The Longest Half-hour

Arnold Tweed

 

During my penurious years of service as a junior medical officer in Her Majesties Armed Forces, I moonlighted in the Emergency Room of a local community hospital. It was a small hospital and the ER doctor on the night shift also covered the ICU. Since the worst disasters went directly to the larger General Hospital most of our ER work was routine. Occasionally, however, a serious emergency would arrive and require ICU admission. When that happened on my shift I would generally try to cope with both the ER and ICU until morning. That was the case the night Mr. Antonio was admitted.

Mr. Antonio was rushed to the ER, crumpled in the back seat of the family sedan, after collapsing at home. His was a classical history. A robust working man of about 50 years, in good health except for hypertension, he suddenly cried out that his head was splitting and fell to the floor. Although he had been mumbling incoherently when they carried him to the car, he was comatose on arrival in hospital. This was long before CT and MRI scans. Probably it was completely unnecessary, but I did a quick Lumber Puncture to confirm that there was fresh blood in his CSF. I’m not sure now whether the LP was done to allay my anxiety or strengthen my case when talking with his family. In either case, I wanted to be certain of my diagnosis that he had had a massive intracranial haemorrhage and the prognosis was hopeless.

He was quickly shifted to the ICU for observation. Meanwhile, the number of anxious relatives now overflowing our tiny waiting room was rapidly increasing. As delicately as was possible I prepared them for the worst, his teen-age daughter acting as my interpreter. There was little hope to offer them. It was my considered opinion that he would not live through the night. The message perhaps came through more bluntly in the interpretation than was intended and it triggered a chorus of wails and tears that continued unabated for the remainder of this episode. As the number in attendance increased so did the volume. They must have derived some comfort from each other’s company because they left my patient entirely to the care of the ICU nurses. Perhaps they realised that the sheer weight and volume of their support was the best they could do.

There was little more I could do so I returned to the ER where there was now a substantial backlog. Even there we could still hear the weeping of the grieving family.

The ICU nurses knew their job well and kept me posted with updates on his condition. When he became totally unresponsive to painful stimulation I was sure the end must be near. By now the disruptions of his noisy and restless retinue were beginning to grate on our nerves. When he developed Cheyne-Stokes breathing I briefly considered the life-support options, but immediately dismissed the notion. There was no need to write ‘Do Not Resuscitate’ or ‘comfort measures only’ orders. The nurses knew what to do and were not about to initiate futile attempts at CPR. That was just as well because the ER had become even busier and I had little time to devote to a hopeless case. Their family priest had arrived and he was quietly advised to administer the Last Rites. When they finally called to inform me that Mr. Antonio had stopped breathing I was relieved, hoping that would bring denouement to the tragic drama that was disrupting the routine of our small hospital.

A quick examination indicated absence of both respiration and radial pulse. I wanted to get the most unpleasant duty over first, to inform the family of his demise. Locating the immediate family members was less difficult than extracting them from their clinging support group but eventually we got them into a small private room where we could be heard. As expected they were devastated and their crescendo of grief was sufficient to transmit the message to the others. For several minutes anguish prevailed. Now they wanted to see him. Perhaps it was a premonition that held me back, the hot breath of my omnipresent evil genie on the back of my neck. I hesitated, “Just give the nurses a few minutes to make him look better”.

While I was sitting at the nursing desk completing his death certificate my genie struck. The practical nurse who was tidying the body for family viewing darted out of the room with a look and manner that I had come to recognize always presaged trouble. “You’d better come back quickly,” she said, “he’s still breathing.” Only after my re-examination confirmed her report did the full impact of my situation hit me. The nurse was mostly right; he wasn’t exactly breathing but he was gasping at a rate of 3 to 4 per minute, agonal breathing. And they weren’t gasps that could be ignored, they reverberated in that small room, accompanied by a heaving chest and flaring nostrils. Moreover he had a clearly palpable femoral pulse and a visible apex beat under his left nipple. It should be obvious to any fool that he was not dead; no lay person stepping into that room would have a moment’s doubt. Within moments his grieving family would expose me as just that fool.

