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A Case Study in Faith

John Shin

Description

In this presentation, Dr. Shin will share a remarkable case study of a patient with acute myeloid leukemia and her family's journey as they struggle with issues of faith in the face of a terminal illness. In the context of this patient's story, Dr. Shin will explore the challenges of sharing one's faith in the hospital setting, the role of faith when medicine offers no hope, and what it truly means to be a co-worker with Christ.

Presenter

John Shin

Physician-fellow of oncology and hematology, Mayo Clinic- Rochester, Minnesota

Conference

Recorded

  • November 1, 2019
    7:15 PM

Series

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Heavenly Father. Preaches a few so much in your sound hours and you're like this group of physicians dentists health care providers. We're going to have in our lives and careers you. Were saying not the score I pray that it will be these one minus maybe Spirit has your feet for us and I'm pretty interesting to watch for when we connect all these it's pretty good it's a matter. Of. So good early roll starting early money 17 July August 17th. This is just one hour started I'm going to call your college gosh you know and I'm screwed he has been at the service human service it's right here in the hearts and you felt Spanish is your headline and any time of the writing you have noticed that you're getting an admission from a few key in each hand. And this was made by those present for me and I was of my relative lack of experience so we're going to keep him in the eyes of what I might want to see or wait. What is a Saturday August 27th we got this and I'll call her it's pretty night and you're all well and who 1st presented to her outside the hospital because of a persistent cough. If you chest x. rays which surely about orbital treating the dentist was funny any of these labs and to surprise the labs should have said a p So we went ahead and did a bone marrow biopsy and that showed up Q b why are we here. At that point she was transferred to the euro or higher to go here and we should write the person we did was going to. Said Raven at her need she had just an oral culture. We got her as well in our class and I doubt you'd see as our confer instead of her overseas and sat down 7 or. 8 in her ear which is the most important thing to you in the colleges confer. To you in the survey. And then we got her report from her outside bone marrow and it showed there was at least 60 percent Merrill involvement by blast cells and to get a diagnosis of acute myeloid leukaemia you need only 20 percent so she definitely had m.l. So we were going to confirm everything with our own testing with our own bone marrow but in the meantime we said this is the real deal she needs treatment right now because m.l. acute myeloid leukemia left untreated is uniformly fatal usually within days if not within hours. But we are in a treatment dilemma because she had 2 things going on right she had the lung infection and she had the m.l. And if you give chemotherapy while someone has an acute infection going on it could be fatal and it could make the infection much worse so we were deciding which one is the more urgent want to treat and we said well let's go ahead and give her a really strong i.v. antibiotics at least for the 1st 2448 hours to try and get on top of her infection and then let's give her the chemo so we decided on that and we talked to her we talked to her family and she was very nervous. But I got the sense that she was a woman of faith simply because of some of the phrases she used and she had a large family she had 6 children 4 of whom were at her bedside the moment she landed in our hospital and her husband was there too and throughout her entire hospital stay I don't think I've seen fewer than 5 people in a room at any given time so woman who's very loved a family that just surrounded her with warmth and care and we said this is the plan we'll start with antibiotics 1st we'll watch you very closely and once we deem that it's safe we're going to charge for it with the chemotherapy for your m.l.. Well over the next 48 hours unfortunately she did not improve with the antibiotics in fact her respiratory function was even worse and she grew increasingly short of breath she was having fevers and on Friday August 4th we did a broad Cosco be with b.l. and that showed an extremely thick discus mucus plug in her left lower lobe and to the point where the pollen allergies tried to grab it with the forceps and was unable to remove it it was so tenacious and he finally said you know what I'm going to leave it alone because I don't want to cause a hemorrhage I don't want to damage anything so they had to leave it in there. Well that night after to be or maybe even because of the bronchoscopy she developed worsening shortness of breath increasing oxygen requirement persistent fever and she had a rapid response called and she had to go to the i.c.u. and there they did a chest x. ray and that showed that things were actually looking worse in addition to the left lower lobe infiltrate looking like it's progressing she had opacity is now appearing on the right lobe and so this is not looking good. So Hospital day for Saturday we noted that Ok she's not turning the corner on antibiotics the. Samples came back and they look pretty bland there was nothing to suggest infection all of her blood cultures and everything were coming back negative so infectious disease didn't feel like this was a primary infectious process that was driving this. So the consensus between the i.c.u. team our team the infectious disease team was that she was developing ards acute respiratory distress syndrome but the etiology was unclear and because they were thinking it's less likely to be infectious we felt well maybe maybe this is the leukemia that's just taking off so much it's actually infiltrating her lung parang come out and if that's the case if that's the real cause and we need to treat her right now but if we're wrong and there's any component of this that's infectious driving it then starting chemo could kill her so we had a really long hard talk with her and her family and they understood the risks but in the end we decided on a compromise because the way you choose treat amélie is you do a regimen called 7 plus 3 it's 2 types of chemotherapy sleeping around for 4 decades and it's the same way we treat a male still today where for 7 days you give a relatively low dose of one chemotherapy called Side tear bean but for the 1st 3 days of that 7 you give a very potent chemotherapy it's an anthro cycling and this is kind of the workhorse chemotherapy so we decided let's go ahead and start the site terribly again and towards the end of that week if she's looking like she's improving then maybe we'll add the and the cycling on the back end so be you'll be 7 plus 3 in a in a reverse way so the family felt that Ok that's a good compromise between treating and not treating him for the whole team felt good about that so we said All right let's go and start chemotherapy today. But I happen to be a Saturday and on Saturdays the fellows get to leave. After rounds so it's a it was a half day for me so I gather up all my things and I go to the elevator press the down button and I'm anxious to leave because if I hurry I can make it to church and catch some of the service with my family they're still there and so I'm eagerly waiting for the elevator door to open when the strangest thought crosses my mind and the