse... Finally, the AC/T attending shouted to the bay at large, "I'm doing an ER thoracotomy."

I couldn't believe my ears. I'd read that ER thoracotomies existed, but I had no idea they were really done. But before my eyes, she seized a scalpel and there, in the ER, without so much as a surgeon's cap, she slipped her blade through the skin, a red line of blood springing up as if from a paintbrush. With one stroke, she cut down to ribs, then exposed his heart and lungs. She did open heart massage, and clamped his aorta. Then, just like that (with his chest open) we wheeled him to an operating room. There, I scrubbed in with the attending and two of the residents.

The patient was in a shaky situation. I watched his exposed heart as it beat an organized but thready rhythym. It wasn't enough to generate a pulse, meaning that his brain (and everything else) wasn't getting blood. The attending couldn't even feel a pulse in his aorta. Her gloved hand up to mid-forearm in his body, she shook her head. "I can't get a pulse." After some discussion with the anesthesiologists, she shook her head again. "We're slamming blood and fluids, the aorta's clamped, he's on epi, we gave intracardiac epi... Am I missing something? I'm thinking this is futile." The residents stopped their work in the abdomen.

I looked down at the patient. I had been slipping off spontaneous prayers and and fragments of Hail Marys during the case, because this was the most desperate I'd ever seen a person on the operating table. Now I knew something drastic needed to be done, because this was very likely the day of this man's death. Why had he lasted so long, though? With an injury like this, with a heart like this...why was he still hanging on? Somehow I knew the answer.

"He needs help to avoid hell," I thought. "Who do I ask?" And I couldn't think of anyone for a moment. No saint's name came to mind, even though I scrambled to find one. Then a name came to my mind: Chiara Lubich.

"Chiara," I prayed, "help this man to live long enough to make it to purgatory."


"Oh," I heard the attending say aloud, her hand still buried in the chest of my spiritual brother. "Whatever you guys just did, it worked. I've got a good pulse at the aorta now. Yeah, it's good."

I could barely control my excitement. We all looked down at the heart. It was contracting much more efficiently now, with a confident double "lub-dub," rather than a wimpy "meh." And then people sprang back into action. The residents closed the abdomen and the attending began to close the chest. The aorta was unclamped. Plans were made to transfer the patient to the ICU.

But a change happened after the aortic clamp came off. The heart again began to beat inefficiently. As soon as I saw it, I knew what would happen next. "Thank you, Chiara. That must have been just enough time. Thank you, My Lady; thank You, my Jesus. I trust You." I was full of joy and peace. The patient was pronounced dead shortly thereafter.

As far as I can tell I witnessed--maybe even took part in--a miracle. When you read this, thank God, and pray for the souls of those dying right now.