August 12, 2009

God's Waiting Room

2009 1522 page14 capuanita Cruz* recently taught me a lot without ever speaking a word. She was my patient in the medical intensive care unit, where many patients cannot speak. In bygone years physicians not only knew their patients; they knew the entire family. This enabled physicians to help families as they dealt with end-of-life decisions. Such is now rarely the case.
I had not known Juanita previously, and she was deeply sedated or unconscious for her entire stay on our unit. A mechanical ventilator supported her breathing. Potent medications were applied intravenously to keep her blood pressure in a safe range. Dialysis, performed every day, mimicked her kidney function. Intravenous feedings and insulin were being given because her intestinal tract no longer functioned. Multiple antibiotics were administered to combat infections in her lungs. Day after day her outcome continued to hang in the balance.
Word came to me that Monty, Juanita’s son, had asked me to meet with the family. That afternoon Monty, his sister, Dana, two of their close friends and spiritual supporters, and I assembled around a table to talk about Juanita.
We went over the medical facts of her case. Juanita’s outlook for recovery appeared rather grim. My best estimate for her chances of survival was around 20 percent. If she survived, she would face prolonged disability and need extended rehabilitation.
2009 1522 page14I asked Monty and Dana if their mother had provided some guidance as to how to proceed, given her serious condition. They told me that until she lapsed into unconsciousness, she was quite clear that unless her brain was no longer functioning, she wanted everything done to support her life. As the meeting concluded, one of the friends suggested we pray. He specifically asked God for wisdom and skill for those treating Juanita and for blessings on her and her family.
A Week Later
A week passed by and Juanita’s condition had not changed appreciably. Monty requested another family conference. We reviewed the medical facts and Dana asked for an updated prediction for her mother’s chances of recovery.
I told her it was no different from the last time we had spoken. Dana voiced frustration at not knowing, not having a clear direction of where things were going with her mother. Words started pouring out of my mouth. “Well, it really is in God’s hands.”
Dana, who didn’t appear to be one who cried easily, was on the verge of tears. “Yes, I know it’s in God’s hands, but it’s just so hard not knowing!”
My thoughts whirled. Should I talk to her about God letting us face circumstances that can build our characters? Should I say that sometimes God lets things come our way to teach us to depend on Him? Should I tell her these “tests,” though unusually tough, reveal that God had a special interest in her and her family, a test beyond which most people are never called to face?

Somehow the words didn’t materialize, and the family meeting concluded.
On the Brink
Several more days passed. Juanita still teetered on the brink. Dana was becoming more distraught over the situation. Monty appeared to be hurting also. Outside Juanita’s room, Dana burst out: “I’ve been reading, studying, praying to get some guidance as to whether it’s OK to discontinue life support. Are you an Adventist?”
“Absolutely!” I replied. Then, more softly, I said, “There’s no answer to your question in the Bible. How could there be? Medical life support was unknown. Back then your mother would have died years ago when her kidneys first failed. We’re dealing with a problem brought upon us by technology. There are no answers from the past to guide us.”
Then I spoke to her about what had whirled through my mind several days earlier. This looked to me like a test, I said—a severe test that showed me she and her family were beloved by God, who was working to stretch their thinking and build their characters in ways that could not be built any other way.

What Do You Think?

1. Who benefits most from discussions about end-of-life issues, patients or their families?

2. Does today's medical technology make it easier or harder to leave things in God's hands?

3. How would you counsel someone who says, "I just want to die"?

On what Bible promises have you staked your physical and spiritual survival? List at least three.

Deep in thought, Dana turned away and said no more.

A day or two later the tension remained. I found myself praying, “Lord, these people have been through enough. I am requesting that Juanita declare herself today—either toward recovery or deterioration. Her family just can’t stand the tension any more.”
A little later I received word from her nurse that Juanita’s condition had started to deteriorate. I met Dana at the door to her mother’s room. Before I had a chance to tell her about my prayer she said, “I’ve been praying that this impasse will be resolved one way or another.”
“That’s interesting,” I replied. “I usually don’t do this, but I also found myself praying the same thing.”
I think God may have been waiting for this. Not one, but two struggling Christians were daring to ask God to act on their behalf. We didn’t even have a clear idea what to ask for beyond “God, please do something!”
Maybe God wanted this to be a memorable, yet humbling experience for the living. Juanita, who did not appear to be suffering, would be permitted to linger until we came to acknowledge that it is God who is in control of life and death, commit Juanita totally to Him, and ask Him to make a move. Monty and Dana were now at peace with their decision to keep their mother comfortable and permit her to pass to her rest.
At 11:35 that evening Juanita’s heart beat for the last time.
Three Lessons
When I recounted the story to one of my colleagues, the pragmatic response was: “Be careful what you tell the family. Don’t put them in an untenable position where they feel they are trapped. Even if you do want full medical treatment, leave your family some discretion to adapt if full medical treatment does not result in recovery.”
Second, Juanita taught me that although we may not understand it at the time, God may permit a dying person to linger so that the living can work through a troubling issue. In this case that issue revolved around withdrawing life support for a patient who did not appear capable of recovery despite her request for full medical treatment.
Third, Juanita taught me that just as in nineteenth-century Adventism, the revelation of truth does not come by God spoon-feeding us. We have to think, pray, agonize, and stretch our minds to accommodate new situations that don’t fit with old rules. That process in and of itself builds character.
However, if answers don’t come, and we get desperate, God is still there to provide us with signs of His will, if we ask. 
*While this story is true, the individuals’ names have been changed to protect their privacy.

David Bland is an attending physician in the medical intensive care unit of Loma Linda University Medical Center.