thought is why don't you go back to Mrs these room and offer to pray with her. I said Ok well that sounds reasonable tomorrow when I come in tomorrow I pray with her 1st thing tomorrow morning no problem but the top of the thought just does not leave me why don't you go right now to her room and pray with her and that's when you have you ever felt that the Holy Spirit was moving on your heart but you felt that what the Holy Spirit was prompting you to do was so ridiculous that you start arguing with yourself and saying well that makes no sense I mean I can come and pray with her tomorrow I will incorporate into my morning rounds it will be natural Why go now and in fact what would you think if you were the patient doctor decides we're going to start chemotherapy you're eagerly awaiting or nervously waiting for chemotherapy to start and then the doctor kind of comes back for no reason at all and says he can't pray with you. What would you think as the patient right I don't want to freak her out and so I'm seeing a single Lord I would definitely pray with her but I think the more appropriate time and contacts will be tomorrow middle of rounds I don't want to scare her and she's scared enough as it is. But the thought would not leave me John go back to her room right now and pray with her elevator door opens I have a decision to make I'm packed up ready to go to church I say Lord. Ok I will go back right now and I'll play with her but you are responsible for whatever happens next. If she freaks out then but I'll tell her that you made me do it. So I go back to her room. And her family is all back at the hotel and just one daughter is at her side and they look at me and obviously they're surprised and they say oh Dr Shane was or something else and I just kind of mumble and say oh I just came back to check on you how are you doing I look at her i.v. bags and act like I'm expecting things. And I don't know how I'm going to bring this up do you ever get the sense that you know what that God wants you to pray with someone you just don't know how to bring it up. And you wish there was like an obvious segue that you can take and say yes I'll say we right into prayer but there's no other alternative but awkward at that moment. And that's where I was and I was totally at a loss of what I was going to do next what home I can a prenup am I just going to a case which like some prayer you can't exactly segue like bad and then I looked and I saw she's wearing a necklace and it's got a little cross on it and I said There you go that's it and I look at her and I said this is easy I take it like that necklace of yours I take it that you're a woman of faith and shoot her face brightened up she's like oh Dr Shand if it wasn't for my faith I wouldn't be where I am today and she and her daughter just open up about how God has been so faithful to her all her life blessed her with a beautiful family it turned out that they were developed Catholics and their faith their faith meant everything to them. And as I listened to her story it became the most natural thing at the end of it to say you know what. I am so glad to hear you say that because you know as a fellow believer I I believe that despite anything that we doctors do any healing comes from Him It comes from above and he is a true physician up there and this is the I want to let you know that he is to one who is the overall overseer of your care. The Lord is in charge of your care and he's the master physician so before we start chemotherapy would you find it helpful if I said a word of prayer for you to bless the therapy and I can see her eyes welling up with tears and she was saying Dr Hsin would June that would mean so much to me so I take her hands in mine and her daughter comes around and I pray for her and I pray that the Lord will bless the therapy but more importantly I pray that he'll be with her during this hospital stain to be with her when she's alone and her thoughts wander to dark places to remind her to turn to Him for help and strength and not to look within and I think after I finish my prayer she has tears we all have tears I hug her I hug the daughter I say God bless you guys I'll be in tomorrow to check on you but let's leave everything in his hands and boy it's you can feel the moment change when she was tense nervous when's the chemo going to start what's going to be like to now after eating is in God's hands. And so I walk out of there and I say Lord thank you for giving me my Sabbath blessing boy I can't believe it took me this long to finally say Ok I'll do that. But I think and I said Lord I don't know why it was so important that I prayed right now but I'm sure glad I did because I feel like that was exactly what they needed. And I didn't know then but the daughter was actually keeping a blog on Caring Bridge and Caring Bridge is a blog site that many patients and their families use to give updates on their loved one's health progress and in the process of prison preparing this talk I happened to find it so all of this I'm looking at a retrospective Lee but this is the post that her daughter rode after after that event she wrote I saw God at work today Dr John Shand who is one of Mom's hematology ists and her favorite doctor. Came to Mom prior to chemo and told us that he likes to pray with his patients before they start their 1st dose of chemo he prayed for Mom's healing for the doctors and nurses to give the proper treatment needed and said I'm a doctor and I try to heal but the true healer is above during his prayer I happened to open my eyes and glance at him and I know I saw God His words of prayer were just what we all needed to hear at that very moment mom remains in great spirits and continues to amaze us with her resilience I read mom all the supportive messages you all have left on this site and we are so very grateful for the prayers and positive thoughts being sent our way thank you we know that God has mom in the palm of his hand and will carry her through this. You know you know when God sends you to do something you leave the results in his hands and he always has a grand design in mind and even though you can't see what fruit your work may bear he is selling seeds through you and the most important question is are you being willing to be used by him in that moment and do you leave the harvest and the results to God and that's what he teaches me every single day. So I went to church wonderful service came back the next day Sunday. And I checked on her chart. And to my horror I find that. Throughout the course of the night she developed worsening respiratory distress and had to be integrated and this morning chest x. Ray looked absolutely terrible. I mean whatever this was it was progressing and the disturbing thought hit me What if I had refused to go back and pray with her and what if that prayer I had with her yesterday was the last conscious prayer that she prayed before she died. And what if I was not willing to pray and what if I said Lord I proved her tomorrow I would not have had that chance had I waited just one more day reminds me of this quote from Picher x. and profits page 423 paragraph one it is important to believe God's word and act upon it promptly while as the angels are waiting to work for us evil angels are ready to contest every step of advance when God's providence bids his children go forward when he is ready to do great things for them state intense them to displease the Lord by hesitation and delay he seeks to kindle a spirit of strife or to arouse murmuring or unbelief and thus