I have since seen many patients undergo neurological death and have come to understand that the exact timing is uncertain and the physical signs deceptive. The medullary brain-stem centres that control breathing do not shut off like an electrical switch; they wind down like a potter’s wheel. Agonal gasping can continue for minutes, sometimes hours. If the heart is basically healthy it requires only a little oxygen to keep beating, and I have seen strong hearts continue to contract for 30 minutes after breathing has ceased entirely. Blood pressure, pulse rate and force of cardiac contraction vary unpredictably. Electrical activity of the heart, the ECG, may continue long after pulse and heart sounds have ceased.

At that moment the reasons for my misjudgement were unimportant; I feared that I was on the verge of more than just embarrassment. The noisy throng milling in the corridor were a sturdy lot of bricklayers and plasterers. They were of an ethnic origin noted for volatility and mistrust of official institutions. When they discovered that their dear relative, who I had just declared dead, was perceptibly alive I wanted to be somewhere else. It would be uncomfortable enough to be identified as the perpetrator of a morbid hoax, but, more seriously, they might immediately conclude that his treatment had been careless.

I needed time and the first necessity was to divert the approaching wife and children. Nurses were dispatched to delay them by any means, using any excuses necessary. With the door firmly closed and locked I had time to consider my plight. What were my options? One: I could slip out the back door and leave town. Two: I could admit my error and face the consequences, but I knew that he was bound to die soon and my humiliation might be averted. Three: I could hold a pillow over his face till he stopped breathing, but my good intentions might be misinterpreted. Four: I could sweat it out.

The next thirty minutes were among the longest of my life. I counted each gasp, I anguished, and I waited. When there had been no gasps and no pulse for a full 15 minutes I came out. His family was restive and didn’t understand my strange ritual. Thankfully they were respectful enough not to enquire. It was the nursing staff that saved my reputation. I never learned what they told the wife and children that kept them pacified for a half-hour, or how they explained my need to be alone with the patient for so long. But they made it appear as if it were part of the routine and hospital routine is inviolate.

Now, when I am called to pronounce a patient dead, I get very busy. For at least a half-hour I am engrossed in another task, cannot be located, or am otherwise urgently engaged. After all, on a scale that stretches to eternity it makes little difference if the patient’s official departure time is delayed for a half-hour. For me that experience was a half-hour that seemed like eternity.

Commentary on “The Healing Power of Prayer”

Our last posts, Harold’s Story and The Healing Power of Prayer have provoked some critical discussion. I am responding here because both Harold and I believe the questions being asked are important and relevant. Our responses are not the expert opinions of theologians, they are the observations of students of human nature who have observed the effects of prayer in the therapeutic setting.

Mike Czuboka asked: “Why is “faith” necessary? Why does God not just come out directly and tell us what we need to know?”

Arnold’s:  A good questions that has puzzled many. Our story is based on a concept of spiritual benefit that I believe Harold and I both subscribe to. I will copy Harold with this message for his opinion.

There are two answers to your question. The first, the one many find unsatisfactory, is that God acts in mysterious ways. This is our heritage from the story of Job, who was punished by God though he was a good man. This portrays God as capricious and a capricious God is of little comfort in times of need.

The second and more satisfactory explanation is that God does not work alone; He works with us and through us, not for us. Through the Holy Spirit of the Trinity He offers His Healing Grace, which is freely offered but with one important condition. The Grace of God must be accepted by faith, only then can its benefits be experienced. Rejected or ignored, it is of no help. God’s Grace is recognized by the supplicant in various ways: a feeling of oneness, peace, hope, embracing love. These are personal and subjective feelings but there are too many such reports to doubt the reality of the transformation for those who have had the experience.

This leaves the atheist in a catch-22 situation. Having no faith he cannot experience God’s Grace. Having no experience of God’s Grace he has no faith. This is a conundrum with only a conjectural solution. Can one acquire faith? Faith is an affective state of consciousness. This means roughly that it is something we know or feel innately, with certainty, and without need for logical proof. Generally it is part of our family and cultural heritage but it may come through various life experiences, through revelation or exercises such as prayer and meditation. I would prefer to refer you to more insightful writers on this topic such as Thomas Merton or William James.

