Between Two Worlds

The other night on call I was presented with a very sick patient. A woman in her early 70s had been admitted with abdominal pain. After a couple days of testing and retesting a CT scan of her abdomen ultimately revealed an ominous finding: pneumotosis colitis, or air in the walls of her colon. It likely meant that she had infracted part of her intestine and would need urgent and massive surgery. If she didn’t, we feared, she would die very quickly. Unfortunately what was required was a resection of whatever portions of her intestines were dead. Sometimes just a little, but often quite a lot – either way, it’s the type of operation that can kill you because it’s such a stress on your body. And so she had to make a choice. Spend a few quality hours with her family and likely be dead by morning, or take a chance at a massive operation which she might not survive. I hated pressuring her, but every moment we waited we risked more of her intestines dying. She looked at me with wide eyes – “I’m not ready to dye tonight.” A part of me wanted to tell her that that decision had likely already been made for us, but I resisted – she needed to find hope in the surgery I was offering. She signed the consent form. And so she was there, stuck between two worlds – so delicately in this world, and so close to entering the next – I could see her closing her eyes and wishing all this were a dream. But it was not. We put her to sleep and cut her open. With my scalpel I took long swipes over her abdomen revealing her damaged bowels. It wasn’t as bad as we thought – I’m haunted by the notion that she might have made it ‘till morning after all. I’ll never know. And so it is often in this work – we make decisions and live with them. But we get to live. Others, not always. The choices are ours; the consequences, theirs. All we can do is our best. And at this Christmas time I am reminded that long ago in Israel someone stood between two worlds, this one and the next. And then too decisions were made, decisions that ended in death. It is all so fragile. The family thanked us for our efforts. I pray we did right.