deprive them of the blessings that God desired to bestow God's servants should be Minute Men ever ready to move as fast as his providence opens the way and delay on their part gives time for Satan to work to defeat them see God this Satan does not need to make us say Lord I'm not going to pay all he needs to make a say is Lord I will obey later. I will obey tomorrow he simply needs to make us delay obedience and then he's one and it sent a shiver through my spine as I was chart rounding on her that morning thinking what if I had waited to pray Lord thank you. You see. Although in this specific instance I obeyed that still small voice it brought to memory countless other occasions where I actually did not and it made me wonder what kind of service that I rob God of that I would never know about now because of my hesitation to obey. Matthew 254-1244 says then he will also say to those on his left hand Depart from Me you curse it into the everlasting fire prepared for the devil and his angels for I was hungry and you gave me no food I was thirsty and you gave me no drink I was a stranger and you did not take me in naked and you did not clothe me sick and in prison and you did not visit me then they will also answer they also will answer him saying Lord when did we see you hungry or thirsty or a stranger or naked or sick or in prison and did not minister to you then he will answer them saying assuredly I say to you in as much as you did not do it to one of the least of these you did not do it to me. In our Christian walk we tend to be preoccupied with things that we should not do but this passage tells us that in the final day of judgment will be judged by the things that we need to elected to do and not so much the things that we did do wrong and it makes me wonder what opportunities to serve God are we missing out on on a day by day basis simply because we're not listening or refusing to obey when we hear him there is a lot of food for thought for me. So as they went by it was she was developing refractory hypoxia despite being on 100 percent f.i.f.o. to the repeated abroad Kosky and this time they showed a large amount of this dark blood creation very consistent with diffuse alveolar hemorrhage so this was d.h.. And we started her immediately on high dose steroids and that's a terrible in chemotherapy though chemotherapy that we were starting we stopped in after just 16 hours of infusion and we were wondering what is going to happen to her but she can't tolerate treatment. Hospital the 6 Monday no change in a respiratory status despite starting high dose steroids she started needing presser support her blood pressure getting soft and she was having persistent fevers even though her infections workup was completely negative and it was clear that she was dying and since nothing else was working no tests were coming back positive for a clear etiology. We decided well just in case this is the leukemia that's doing this to her lungs which would be highly a typical But maybe it's really bad there's nothing else that we can point to in her body that's an active process. Let's go for broke let's try to resume the chemotherapy because it's clear that if we do nothing she's going to die anyway so let's died trying to treat her and that was the consensus of her family as well and they said you know she's deteriorating fast please do something so we resumed the site here between. Hospital day 7 a Tuesday little bit and create a little bit of improvement in her if I have to came down 60 percent she was weaned off press or support and we were thinking she was turning a corner and then on hospital day 9 August 10 we note that she developed severe thrombocytopenia so she was she had low platelets to begin with coming in and we knew that giving her some chemotherapy might further lower her callous but that we weren't expecting to this degree with the small amount of chemo that she received and so quickly so naturally we tried to give her platelet transfusions to bring this up but the moment we give her plate the transfusions that we check her platelets again they have not budged they refused to budge an inch in fact they would frequently go down more. And in the world a transfusion medicine when you give a transfusion of platelets and you check a c.b.c. within the hour and the number hasn't changed this is highly suspicious for aloe immunization which means the patient has developed an antibody to an antigen that occurs on most platelets and so now and this is out of nowhere you usually see this condition in patients who've been heavily treated in the past that needed multiple transfusions they've had time to develop antibodies against other people's blood as far as I know she's never had transfusions in her life she just happened to have an ally antibody against platelets in this time when she needed it the most so the transfusion medicine team scoured the databases that mailed to look for any match don't. Hours and they found that in a 300 mile radius there were 2 people who could give her compatible platelets and they put out an s.o.s. call for them and God bless these 2 people I don't know who they are but they agreed to come in and alternate every other day coming in to donate platelets for as long as it took and they were just on standby but what that meant is that her platelets were such a precious resource we had one unit maybe every other day going in and and if it didn't whatever good it did if they were consumed or she lost platelets we have to wait until the next donor could come in and donate more platelets and remember she's bleeding into her lungs diffuse alveolar hemorrhage with her plate this dropping she was in a very tenuous situation here. On top of that as if this wasn't bad enough around the same time she started developing renal failure and as she became more you remake Well that's not going to help her play the function either so we see she's really going down the tubes really fast here. So as if that wasn't bad enough news around this time we were her bone marrow results that we did came back and in order to diagnose him l m l is not the same acute myeloid leukaemia is categorized into favorable intermediate and poor risk based on the spread of certain genetic mutations and when we saw her bone marrow report we saw that she had the poorest risk imaginable she had a p. 53 deletion complex side of genetics which means multiple multiple chromosomal abnormalities this is the type of m.l. that is highly likely to be refractory to therapy and even if a response to therapy is at a high risk for early relapse cane. So. We kind of took a step back as a team and we surveyed the landscape Here's a lady with an extremely poor prognosis she's got this respiratory failure with acute respiratory distress syndrome of unknown etiology with diffuse alveolar hemorrhage and on top of that she's pants had a penis and now Worsley thrombocytopenia aloe immunize against platelet transfusions in renal failure and now just diagnosed with the worse risk category m l that we know of not tolerating even a single monotherapy with side terribly which is the lightest dose of chemo we can give for m.l. not even tolerating that and even if you could tolerate the whole thing highly unlikely that her leukemia would respond because it's such a terrible risk. So a very very poor prognosis Indeed I'm. So on Saturday August 12th. We completed only 6 out of the 7 days of site air bean because her plate was became so low that we became afraid that at any moment she was going to hemorrhage diffusely in turn lungs