You don’t have to reject logic to accept faith, you simply have to understand that parts of our psyche never did and never will run on logic. Logic is a late addition to our mental processes. It explains how the material world runs, but intuition explains how the personal world runs. The vast majority of our important life decisions, like choosing a mate or a profession, are not based on logic but on intuition. All of our fundamental concepts of self (who am I?), particularly our spiritual self, are intuitive. ‘Knowing’ something intuitively is insight freed from the restraints of conscious reasoning. Plato described it as “the innate ability of the human mind to comprehend the true nature of reality.”  It draws upon the resources of the mind: memories, past experiences, pattern recognition, emotions, imagery, spiritual longings and, yes, revelations.  Some of this is hidden in that mysterious part of the subconscious that Sigmund Freud called the ‘Id’. If empirical evidence and logical argument were the only paths to ‘truth’, then faith must be rejected. But, if you listen to your intuition you can have faith without offending your logic.

 

This is a rather long explanation Mike, but I hope it explains why I was compelled to write the story. For much more scholarly discussions I refer you to Thomas Merton, The Seven Story Mountain (1948) and William James, The Varieties of Religious Experience (1902).

Harold’s Answer: I would like to address your second question. Why does God not just come out directly and tell us what we need to know?

I am not a theologian but I have been a Christian since my youth. God has told us exactly what we need to know. My wife and I read through the Bible every 2 to 3 years.

God has revealed his nature and what He demands of us clearly in the Old Testament. He also has revealed His triunal nature through the writers of the New Testament.

I challenge you to set aside all the philosophers and who write about God and read what God says about himself.  At the least read several books of Wisdom, Proverbs and Ecclesiastes as well as Matthew, Mark, Luke and John. If you have not had your questions answered I would love to meet you and discuss these concerns you have.

Harold Wiens 

 

Mike, as usual, responded with more questions.

I have read the Bible, but I find it to be confusing and contradictory in many places. Even dedicated Biblical scholars can’t always agree on what the Bible tells us…The Protestant Reformation took place because some Christians did not agree with the theology of the Roman Catholic Church. Christianity today is divided into many factions with different interpretations of the Bible…But what about the billions of people, living and deceased, who have never heard of Christ? What about the radical Muslims who march to a different drummer and who will kill Christians if they do not convert? Why did Christians burn so-called heretics at the stake? Why did God not intervene?  If God created us why are we imperfect? That’s a question I pose to Muslims as well as Christians…Does God answer prayers? He has not answered all of mine. Some good things have happened, but others have not. About 6 millions Jews died in the Holocaust, even though many of them, I am sure, prayed desperately while being gassed, shot and burned to death. Why did God not answer their prayers? How many Albert Einsteins did the Germans kill?

Arnold’s Answer: Mike, these are all legitimate and penetrating questions, but theological rather than medical. I will simply offer you some of the assumptions I started with when I began this inquiry into the medical uses of religion. Please note that I don’t speak for Harold; he may disagree completely.

First, I read the Bible, both Old and New Testaments, as literature. Certainly there is a great deal of wisdom in both, but it is wisdom written by men (largely if not exclusively men and not women) and reflects the issues of their times. For example, the revival of Lazarus can be understood as a symbolic event, meant to convey an image of control over life and death.

Second, I view the Institutions of religion, not just the Catholic Church but all other forms of organized religion, as institutions founded by men (again) for the purposes of men. The only institution that I can trace back to Jesus is that of ministry. Therefore when we, for instance, look at the celibacy of priests, or birth control, we can view them as the dogma of a particular institution. Similarly. we can view the crusades as products of the ambitions of men, not God. And so on!

As far as I can determine from my study of prayer as an aid to healing, the benefits are freely offered but only received by those who request them in faith and humility. I don’t know what happens to the others. Perhaps they have other sources of spiritual succor which provide for their needs. In the current age, our Christian God is usually asked to provide spiritual comfort for those suffering illness, bereavement or other personal tragedies. In Biblical times He was often reported to actively intervene in the affairs of the world, but there is little evidence for that now. The material aspects of the world have been left in the hands of the evolutionists and physicists. Any claims for his active intervention in world affairs, for example the reassurances offered by George W. Bush and Tony Blair that he was on their side in the destruction of Iraq, should be met with serious skepticism. As a physician I see the purpose of God, as exemplified by the ministry of Jesus, primarily as a healer and teacher.

