Karen, Do You Know Him?

Karen, Do You Know Him?

From A 5th Portion of Chicken Soup for the Soul

Karen, Do You Know Him?

Miracles do not happen in contradiction with nature, but in contradiction with what we know about nature.

Saint Augustine

I was an intern in pediatrics, fresh out of medical school. A lot of facts and figures were crammed into my brain, but my clinical experience was somewhat limited. But that’s what it means to be an intern.

One of my most memorable first patients was a young lady named Karen. She had been referred to our city hospital from a small community in North Carolina because of symptoms of weakness and anemia. I knew when I first met Karen that I was dealing with someone out of the ordinary. She was not the least intimidated by the title “Doctor” or the white coat, and she always spoke what was on her mind. During our first interview, Karen wanted to know my credentials down to a tee, and wanted me to know that she knew that I was, indeed, “just” an intern. She was fourteen years old and full of life.

Unfortunately, our evaluations revealed that she had a type of leukemia that was somewhat unusual, and not as responsive to different treatment modalities as were other types of leukemia. In fact, the prognosis for her surviving even one year was unlikely.

Chemotherapy was initiated, and Karen was never shy in telling us how sick we were making her with the medicine. She never spoke in a mean way, but simply in a way that always made her feelings known. If we had difficulty with an IV, she would readily point out our incompetence. However, she would just as readily forgive us and compliment us when an IV was maintained in her fragile veins on the first try.

Remarkably, within three months Karen went into remission, becoming free of her disease. She continued to come in for routine chemotherapy. During those short visits, Karen and I became friends. It was almost uncanny how, during random rotations, I would turn up as her physician. Always when she would see me coming, she’d gasp, “Oh no, do I have to have Dr. Brown?” Sometimes she was kidding, sometimes she wasn’t, but she always wanted me to hear her.

About a year after her original diagnosis, her disease returned. When this type of leukemia returns, it is almost impossible to regain remission because all of the therapeutic modalities have already been spent. However, once again—remarkably if not miraculously—Karen went into remission. I was now a second-year resident, a little more competent and quite a bit more attached to this family. I continued to see Karen and her family over the next year and a half. She proceeded in her high school career and remained an outspoken, fun-loving teenager.

I was now in my chief residency year, spending my last month on the inpatient ward prior to completing my training. Karen came in once again with an exacerbation of her disease; she was extremely ill. There was involvement of every organ of her body, including her brain, and literally no other chemical agent to be tried. There was nothing we could do. Karen was made comfortable, given IV fluids and medication for pain. After long discussions, Karen’s doctors and family decided that the goal would be to keep her comfortable and pain-free. No unnecessary heroic measures would be performed to prolong the inevitable. In fact, there were no heroic measures left.

Karen soon slipped into a coma. After viewing the CT scan and seeing the diffuse brain involvement, it was easy to see why. We expected each day to be her last. Her eyes were fixed and non responsive, her breathing shallow. Her heart was still strong, as we knew it would be. However, the disease was ravaging her blood system and brain, and there was evidence of opportunistic pneumonia involving both lungs. We knew that she would soon die.

I began to have a tremendous dread of Karen dying while I was on call. I did not want to pronounce her dead. It came to the point where I hoped that her death would come on nights that I was away from the hospital because I feared that I would not be any emotional support for the family, or that I would even be able to perform my duties as a physician. This family had come to mean so much to me.

It was a Wednesday night, and Karen had been in a coma for four days. I was the chief resident on call for the wards. I spoke with the family and peeked in on Karen. I noticed her breathing was very shallow and her temperature quite low. Death could be imminent. I selfishly hoped to myself that maybe she’d wait until tomorrow to die. I went about my chores until about 3:00 A.M., when I finally tried to get some sleep. At 4:00 A.M. I received a STAT page to Karen’s room. This puzzled me somewhat because we were not going to make any heroic interventions. Nevertheless, I ran to her room.

The nurse greeted me outside the room and grabbed my arm. “Karen wants to talk to you.” I literally thought this nurse was crazy. I couldn’t imagine what she was talking about—Karen was in a coma. At this point in my life, my scientific, Newtonian way of thinking ruled my thoughts, primarily because this is the approach we are trained in day in and day out in medical school. I had neglected other,more important spiritual aspects of my being, ignoring the instinct that knows what reason cannot know.

I went into the room, and to my amazement, Karen was sitting up in bed. Her mother was on the left side of the bed, her father on the right. I stood next to the father, not saying anything, not knowing what to say. Karen’s eyes, which had been glazed over for four days, were now clear and sharp. She simply stated, “God has come for me. It is time for me to go.” She then went around to each of us at the bedside and hugged us tightly, one at a time. These were strong hugs, hugs that I kept thinking were impossible. I could only visualize her CT scan and the severe degree of brain damage. How could this be?

Then Karen lay down. But she popped back up immediately, as if she had forgotten something. She went around the bed to each of us again, with her penetrating eyes fixing our stares. No hugs this time. But her hands were strong and steady, squeezing our shoulders as she spoke. “God is here,” she said. “Do you see him? Do you know him?” I was scared. Nothing in my experience could explain what was happening here. There was nothing else to say, so I mumbled, “Yes. Good-bye. Thank you.” I didn’t know what to say. The entire time, I kept visualizing that CT scan. Then Karen lay back down and died—or I should say, she quit breathing and her heart stopped. Her powerful spirit went on living.

It was years before I could tell that story, even to my wife. I still cannot tell it without feeling overwhelming emotions. I know now that this experience is not something to be understood through the limited viewpoint of the scientific realm. We are, in essence, spiritual beings in a spiritual universe, not primarily governed by Newton’s laws, but by the laws of God.

James C. Brown, M.D.

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