and just die so we said we have to stop because it's a tear being it's not going to help her platelets we just cannot continue. And so we held a family conference the next day and the i.c.u. team was there we were there as a human team and we were very honest with them we said Look cure is off the table Ok let's get that strain and your mother's only hope for a meaningful remission is to get her to the point where we can do an allergen a bone marrow transplant but a bone marrow transplant is not even upaya in the sky kind of a dream for her it is absolutely impossible she's not even able to tolerate side terribly monotherapy there is no way she's going to tolerate high dose chemo that will condition her bone marrow to get transplanted it's going to kill her without a doubt so let's just take that off the table there so without being able to do a bone marrow transplant and not being able to tolerate even the weakest chemo we have and having the worst type of e-mail she has it's a pretty hopeless situation plus her multi-organ failure bit unlikely that she could ever leave the hospital. And as we're spending this out trying to do it as gently in a sensitive way as we can as we could the family members nodded that they understood they were tracking along but at the end of it they said but you know what we believe that God can still work a miracle. Have you been in a situation like this where you have to tell the patient extremely bad news and as a physician you know where this is headed. And then the family with all their sincerity says but we believe God can work a miracle. What do you say in a situation like that you want to you want to preserve that space where God can intervene but you also want to help them prepare for what very well may come next and so when the family said that all the physicians at the table kind of looked at each other sideways and they said yeah see crude work a miracle but what's far more likely to happen is that your mother will probably pass away here in the hospital and we want to know if you knew what her wishes might be in this situation the family did not want to hear and they said no we have to give God time to work because you see they were claiming Bible promises such as this one Mark 1124 Therefore I say to you whatever things you ask when you pray believe that you receive them and you will have them. James 1638 but let him ask in faith with no doubting for he who doubts is like a wave of the sea driven in tossed by the wind for let not that man suppose that he will receive anything from the Lord He is a double minded man unstable and all his ways or maybe even Hebrews 116 but without faith it is impossible to please Him for He who comes to God must believe that he is and that he is a rewarder of those who diligently seek Him So they were quoting these texts and saying we are going to hang on to the belief that God will heal our mother. And he said that's fine and we sure hope he does but for now. I guess we just have to revisit the question later so they refused to change your code status or they said they just weren't there and we completely respected that but as we walked out of that room. There was a heaviness in our hearts because we knew well I don't think they're seeing reality. But you seem as Christian physicians we often struggle to strike this balance right this balance between informing our patients of what's most likely to happen without eradicating hope how do you do that and we always want to give God room to intervene right but we also don't want to give our patients false hope so how do you navigate that fine line where you have to bring them down to earth and be realistic and at the same time say but don't give up hope and this is something that I struggle with on almost a daily basis as I work with cancer patients with people who are Christians specially. So after that day you know the family knew that I prayed with this is the at the beginning and so they would not let me leave the room without praying with them and I love to pray with them but I struggle to find the right words words that would not take away hope but yet would acknowledge that everything is in God's hands and that our eyes are on him. Hospital day 17. So after 12 days at this point of being in to beat it the i.c.u. team was saying look there's no respiratory there's no improvement in a respiratory status this error d.s. is likely to have set into permanent fibrosis so whatever pulmonary deficiencies we're seeing now likely to be permanent it's not going to turn around she's still having refractory thrombocytopenia and so the i.c.u. teams that we need to have another care conference we have to talk more about goals of care so we did the next day Saturday we had a with later that day on Friday we had a care conference and again i.c.u. team hematology team we sat down with the whole family and we explained Look the i.c.u. staff is very concerned about the prolonged to be Asian. Typically at this point they would translate a transition to a tracheotomy but because her platelet count was so low no one was willing to do that in touch or so they couldn't transition her to trick which means that now there's a high high risk of vocal cord damage the prolonged sedation they're worried about cognitive deficits neurologic deficits. And then on the human side we again told her about the grim prognosis to say look there are pieces off the table she could not tolerate even the lightest chemo and even if we could give her the best chemo we had it's not going to touch the Kenya it's of such high risk and with her platelets being what they are no one's going to do anything for so there's unfortunately 3 options for your mother none of which are good the 1st one is just observe don't do anything and that's likely to end in eventual death as one organ system fails after another like it's doing now the 2nd option would be compassion exhibition but with her function being what it is we all know that's going to end in quick death and the 3rd option is going to be let's go for broke and let's just treat her but given what her platelets are and the hemorrhage in her lungs we knew this was likely going to prove fatal to 3 options all of which and in depth and we were basically telling the patient's family so which one do you want which one do you want and you can see tears in their faces they were tracking along this was not an unreasonable family you know you need some families medical literacy is very low and it's frustrating to try to help them to understand what's going on this was not that family educated tracking along they knew exactly what was going on but the daughter said you know God can still work a miracle and she said it softer this time but there are still conviction in her voice God can still work a miracle and at this point it was obvious to me that the i.c.u. attending and the hematology attending had pretty much run out of patience and looked at each other again and they said look. You guys we know how this is going to end but we respect that it's a difficult decision for you take as much time as you need and they said yeah we're not ready to give you an answer now we want to leave her full code as it is so please let us talk amongst ourselves we totally understand what you're saying we know this is a serious situation but we need more time and so all the doctors that that's totally fair take as much time as you need and so we all filed out of the room. As we walked out I saw the i.c.u. tending and our human knowledge attending kind of looking at each other shaking