Mike, I apologize for this feeble response to your questions. It is as close as I can come to a scientific explanations of God’s works. William James pointed out, more than one hundred years ago, that you could only know God by his actions. Our observations as medical scientists are limited to the actions on individual lives, such as Harold’s. If we have not, ourselves, experienced these benefits, then our knowledge of God must be gleaned from the case reports of those who have. Case reports are accepted as scientific evidence if they are compelling, if what they describe is well outside the range of usual experience. Listen to the stories. Many of them are compelling!

 

The Healing Power of Prayer

Arnold Tweed 

This story is not about surviving the physical ravages of disease, it is about mental and emotional survival. I am attaching Harold’s own account of his illness. It should be read in full and sympathetically because only someone who has walked that road can fully appreciate the emotional as well as the physical pain. (Go back one to Harold’s Story). Harold describes some of that, but he focuses more on the positive, on the comfort and hope that he drew from his family and his Christian faith. His is a story about hope, love and faith – and the healing power of prayer.

Modern scientific medicine has made such dramatic progress in treating and even eliminating disease that we tend to see treatment solely in terms of physical interventions: drugs, surgery, radiation, manipulation. The science of medicine dominates the field today; the art of medicine is seldom mentioned. This is a story about the subjective aspects of healing and the importance of mental, emotional and spiritual factors in illness. But being subjective does not put it beyond the scope of science. I approached this as a medical scientist and looked for empirical evidence for benefits. I found much more than I had expected.

First, a word of caution, please do not confuse the use of spiritual in this context with ‘spiritual healing’ cults. The world is awash with such cults; just Google ‘spiritual healer’ and you will be flooded. One cult, the Aetherius Society, claims that its founder, Dr. George King, was taught the arts of psychic healing by extraterrestrial beings. Aetherians and similar cults often claim to manipulate some sort of ubiquitous ‘spiritual energy’ by ‘contact healing’. A recent expose in the Toronto Star warned of the fraudulent nature of purported ‘healers’ (Mendleson 2015). Harold and I use spiritual in a very different sense – not as a substance or force to be manipulated – but as a personal conviction that there is a being, greater than us, who loves us and asks only for our love in return. Harold never expected to be healed by prayer; he prayed for the strength to endure his illness.

Prayer for health is more common than we suspect. A national survey in the U.S. in 1998 found that 35% prayed for some aspect of their health and two-thirds of those found prayer to be helpful (McCaffrey, Eisenberg et al. 2004). Most did not discuss prayer with their physicians. This suggests an interesting dichotomy in health care: patients consult their physicians for the medical aspects of care but not for their spiritual, emotional and mental needs.

The use of prayer as therapy is a very private and largely ignored practice. Prayer can be for the benefit of others or for self. The first is called intercessory prayer, prayer by an individual or group for the benefit of another. The second is petitionary prayer, prayer for oneself. Harold was the beneficiary of both. His church community prayed for him; and his sometimes anguished personal prayers are well described in his story.

Intercessory prayer has been studied empirically by several groups, probably because it lends itself to the rigidly controlled studies necessary to ensure scientific validity. Leanne Roberts (Hertford College, Oxford, UK) has published three Cochrane Reviews (latest 2009, Intercessory Prayer for the Alleviation of Ill Health) which have summarized by meta-analysis the Randomized Control Trials (RCTs) completed up to that date. Now this is a heavy dose of academic shop-talk so let me clarify the terminology. The Cochrane Database is a gold standard for evidence based medicine; Cochrane reviews are carefully edited and scientifically vetted. Meta-analysis is a statistical technique for combining the results of several studies. RCTs are the gold standard for medical research and are designed to measure the effect of one treatment, and one only, on a target outcome. In their latest review Roberts and Company combined ten RCTs by meta-analysis (7,646 patients). First, you might be surprised to hear that there have been ten scientifically valid studies of this subject. Second, you might not be too surprised to learn that the results were equivocal. What does that mean exactly? Well, some studies showed beneficial results, some did not, but the combined analysis did not reveal a statistically significant benefit. Not surprised?

