December 24, 2018
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JIM McCUTCHON
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Today is Christmas Eve. The year is 2018, but, as I do every year, I think about a fateful Christmas Eve that must have been 30 years ago, more or less.
I was looking forward to a quiet evening and a happy Christmas morning. That was until I got a call from the emergency room. A man had arrived with a stone blocking his right kidney. I’m retired now, but I was an active Urologist then. Kidney stones hurt. I know. I’ve treated many of them, and I’ve had a couple of my own. I went to see the man. I was amazed to learn that, in extreme pain, he had come to the hospital by bus from a small town in the brush country west and south of Corpus Christi, and he had come alone.
X-rays had already been made. There was no doubt about the diagnosis, and there was no doubt about what he needed. The only way to relieve his pain and to save his kidney was immediate surgery. The problem for me was that he was a Jehovah’s Witness. What to do? I couldn’t stand by and watch him suffer, but I had a self-imposed rule against doing major surgery on a Witness who strictly observed their religious prohibition against transfusion. I talked to him as well as I could. The ER doctor had given him pain medicine that dulled his pain. It also dulled his consciousness, but he was not so mentally dulled that he couldn’t tell me that he would rather die than accept a blood transfusion.
I called one of my partners. He was no help as far as the quandary I was in, but he was helpful in that he agreed to come in to assist with the surgery. I had done many operations of this sort, and I had never had a bleeding problem. I broke my rule, reasoning that I could be in and out in 30 minutes without going near a major blood vessel.
Since the stone was impacted at the upper end of the ureter, the tube that carries urine from the kidney to the bladder, we positioned the patient on his left side for me to make the standard incision for right kidney surgery. The kidney was easily exposed. The kidney pelvis was opened. The stone was removed. The opening was sutured shut. It took about 20 minutes. No bleeding. All done. Not quite.
Something caught my eye. Beyond the kidney, I saw a small patch of black fat. Everyone who has ever seen a raw steak knows that fat is yellow, not black. I paused with the needle holder in my hand ready to begin closing the incision, but I was trying to figure out why that fat was black. As I watched, a faint trickle of blood oozed up through the fat from somewhere deeper. Then the fat began to throb. Oh God! I knew what was happening. He was beginning to rupture an abdominal aortic aneurysm. The aorta is on the left side of the body. We were on the right side, not an advantageous approach to the aorta.
What happened next was a blur of speed. Two excellent general surgeons were standing in the hall waiting for me to finish so they could do an emergency appendectomy. In less time than it takes me to write this, they came in, repositioned our stricken patient, made a new incision and compressed the aorta above the bleeding point. That helped greatly, but there is always back bleeding. They couldn’t control it all. Quickly, they resected the aneurysm and replaced it with a graft. I stood by and watched the fluid in the clear suction tube become paler and paler until it was pink. It was the classic story. The operation was a success, but the patient died.
Two weeks later, I got a call at home. Our patient’s wife had come as he had come, alone and by bus. She hadn’t called in advance. She wasn’t sophisticated enough to know how to do that. She assumed that, if she came to the hospital, she could get answers to the questions that hung on in her mind. I came to meet her. I found a woman much younger than her husband, but she was old beyond her age. She was painfully thin, and she wore a faded yellow dress that hung shapelessly from her shoulders. Her yellow-brown hair wasn’t styled. It hung as shapelessly as her dress. Her eyes were sad, and her face was drawn. I had to hold back the tears and resist the urge to wrap my arms around her to comfort her. She asked her questions. I answered as gently as possible. Finally, she asked the dreaded question: “If my husband had accepted blood transfusions, could he have been saved?”
The truthful answer was, “Yes”. The lie was, “No”. I don’t lie, but I couldn’t bring myself to tell her the truth. Her simple faith would have been shattered, and I feared that she would have been shattered with it. I looked at her and saw hope fight with fear in her eyes. So sweet and so simple. Her simplicity gave me the words: “You know what I think? I think God called him.” She relaxed visibly. All she said was, “That’s what I believe too.” We said our goodbyes and our God bless yous. I hope she went back to the brush country consoled. I know I was. I thanked God for the words that I was given. I will remember her on Christmas Eve until I die.
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