their heads saying this is not going to end well and they were pretty much exasperated and they're like well I hope to make a decision soon because the disease is going to make a decision for them very very soon. And as I was walking away. I felt that still small voice again and this time the voice told me John. Go back into that room. And talk to them. And I stopped dead in my tracks I said that is the last thing I want to be doing why would I leave this emotionally charged meeting where they need space to talk amongst themselves and what am I going to do by myself and walk back in there and say hey guys are you kidding me knoll that was not you and I keep watching. And I'm getting to the elevator and I'm here and I just can't shake the impression John go back there and talk with them by yourself. And I'm saying no no no this is not happening I am not going back in that room there is absolutely no way and really if you saw me at that moment you would think that I'm hearing voices or I'm schizophrenia is I argue with myself like what am I even going to say if I go in there and I get a knock knock Hey guys. Just wanted to know if you need some more company like what am I going to say. And the thought hit me John tell them the story of your father. Because you see my father was diagnosed with brain cancer in 2008 and I was in a similar situation to them where he was intubated and sedated and the doctors were giving us no hope and they sat around in a conference similar to this one where they told us you need to decide on his code status and my mother and I we were not willing to change his code status because he was still responding to us when he lowered his sedation I would ask him questions I would ask him to squeeze my hand he squeeze in when I ask a yes or no question he would not his head or shake his head he was still there how could I pull the plug on my father and so we left him full code and we couldn't decide and the hospital staff was not subtle about showing us their displeasure and they basically told us to our faces you know what we hope that our family would never love you us as much as you love your dad because that's selfish love and you're actually hurting him. So. That's probably not the best way to have a goals of care conference. And so we weren't we didn't come on that strong but I can I knew that's where our hearts were as practitioners we were frustrated with this family guys this is what's happening you have to come to grips with reality and move on. But I remembered my story and I remembered how after talking to the doctors and feeling their exasperate I ran into a bathroom in the hospital locked myself in there and cried my heart out to God and I said God if you're going to heal my dad if you're going to work a miracle now is the time now is the time but if you're not going to heal him then what are you waiting for and put him to rest let this end but please don't put me in the position where I have to pull the plug on my father. And with tears in my eyes pounding the bathroom floor I pried my heart out to God. I remember in the days following we had been 6 months by his side eating drinking living in the hospital and I decided that my mother and I were burnt to Al and so I mother and I and my father's mother my grandmother were there and I decided one Sabbath morning Mom we have to go to church you and I we are so burnt out our cup is so empty we need to go to church my mother did not want to leave his side you know what if something happened while she was gone she would never forgive herself and said Mom he's going to be fine we're going to church and we'll come back and as we're trying to go my grandmother looks at my mom and says oh you're leaving aside. What if something happens I'm like quite grandmother. We are going to church so I traveled to church for the 1st time in 6 months in the message we heard that day was a message about this in the near Innes of Jesus' return about a soon coming and I felt like it was the message that we needed to hear and driving back from church to the hospital and my mother and I talked about how we've really been asleep we've been Christians all our lives in the administration all our lives but we were asleep and we needed to wake up and we need to stop being so preoccupied with things of this world and get ready for the next. And it really felt like this was an awakening moment that God wanted us to have and so we sealed the decision in prayer and we really felt like God gave us what we needed that day went back to the hospital father is still there he's fine my grandmother's glowering judge mental eyes my mother saying how was church. And I take Grandma and I said whoa grandma we're going home Ok so my mom can relieve you and as we're stepping out the door my mother is this hey can you just help me turn in one more time for you leave so I said sure so I walked by we turned him my mother comments boy he just looks a lot more calm and peaceful doesn't mean you're right he does and then my mom says he's also looking a little more pale and then a nurse poked her head in looks at the monitor looks at my father runs out and the next thing I know there's 30 people in the room and they just call the code my father and someone jumps onto the bed and starts to chest compressions. And what I realized then was that the reason why he looks so calm was because he had stopped breathing right after we turned him and they start shocking him trying to get back he comes back for a few seconds and he starts peeling off again and I start pounding away on his chest I see my mother my grandmother out in the hallway holding each other crying and then I look at my father and now I see blood coming up his tracheotomy tube as these people are pounding away at his frail body and then I think this is not the way should and this is not right. So I grabbed the i.c.u. attendings arm and I say please at this point just make him comfortable and he looks at me and he nods his head and he orders everyone out of the room and I take one of my dad's hands in mine and my mother goes to the other and we stand there and we watch this pulse fade away into nothing and you know that was one of the saddest moments of my life. But it was also one of the most sacred because the timing of his death to me was not coincidence there was no way that was coincidence if he passed away by the sea simple act of us turning him that means he was hanging on by a thread and he very well could have passed while we were at church for the 1st time in 6 months can you imagine the kind of guilt my mother would have to live with she she walked away from her post for one day in 6 months and that's the day my father passed away can you imagine her living with that but God kept him there he gave us a message we needed to hear and when we came back it was as if God was saying now it's time to close this chapter of your life and my father to rest and he answered my prayer in the bathroom. And so all I could do in the midst of my sadness was to bend my knee and say the board you are in control take my heart let it be consecrated or 14. So I shared the story with Mrs these family. And at the end of it I told them Don't let anyone push you. Into making a decision that you're not ready for. He said I know you have faith but I also know where you are right now and you're wondering what God is doing and I don't know what he's going to do either but I do know that your mother's life is in his hands and that if you leave it up to his timing he will work it out in his providence to show you