Does that mean there is no value whatsoever to intercessory prayer? No one has yet considered that the main, and perhaps intended, benefit may be to the prayer group. Group prayer fosters group cohesion, common purpose, shared values and reinforces faith. It enfolds the object of the prayer into the nurturing bosom of the community and reinforces group identity for all. Group benefit and individual benefit are difficult to separate.

However, before reaching a final conclusion, consider this. An RCT performed by Olver and Dutney from the Royal Adelaide Hospital in Australia with 1000 patients, published in 2012, showed small but statistically significant benefits in spiritual, emotional and functional well-being in patients who were prayed for (Olver and Dutney 2012). Now are you surprised? I am amazed! The design of their RCT was technically called ‘double-blinded’, that is the patients were randomized to treatment (prayer) and control groups but were not told which group they were assigned to. The group who prayed, an external prayer group, was given details about the patients but not their identity. In other words, the prayer group was praying for someone, they didn’t know exactly who, who in turn didn’t know if they were or were not being prayed for. Sound ridiculous? Well, that’s what you have to do to meet the scientific rigor of an RCT. There must be something about intercessory prayer that works at some level to survive that amount of obfuscation. Perhaps this issue is just too complex for science and we should abandon scientific efforts to prove or disprove religion.

Petitionary prayer has not been as well studied. In large part this is because it is so subjective and private. Since belief in the efficacy of the prayer is integral to the effect, it is difficult to conceive a study design where subjects could be randomly assigned to treatment (prayer) and non-treatment groups. However, there is a huge literature on religion and health outcomes and most studies used a general classification of religion/spirituality (R/S) to cover all aspects of belief, ritual and prayer. The specific contribution of petitionary prayer is hidden in the whole. Two major reviews were published in 2015 with meta-analysis of literally hundreds of studies (Jim, Pustejovsky et al. 2015, Salsman, Pustejovsky et al. 2015). Overall they concluded that there was a positive benefit of R/S on several measures of patients’ physical and functional well-being, including their symptoms and mental health. Several studies reported increased tolerance to pain and improved function, even when intensity of pain was unchanged.

It is also interesting that there is a trend in the recent palliative care and oncology literature to separate spirituality from religion. Medical providers are appropriating spirituality and relocating it into the bio-medical and psycho-social fields of research. Spirituality is being reshaped to encompass considerations of self and relationships while shedding the dependency on religious beliefs. A brief quotation from a recent review may give you a flavor of this change: “A ‘spirit to spirit’ framework for spiritual care-giving respects individual personhood.” (Edwards, Pang et al. 2010) If you understand that please enlighten me by writing a commentary to this article.

Medical science has identified that the benefits of prayer are mainly on subjective outcomes and coping behaviours. Please note that, in all of the literature documenting the benefits of prayer, there are no scientifically valid studies that demonstrate prayer to be an effective substitute for medical treatment. The main reason that prayer is held in disdain by scientists and medical doctors is the exaggerated claims made by some, Christian Science foremost, that prayer can replace medical treatment. There is no credible evidence whatsoever for these claims. Prayer can be complementary to medical treatment but it is not a substitute. If you read Harold’s story you will see that replacing medical treatment with prayer never occurred to him, not even when his treatment was causing him more distress than his disease.

The physical benefits of prayer may be attributed to a phenomenon well known to medicine, the placebo effect. Henry K. Beecher, Professor of Anesthesiology at Harvard brought the placebo effect to public attention in 1955. Its most important application since has been as a sham treatment administered to the control group in placebo-controlled clinical studies. However, there is new interest in placebos as a therapeutic tool in their own right. This is summarized in a recent feature article in the National Geographic magazine (Vance 2016). A more scholarly review published in the NEJM in 2010 combined studies (again by meta-analysis) in which placebo-treated groups were compared to no-treatment groups. They concluded that placebo treatment had a significant benefit when the measured outcomes were subjective and patient-reported, such as pain and nausea (Hróbjartsson and Gøtzsche 2010). These articles support the hypothesis that placebos act by psychological mechanisms, perception and expectancy effects, and by triggering the release of endogenous hormones in the brain (endorphins and cannabinoids). The magnitude of the effects are still controversial but estimates range from 7-35%. Evidence is mounting that the placebo effect is part of a natural defence mechanism. Are the medical benefits of prayer a placebo effect? They have similarities, and may depend on the same mechanisms, but we wait confirmation from appropriately designed studies.

