Magic

There is a part of me that believes in magic. I'm not sure how to explain it, and almost certainly, it stems from deep within, from my youth, from my world view. No matter how much science, mathematics, and logic go into medicine, there is still some measure of magic in the simplest moments: the clasp of a hand, the holding of a vigil, the crestfallen grief, the elation of success. Maybe these are just emotions, but part of me believes there's something more, something almost sacred. It is the same as the quivering voice making marriage vows, the same as the quiet in a memorial service or the susurrus of the ocean. For how can you stand under century-old redwoods or witness a birth or connect with a human being at their most naked and vulnerable and not feel some sort of magic? We say we go into medicine "to help people" or because we "like physiology and pharmacology" or even because we "want to deeply touch others." But the truth is, there has always been some touch of magic for me, the moments that are truly special, and that is somewhat addicting. I still remember what it felt like the first time meeting a person who I knew would die; what it felt like when I delivered a newborn; what it felt like when I saw lungs transplanted into another body and inflate when I squeezed air into them. There is still magic in this world.

A middle-aged woman who had never been to a doctor in her life collapses at home. Paramedics bring her into the emergency department, chest compressions ongoing. Her heart is in disarray, squeezing erratically and ineffectively, a call for help. Everyone in the emergency bay recognizes the rhythm, ventricular tachycardia, a precursor to flat-lining. Pads are slapped on her, she is shocked; her body convulses, and we are on top of her again with compressions. This is our laying of hands, our most desperate measures. We pump epinephrine through her veins. All of a sudden, her rhythm converts to sinus, but there are ugly wide complex beats threatening to take over. Her heart teeters on some edge between life and death, a cliff on one end, and a large gray zone on the other. We rush her to the cardiac cath lab where a cardiologist finds a blockage in the vessels of the heart, stents it open, and brings her, still alive, to the intensive care unit. She is cooled so that the brain, reeling from this trauma, can recover. Over the next three weeks, her heart cries out; every few nights, she goes back into ventricular tachycardia and requires a shock to reset. The cardiologists ply their trade: amiodarone, lidocaine, potassium, magnesium. We entreat the heart.

But when I hear of this case, I ask: what of the brain? What of Descartes' "seat of the soul?" Will she be who she was? When we lighten her sedation and wake her up, we find only howling wind and thunderstorm. Her eyes are vacant. A voice, a light tap, a pinch, knuckles on the chest - none of these cause her to stir. But she is not brain dead; her brainstem still glimmers; she breathes, but not much more. I say we wake her up, but the entire week I attend in the intensive care unit, I wonder whether there is a person to wake up, or whether the state she is in counts as awake. 

I talk to the neurologist. We pour over EEGs, brain scans. Uniformly, we hold a grim expression. We don't think she will wake up, we tell the family. Yes, there are cases in which a patient may improve from a persistent vegetative state, but nothing here gives us optimism. We wish we had something different to say. Hands are held. Prayers are whispered. We ask those dreaded words: "What would she want in this situation?"

I go off service, but the following week, I go up to the intensive care unit to visit. To my astonishment, a month after her initial heart attack, after weeks of shocks and cooling and chest compressions and blocked vessels and medication after medication after medication, something happened. She began to move purposefully, and to the disbelief of every clinician in the ICU, she followed directions. We say "followed commands," but that word is so harsh; I would never command a patient to do anything, but at our gentle suggestion, she gave a thumbs-up, showed two fingers. She - not just her body, but something more, something sacred - survived.

There is magic in this world. In my professional and my personal life, the more experiences I have, the more I am convinced of this deep, wonderful thing.