what the right decision is so until you receive clarity from him don't do anything. And at the end of it I had a word of prayer with them and after the prayer the mood was completely different. And there were tears all around the thanked me profusely for coming back and sharing the story. And when I left that conference room the 2nd time it was much different because I felt that I left him in the presence of the Holy Spirit and it was only after the fact that I saw the sheep the daughter wrote this blog post after I left and she said I want to share with you all that last Friday we had a meeting with the i.c.u. team and human knowledge a team and as a family we were crushed to hear their poor prognosis in their words quality over quantity they had informed us that there is a high risk of infection or another organ system failure and if that arises then as a family we may have to make some very tough decisions as you can imagine we were tearful but as a family we told them that we were not going to give up on mom and that we know miracles happen and that it's God's final decision not ours they told us they would continue to do everything in their power to bring mom back to health after hearing all of this the team left us in the meeting room and told us to take as long as we needed to process and talk about things a few minutes past and Dr John Shannon the mythology doctor that prayed with us returned to the room and said I felt the need to come back and tell you a story 10 years ago I was in your exact position my father had a brain tumor and was unconscious and on life support with no real hope for recovery by heart goes out to your family because I know exactly what you're going through Dr Ch'ien went on to explain that he battled with the decision of what was best for his father he states that he prayed to God that if his father was supposed to pass the god needed to take him when the time was right he prayed to please not make a man his mother be put in a position to make that extremely difficult decision his father did pass away several days later and he said that he knows God was to want to make the final decision so he didn't have to he told us not to let the doctors push us into a decision not to ever give up hope and lose faith he then prayed with us it was at that moment that I felt God's comfort and presence more than ever. Seme. I believe that the Holy Spirit prompted me to go back into that room and the surest sign to me that God orchestrated this was at the end result of my obedience was that they were left in the presence of God and I believe that the surest way that we can know the crisis working in us is that others see Christ in us and not you when people look at you and what they remember is Christ and God's presence you can be sure that God was working through that day. And I realize that the key to allowing your patients see Christ in you is to listen and obey when Christ calls you to act on his behalf it's not about technique or eloquence It's not about education or personality it's about being open to the promptings of the Holy Spirit in the moment no matter how illogical or how inconvenient it seems it to me it's summed up in Proverbs 3536 which we all know right trust in the Lord with all your heart and one lean not on to one your own understanding in all your ways acknowledge Him and He shall direct your paths see friends I believe that the greatest barrier to allowing God to use us is that we tend to lean on our own understanding. The only reason why we would ever rob God of our service is because we decided to lean on our own understanding the moment he prompts your heart and you see that's a crazy idea you are leaning on your own understanding. Learn to recognize the voice of your shepherd the still small voice and when he calls the learn to listen and to obey and that to me is the heart of what it means to allow Christ to work in you that's it you bring your meter loaves and fishes to him and he will take them and multiply them to bring out a work that you could have never done by yourself. So the next day Saturday the day after this conference happened I come into work and I notice that this is these 2 requirements had actually come down a bit overnight she was at 80 percent now she is a 65 and here's an excerpt from the i.c.u. attendings notes and he says hey Overall it appears that her hypoxia has slightly improved and her respiratory status is slightly more stable. However on the heels of the emotionally charged meeting that happened the day before what do you think the family did with this information can you guess they took this and they said Dr Shannon has sat with God is healing our mother. Ah On no. It's like we took 2 steps forward and 10 steps backwards in our goals of care discussions you know they're saying whoa now there is no way we're going to God is going to do this thing he's going to knock this out of the park we can see it and I transfer over to requirements for the last week or so and I see that this is within the realm of variation for her. And so I say you know yeah I try to celebrate the small victory with them and say yes it is definitely lower but she's been there about who we could go to and then she goes higher and lower and so this might just be noise and I think overall read too much into it so again the tension between how to leave room for God while still being realistic with your patients and they're all the king at each other exciting thing now remember we prayed last night and we all laid hands on mom and we asked God to give us a sign that he's going to heal her skin to give us a sign and look oxygen is down this morning this is the sign. And I walk at it like I know. I didn't tell my team but. I figured that they would just dismiss her from their service I just didn't want to even tell them what they told me I said thought this is not going to end well. That Saturday or Sunday I come in. And of course I checked her chart and I'm like what's going to be today. And her oxygen came down to 45 percent. So this time it really caught my attention because I trended her all to requirements and this is the lowest ode to requirement that she's been on since she entered the i.c.u. So this is new territory for her I said well if this is within the realm of variation now she's she's making new ground so that's kind of strange and then I hear from the i.c.u. team that they tried to withdraw the sedation of it to see to check on her neurologic status and they found that she's still there well being all commands and she's neurologically very intact. So later that afternoon I received word that they lowered her sedation enough that she was able to actually sit up in bed and dangle her feet at the side of her bed. And I was like Are You Kidding Me and the nurse with a big grin on her face like for 10 minutes and as she told me that all the family are in the background just nodding their head saying like you see what I told you see what I told you this Is it God's giving us that sign we ask for a sign this is the side Dr Sharon he's healing her I think yes something is definitely happening. But let's curb the enthusiasm because it's there's still tomorrow and your mother is still very sick on the vent. It's to the point that I caught my hematology is tending to tension and she he wrote in his notes that they will she appears to have made some improvements in her Palmeri function but you have to understand this man he's absolutely devoid of emotion. His mother was probably a librarian his father was I'm sure a robot I was at 0 