This brings us to our last consideration; is prayer a psychotherapeutic or spiritual exercise?  It may be both since those who pray with conviction experience both spiritual and physical benefits. Although the spiritual side is opaque to empiric methods of study, bits of the enigma, the physiological and psychological bits that can be measured, are emerging. Hans Lou and colleagues at Aarhus University, Denmark, have observed that meditation exercises (they studied Yoga Nidra meditation) were associated with activation patterns in specific areas of the brain that modulate self-awareness (Lou, Kjaer et al. 1999). The same may be true for prayer. This is a start in understanding the complex cognitive processes associated with prayer and meditation. But the spiritual realm remains impenetrable to our methods, though spiritual needs are still a reality in our lives. Fear, grief and despair are the constant companions of disease and are not comforted by tranquilizers. Prayer is not just the bridge to the spiritual domain, it links the physical and spiritual domains so that its benefits are experienced in both.

Spiritual needs are traditionally met within a religious framework and Harold’s story describes how he found spiritual comfort in prayer and scripture, within his Christian faith. Some recent literature suggests that spiritual needs can also be addressed outside of a religious context. This at least recognizes the existence of spiritual needs, especially for the elderly, sick and dying, but we wait to see how these alternative approaches will evolve. Spiritual needs aside, my reading has convinced me that prayer is a powerful adjunct to medical treatment and is probably underutilized. The medical literature confirms that prayer, when offered with conviction, improves patients’ outcomes. Since most patients do not discuss their religion with their doctors the medical profession’s indifference to prayer is understandable. This is the business of hospital chaplains, but doctors rarely speak to them either. Instead of “Integrative” health care we have partitioned health care. If prayer were offered as part of the treatment plan would patients feel better, recover faster, and use less fentanyl? This is a challenge that our modern “patients first” policy makers might consider.

Postscript:

Before closing this story I want to add a personal postscript. I wanted to write about Harold’s experience for several reasons. I knew that Harold was articulate and insightful and could help us, as sympathetic spectators, share his experience and better understand the physical and mental agony of life-threatening disease. Harold and I are medical school classmates and have been friends for more than fifty years. We share the same medical education and the same scientific view of medicine and disease. Harold is also deeply and sincerely religious, as his story proves. What we see clearly in this story, and others of similar genre, is that his religious and his medical responses to his illness were never in conflict. There is never a suggestion that his medical treatment was threatened by his religion nor that his religion was threatened by medical science. His spiritual needs and medical needs were in different spheres and required different therapy. Medicine and prayer were certainly compatible and may have been complimentary. Those who claim that science has conquered religion, or that religion denies science have a very shallow understanding of both. Harold’s story shows that science and religion are not at odds; they serve different needs towards the same end.

 

 

. “The Aetherius Society.” from http://www.aetherius.org/dr-george-king/.

Edwards, A., N. Pang, V. Shiu and C. Chan (2010). “The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research.” Palliat Med 24(8): 753-770.

Hróbjartsson, A. and P. C. Gøtzsche (2010). “Placebo interventions for all clinical conditions.” Cochrane Database of Systematic Reviews(1).

Jim, H. S., J. E. Pustejovsky, C. L. Park, S. C. Danhauer, A. C. Sherman, G. Fitchett, T. V. Merluzzi, A. R. Munoz, L. George, M. A. Snyder and J. M. Salsman (2015). “Religion, spirituality, and physical health in cancer patients: A meta-analysis.” Cancer 121(21): 3760-3768.

Lou, H. C., T. W. Kjaer, L. Friberg, G. Wildschiodtz, S. Holm and M. Nowak (1999). “A 15O-H2O PET study of meditation and the resting state of normal consciousness.” Hum Brain Mapp 7(2): 98-105.

McCaffrey, A. M., D. M. Eisenberg, A. T. Legedza, R. B. Davis and R. S. Phillips (2004). “Prayer for health concerns: results of a national survey on prevalence and patterns of use.” Arch Intern Med 164(8): 858-862.

Mendleson, R. (2015). Purported spiritual healers a wideapread problem. Toronto Star. Toronto.

