An open-hearted patient teaches her doctor about trust, religion, and authenticity.
By March 5, 2019 - last reviewed on May 7, 2019published
Sara* was a dancer with an impish smile and bright brown eyes. Her dark hair was cut in bangs that framed her face like a porcelain doll. She had small, delicate hands—which were currently fidgeting with a small silver cross around her neck.
Sara visited my clinic following a wave of headaches and vision problems. An MRI scan revealed that she had a tumor, roughly the size of an orange, in an important part of the brain called the temporal lobe. As a neuropsychologist, I work with neurosurgeons during surgeries for which patients stay awake to ensure brain function is not disrupted.
"My partner, Dr. C, referred you to me for an evaluation," I said. "But first, I was hoping you could tell me a bit about yourself."
Sara's husband, Chris, held her hand as she began. The couple recently moved to New Mexico to join the staff of a large church. Chris was the music director and Sara worked in children's education. The church had over 3,000 members and provided the couple with employment and a spiritual community. They were planning to start a family before Sara began experiencing the symptoms that led to the discovery of her tumor.
"I was having headaches, and they were getting worse, so I went to the doctor," Sara said. "He suggested that I see a neurologist, and long story short, I got an MRI which showed that there was a tumor in my brain." She wasn't messing around.
"Dr. C recommended that Sara have the surgery awake so that you can make sure things are going well while he removes the tumor," Chris added.
"That's exactly right," I replied. "The surgery takes about four hours, but you will be awake for only one hour. I'll keep checking with you to make sure that we don't hurt your language or motor skills as we remove the tumor."
After delivering the rest of my speech, I paused. "I know this is a lot to process. Do you have any questions?"
Sara thought for a moment. "Are you a believer?" she asked.
I've been asked this question by only a handful of patients over my 20-year career. It always catches me off guard. I'm more than agnostic, less than Christian, and I attend church with my wife, who is an Episcopalian. It's complicated. "Yes," I said simply.
"I believe that God will heal me of this tumor and will watch over you and Dr. C during the surgery," Sara continued.
I was at a loss for words. I wanted to support her belief, but I knew that her tumor was severe. It would probably kill her eventually, even if it was removed successfully. We were attempting to make that date later rather than sooner.
"I believe that we will do everything we can to remove this tumor and get you back to your life without hurting you. The rest is up to God," I finally responded.
Eighty-four percent of the world is religious, and one-third of that group identifies as Christian. In the United States, the vast majority of believers are Christian, although the number of adherents has been declining over the last 50 years. Atheists represent a small sliver of the population.
Religion in the United States is practiced largely as a cultural convenience, with a small portion of the week set aside to trundle off to church, synagogue, or mosque and remind oneself of the old teachings. Some, however, have a deeper religious belief that permeates their life each day, like the very breath that sustains them. Their faith is unwavering and profound. Something in their neural makeup allows even the most terrifying and hopeless events to have deep meaning and purpose. Sara was one of the latter group.
Normand Geschwind, a famous neuroscientist, described a constellation of behaviors that occur in many patients with temporal lobe epilepsy, including increased religiosity and increased, often compulsive, writing. He believed that these behaviors are associated with dysfunction in the temporal lobes, the brain structures most associated with memory.
Is it just a glitchy temporal lobe that makes us more religious? Could Sara's slowly growing tumor be the source of her faith? The answer, of course, sat by her side. Her husband, Chris, was equally faithful yet had no tumor or known abnormality. Something about human religion might exist in the temporal lobe, but the connection eludes simple cause and effect.
Waking a patient during surgery is always fascinating. Some emerge as coherent as they were in the clinic, while others wake up like wild animals, ready to run or fight. Sara's eyes fluttered open gently. She looked around and focused on my face.
"Hi doc," she said. "Is everything OK?"
"Everything is going perfectly," I answered.
Her brain was exposed now, with the skin, muscle, and skull removed. Her brain pulsed slightly, marking each heartbeat. Dr. C and I had identified an area near Sara's tumor that was connected to her language production, and we needed to determine whether it was critical by temporarily interrupting its activity. To do this, Dr. C would deliver a small electrical current between two prongs of what looked like a small tuning fork on her brain. It's like turning off a breaker switch on the back of the house to see if a particular light went out or not.
"I want you to begin saying the months of the year, about one every second," I said.
"January, February, March," Sara began.
Dr. C gradually increased the electrical current. We got to 5 milli-amps.
"January, February, uh..."
"That looks like speech arrest," I said loudly to Dr. C.
Sara smiled and licked her lips briefly. "That was weird," she said. "I wanted to say it, but I couldn't."
"Just pick up from the beginning again," I said. "You're doing great."
We confirmed that this node was vital to Sara's speech and could not be removed. After establishing that other regions around the tumor were not critical, Dr. C began to carefully extract the tumor.
At this point, I usually spend time getting to know the patient. Chatting tends to keep patients calm while allowing me to assess any change to the ability to comprehend or produce language.
"How did you meet your husband?" I asked.
Sara smiled brightly and let out a laugh. "Match.com. I had just moved, and I didn't know anybody. My friends back home told me it was a good way to find the type of guy I was looking for."
"What type of guy was that?" I asked.
"Well, it was important to me that he was Christian," she said. "And it was important that he wanted to start a family someday. I went on a couple of dates, and the guys were nice, but there was nothing there. When I met Chris, though, I could see the light of God shining through him, and we began our life path together," she said.
Sara spoke in a manner that was at once bracing and comforting. It's not often that I meet someone so secure in their beliefs as to speak so fearlessly and openly. This is rare in our secular world, where we can be so deeply fearful of offending or appearing judgmental that we extend a bland face of indifference, which can rob us of individuality, of dignity.
Sara and I discussed her childhood in a small Midwestern town, the places she'd traveled, and her plans for the future. Dr. C occasionally asked me to check her strength ("Squeeze my hand as hard as you can"), whether her face was symmetric ("Give me a big smile and show me all your teeth"), and her foot strength ("Wiggle your toes up and down"). Finally, it was done.
"Let's put her back to sleep," Dr. C said.
"Sara, you did great," I said. "I'll see you on the other side."
Sara continued to do great in the months after surgery. Dr. C had removed over 99 percent of the tumor, which was a glioblastoma multiforme.
Sara went back to teaching dance, which she loved, and traveled to visit family. Through social media, I learned that she and Chris had matching printed tee-shirts with #GODHEALS emblazoned across the front, and that members of the church created a prayer campaign for Sara's recovery. She was active and giving, a source of inspiration to her family and her community.
Sara and Chris visited Dr. C about a year after her surgery. They expressed gratitude, thanks, and a sense of serenity during the visit. They seemed to understand and accept that the tumor had returned, with a vengeance, and that there was nothing to be done to extend her life. They were at peace. Sara wanted to make sure that Dr. C knew she was thankful for the year she had had, which otherwise would have been lost. She was still smiling.
*Names have been changed.