personality he's all brains. With 4 limbs attached to a huge brain. And he just wanders through the hallways and makes medical plans on people and he had this is your emotion just this it seems like she needs improvement move on so. That's a lot more than I got out of him last week. But you can imagine. The family reaction to the family reaction at this point there was no dissuading them that this was anything other than an answer to their prayer this is a bona fide miracle as far as they were concerned and the blog post was this since that Friday afternoon at the end of the day before the others take off for the night we lay our hands on mom and pray for God's will to be done and mom has made steady improvement since over the weekend her sedation was lowered and she was able to interact more with us p.t. and o.t. started working with her and seeing her at the side of the bed doing light exercises she's even been able to face time with her grandson several times and also her niece in Texas I know this is not some kind of irony I think she meant to sequence events mom has surprised us all including the doctors and I'm absolutely 100 percent positive without a doubt sure that God is in control and his healing hands are at work so this is what we were dealing with but I couldn't see anything in the light of the remarkable progress that she was making here. But. The next day Monday what do you think happened. Her reaction came down to 30 percent I. And the problem was that. It keeps coming down in the i.c.u. team is now running out of reasons to give them of why this might be just normal variation and at this point they just frankly told them we don't know what's happening. But we're happy that it's getting lowered and they're kind of having a little bit of uncomfortable egg on their face saying well yeah she's improving but this is fantastic and the family is saying The Lord is healing my mother and they're saying well something's happening I'm not sure it's the Lord but something's happening but let's not celebrate too quickly Ok so all the hospital staff are just kind of the you know the sticks in the mud saying well you know calm down yet you know this is remarkable let's take it one day at a time and a family were just like on Facebook on social media saying God is healing Mother mother and while all this is going on. We realize that well she's making progress more respiratory standpoint but the issue is that she's been intimated for greater than 2 weeks and she needs a tracheotomy however she needs that she would need a tracheotomy only she could only get a tracheotomy if she had adequate platelets in her plate this were not coming up and so they decided to console the n.t. to see if they'd be willing to do this even with a low platelet count in light of her improvements. So the next day Tuesday hospital 21. Her oxygen requirement stayed stable but her peep came down her and x. returned pressure to 12 which was a new low for her and the i.c.u. team continues document respiratory improvement and I have to admit that during this time every time I came in to round on her every time I opened her chart I held my breath is today the day that the other shoe is going to drop and is today the day that their hopes are going to get crushed and I have to tell them you see it was all noise. And that's a lot of tension. To a hospital day 23 Thursday that there is there was no different I come in the morning I open up the chart and I braced myself for the inevitable bad news that I knew was going to come. And instead what I find out is that she had made so much remarkable progress that they were actually going to consider going straight to x. to be in and skipping with the tricky asked of me. And. That was hugely unexpected on our end the fact that she can go from being on death's door to now the i.c.u. team is considering let's axe to beat her we had no words to describe what was going on. That Friday August 25. In the midst of her continued respiratory improvements all was not well because despite her breathing improvements we see that there were circulating blasts in her differential c.b.c. which means that even though her lungs were getting better she had the underlying leukaemia that wasn't going anywhere and we knew that that was still uniformly fatal So even though the i.c.u. team were happy about her progress we have seen mythologists we were still that yours in the room saying yes we're so happy that her breathing is improving but guess what's the waiting for the Leukemia that brought her here to begin with but still I celebrated the victories that we could see. Another inexplicable development was that all of a sudden her drama side of her low platelet started to resolve on its own and every single day the numbers are rising and rising and it was to the point where we were saying well now you could even do a tracheotomy even if you wanted to you could do any procedure you want it's so robust and we didn't do a single thing to intervene and the plate was started to rise and now you could say well you know you stop the chemo and her bone marrow is maybe recovering and none of her other counts are going up but her platelets were inexplicably going up by themselves so I celebrated that victory. Now hospital day 26. Her people came down to 7 that morning and so the i.c.u. teams goal for the day was they were going to try to extirpate her and later that morning sure enough we received word that she had been successfully extubated the family was overjoyed and all the doctors called it a miracle. And remember we had not done any new intervention in her and somehow inexplicably ever since that Friday night when we had the care conference and we prayed and the family gathered around and lay hands on her mother and asked for God's will to be done from that moment she had marched along and made steady progress and all the doctors took note and they started calling it a miracle and I know these doctors did not have a religious background. Monday August 28th hospital a 27 so following her exhibition the i.c.u. position noted that she was doing remarkably well her voice was a bit horse which is to be expected but no evidence of permanent vocal chord damage she was mobilizing better or overall she was improved to the point where they were considering transferring her to the floor so the i.c.u. attending told me later on that morning he said in his entire career he has never seen a patient so sick and to be to for so long to successfully extubated without any vocal cord damage or cognitive deficits he said this is new territory for me and he said John I don't know what this is but if this is not a miracle I don't know what is and he walked away I said Praise God Praise God. So. Tuesday August 29. Here's my hematology attending you know the man with no emotion he was absolutely amazed at the day to day improvements and normally a very reserved man even in his note writing he uses words like she has done exceedingly well in terms of recovery from her severe r.d.s. and she has full human Humana poetic recovery of her white count and her platelets and he notes Well she does still have 4 percent circulating blast which may indicate recovering bone marrow or underlying residual leukemia which is more likely so the plan from our hematology standpoint was when she's ready we have to do another bone marrow and see what's going on so I lead this is caution with the family and with the patient and I told Mrs e. look we're so happy for you this is incredible all glory goes to God but all is not well remember you