Olver, I. N. and A. Dutney (2012). “A randomized, blinded study of the impact of intercessory prayer on spiritual well-being in patients with cancer.” Altern Ther Health Med 18(5): 18-27.

Salsman, J. M., J. E. Pustejovsky, H. S. Jim, A. R. Munoz, T. V. Merluzzi, L. George, C. L. Park, S. C. Danhauer, A. C. Sherman, M. A. Snyder and G. Fitchett (2015). “A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer.” Cancer 121(21): 3769-3778.

Vance, E. (2016). “Mind Over Matter.” National Geographic 230(6): 30-55.

Harold’s Story

Harold Wiens

When my hip pain began in March ’95 I didn’t know that it was the onset of a life changing crisis which would affect me both physically and spiritually. My profession had prepared me to deal with others as they faced serious illness but I found that dealing with my own illness was much more difficult.

First, I will recount the story of my illness and then describe the ways in which my faith supported me. The diagnosis of primary cancer of the pelvic bone (osteosarcoma) was made 3 months later. My treatment was chemotherapy for 6 months and then an internal hemi-pelvectomy with an allograph (transplant) and a total hip replacement. In lay terms this is removal of the entire half of the pelvis and replacing it with a cadaver pelvis and an artificial hip. Limb salvaging surgery was rare at that time and had only been available for about 15 years in Canada. Prior to this amputation or palliative care were the only options. In Canada this surgery was done only in Toronto and only 25 persons had had this operation in the previous 10 years.

My chemotherapy was a horrible experience. I was nauseated, vomiting and had 2 intravenous pumps beeping day and night. For 72 hours I was unable to eat and too weak to do anything. To stop the vomiting I took medications which scrambled my brain.  I couldn’t concentrate and I was emotionally labile, sitting and brooding for hours. It felt like “Hell on Earth” and I was totally dependent, especially on my wife, Carolyn.

After six chemo treatments I went to Toronto in Nov. of 1995 for surgery. The operation lasted 10 hours and I received 17 units of blood. After six weeks in bed I started to ambulate, but with the assistance of 3 physiotherapists. My post-operative recovery was delayed by many complications. First, my new hip dislocated. Then, just when I was ready to go home, a CAT scan of my chest showed a tumor, so I underwent a lung operation (thoracotomy). Fortunately the lesions were benign, but next I developed an extremely high fever due to a blood clot in my leg (DVT), and a serious infection in my hip. I was placed on antibiotics, told to pray and I was slated to have my leg and pelvis removed in 5 days. Fortunately my fever subsided with antibiotics, the amputation was cancelled and I was finally able to go home on March 13, 1996, 4½ months after my admission to hospital. When I left Toronto I had lost 40 pounds, could sit for only short periods and only walk short distances with crutches. I flew on a stretcher from Toronto to Winnipeg, but when we got home I felt my recovery was beginning. Carolyn and I had dinner with our family and it was our first night in bed together in more than 4 months!

I gradually gained weight; strength and energy returned. I can now walk a mile with arm crutches, rarely nap during the day, swim frequently, read, concentrate well and my weight is back to normal. I have minimal pain and can socialize normally.

My leg was almost completely separated from my body during surgery and yet has once again become mine. Initially it felt foreign to me because some nerves were cut and others stretched. All my muscles and tendons were severed from my pelvis. Many have reattached to my new pelvis and I now function at about 50% of normal with crutches. Angels truly have protected my leg.

Those are the medical details of my illness but the mental distress was worse. I spent many hours contemplating my dying and worrying about my illness. The loss of hope creates a feeling of futility in us, our self-image drops, our sense of worth is lost. Fortunately I had spiritual reserves to sustain me. We realize in this lost and fallen state how important God is in our lives. Our earthly hope in self is replaced by the hope instilled in us by our faith in Jesus Christ. In that time of despair I found four scripture passages which helped me. When I was ill and going through my deepest valleys of despair I would turn to these passages. They were Psalm 91, Psalm 103, Luke 11 and Romans 8. God would speak to me and a “peace beyond understanding” (Philippians 4:7) would flow through me. God has promised us that any trial can be endured with His help. He helped Carolyn and me during the darkest moments, even when hope appeared to vanish.

I was not alone; many friends counseled me during this time.  Others prayed for me in their churches, prayer cells and in their personal prayers. This resulted in tremendous encouragement and support but ultimately I was left alone with my thoughts and found my solace in scripture.

PSALM 91: The key thought in this Psalm for me was that we are secure if we trust in God. “He who dwells in the shelter of the most high will rest in the shadow of the almighty.” (Psalm 91:1) This security is not dependent on us or our circumstances: all personal disasters or crises are covered by the umbrella of security which only God can give. There is, of course, a responsibility if we want this shelter. This security is ours only if we are willing to follow God. If we choose not to dwell in God’s shelter how can we expect to share in his promises?

As I read these passages my hope returned. I was reassured that I was secure even in my difficult circumstances. In my darkest hours my spirit soared. These promises were not only an abstract statement but a real and powerful force. How can people go through personal crises if they don’t put their faith in God? God will be your security even as He was for me.

PSALM 103: (a Psalm of David)

Psalm 103 is a Psalm of praise and thanksgiving. After reading Psalm 91 how could I not be filled with praise? I was no longer focused on myself but moved to praise God. What a change in emotions, from the depth of self-pity to the height of being in the presence of God himself. I could join David in singing praise in my heart. “praise the Lord, O My soul” (Psalm 103:1).

David praises the Lord with all of his innermost being. This is so meaningful to someone who is physically disabled. Our inmost being is intact, whole and not dependent on our disabled body. He praises with his soul which is eternal and will be with God.

LUKE 11: In Luke 11 and Romans 8 we see our relationship to God as our provider in all circumstances. I frequently cried out to God for relief of my emotional suffering and physical pain. When my problems became insurmountable I would turn to the promises found in Luke: “Ask and it will be given to you, seek and you will find, knock and the door will be opened to you—for everyone who asks receives, he who seeks finds and to him who knocks, the door will be opened.” (Luke 11:9-13) I did not pray that I would be healed.  If we pray selfishly and the answer we receive is not what we expect we blame ourselves for not having enough faith and God for not listening. Our responsibility is to pray in the will of God. What is the will of God? This is clear if we read his word: He wishes us to love the Lord our God with all our heart and mind and soul and to love our neighbors as ourselves.

My prayers during my illness were directed at the promises given to me in scripture, namely, to give me peace under all circumstances. The psalmist reassures us by saying, “I am with you always, I will not tempt you beyond your ability to withstand it, you are my child and you will be with me in eternity.” (Psalm 73:23) My prayers were answered with peace, patience and self-control.

Many times I would pray, “Dear God you have promised me the Holy Spirit. Allow Him to work in me and give me the fruit as promised” and a feeling of peace and joy would overwhelm me. The veil of fear and despondence left. This did not necessarily mean that I would be healed or restored to any semblance of normality. This was not the important thing. I was not concerned whether I would live or die but rather how I would live until I died. Now my physical, emotional and psychological state is much healthier but I still pray that the Holy Spirit be with me.

ROMANS 8: The last passage which has been so meaningful to me is Romans 8. In this letter Paul deals with the lifestyle of a person living with the spirit. He discusses the hope we have for the future. In times of stress and mental anguish the whole concept of a continuing hope is often lost. In my misery I felt things were hopeless and my thoughts had to be directed away to a bright and glorious future.

Paul also suggests that we wait patiently. How difficult this is. Patience is easy when things are going well and we are enjoying life. When we are going through difficulties patience can be a real struggle.

When we don’t know what to pray for or how to pray the Holy Spirit himself intercedes for us. Christ Jesus, sitting at the right hand of God, also intercedes for us. We are in the hands of the Holy Trinity; who are all concerned for us and our welfare. How this spoke to my heart and instilled a sense of perfect peace!

Since my return home I have had twenty wonderful years of recovery with increasing strength and return to normality. When I have concerns I return to the above passages for comfort. If you are going through difficult times I would like to share my “peace beyond understanding” with you. It works—give it a try!

If you wish prayer or a visit please contact me.

Harold Wiens MD, FRCP

#7-4025 Roblin Blvd., Winnipeg

204-832-0231

chwiens@mymts.net

12 December, 2016