have the leukemia so when you get strong enough we're going to repeat a bone marrow. I'm just warning you by it's likely going to show leukemia Ok And so but we'll talk about we'll cross that bridge when we get to it I don't think they even heard me they're just grinning ear to years saying all right doctor are right you have a chair you want to come take a picture with us I. Don't know she looks so great Dr look at her as she's a sitting up in bed spiling is amazing when I don't think you just heard what I said and that's fine and we can talk about this later but leukemia can wait let's celebrate. So the i.c.u. team felt that she was doing remarkably well she passed her swallow evil which is another milestone and then she was downgraded from her high flow up the flow to just low flow these which is a tremendous accomplishment in and of itself so then September 1 hospital 831 exactly 2 weeks after our Carrick on friends Mrs e. was transferred out of the i.c.u. despite absolutely no new intervention being given in the i.c.u. setting this was truly a bonafide miracle and everyone up and down the food chain was now freely using the miracle word and we all nicknamed her the miracle lady how is the miracle lady doing this morning how's a miracle lady no one was playing any more she's out of the i.c.u. on the floor extubated on just low flow nasal cannula this is a bonafide miracle. September 2 Saturday now that she's out of the i.c.u. on the mythology floor we have to focus on her leukemia She's now back to us and we had to take care of what was originally what brought her into the hospital so this was now 29 days after her getting her abbreviated chemo so she's made a full recovery in terms of recount so now she's ready to tolerate some more chemo but she still had these intermittent circulating blasts which were very very concerning to us and so given that she had the suboptimal induction therapy of course this is likely to be still leukemia and it's going to be life limiting. But after witnessing the miracle of the last 2 weeks nothing we could see would take away their perfect peace Mrs e. she had this smile on her face every day she says Dr Shand How are you doing like no how are you doing. I'm doing well I'm blessed How's your family I'm like no no this is about you how are you doing how are you feeling and then every time I kind of sheepishly try to bring up a just let me know we're going to do a bone marrow soon and it's not going to be the best of news but at least you're still feeling good to see the facts fine Dr Shand I'm living on borrowed time as it is and so anything extra from here is just gravy and that's what she would say. And so one of the 2 of us was in perfect peace during this time I and it was not me. But if it reminded me of the story of last rites you know after Jesus' reason from the dead Ellen White says that well we know the Bible says that the fair is conspired to kill Lasser's as well because so many people believed in Jesus as a result of that and and when this affair sees were conspiring to kill Lazarus How do you think Glasser has felt Who do you think he was concerned that they were going to try and what kill him. Right I'm sure he was in perfect peace he came back from the grave What does he need to fear. Bring it on. And that's exactly how Mrs e. was like she says God brought me back from the grave what need I have to fear for anything that lies ahead for me so well that's that's very true this is the I can't argue with that. Sunday day 33 mm she continued to improve clinically on the floor sitting up doing well she's even a nurse walking around the nursing Pod and her breathing is doing better and I tell you it threw me for a loop when I saw her just walking around the nursing Pod and I'm thinking 2 weeks ago you were prone in the i.c.u. and we're talking about compassion extirpation this is this is incredible. September for so our hematology attending continued to be amazed at her recovery kept calling it a miracle you know saying quite remarkable considering her unconventional induction regimen that's his language but however as she got stronger and stronger we focused more on her leukemia and we said Ok it's getting imminent I think we can plan for a repeat bone marrow biopsy and talk about more chemo after that so they 35 continues to get stronger physically making remarkable progress and we decide Ok the next day we're going to do it you're improving so much we're going to actually plan for a bone marrow biopsy so Wednesday September 6 we report we repeated a bone marrow. And when the results came back. What do you think it showed. With the circulating blasts in our c.b.c. it was a foregone conclusion. But there was no evidence of leukemia and her bone marrow. Morphological complete remission and when the genetic testing came back no evidence of the genetic malformations that was initially detected on her bone marrow completely clean and this gave me the shivers and when I presented the bone marrow results to my tending I wish I had a camera. If ever in my life I wish I had a camera it was at that moment because his face looks something like this that I. Have he was at a loss for words and he started mumbling something about this is I'm just a miracle this miracle I can't believe this that this is just doesn't happen this does not happen because with a high risk strategy medics we would expect to be refractory even to standard induction chemotherapy would fool those chemo but with this weenie side tear being monotherapy in abbreviated course that that just 6 out of the 7 days with interruptions in between she went into morphologic complete remission and he said this is like a case right up like we had never seen this happen in this kind of scenario nothing short of a miracle so now he was sold before she was the i.c.u. is a miracle and now she was hematology miracle and he and he would walk up and down the different hematology department in the group and knock on doors and say hey you need to see this bone marrow remember that lady I was telling you about look at her bone marrow is this is same patient like yes and they would compare before and after bone marrow and say Can you believe that this happened absolutely Florida so the entire Miley group at Mayo we're talking about her. So. Thursday September 7th possible date 37 so my attending documented that she was in morphologic complete remission after just using so terribly alone despite her having a very high risk area type at diagnosis and what was incredible was that given her physical recovery and this new found remission he slipped it into his note that day he didn't tell me but he said you know we could consider going with the allergen a bone marrow transplant in the future. And I was floored I was like this is that option that only that one single option that could provide her with deep remission that she could never be a candidate for and now he's actually putting it into his note saying we could consider that at some point it wouldn't be unreasonable and I was a lot is going on here. So then Saturday September 9 hostle day 39 after 43 days in the hospital counting 4 days at the outside hospital Mrs e. was discharged home. Discharged home she walked out of her own 2 feet. And so she can to deplane was to get several more consolidated cycles of chemo in order to maintain her remission and afterwards assuming she continued to do well the plan was to head her for transplant so I followed her as an outpatient now September 25 we repeated the induction with the fool 7 plus 3 regimen and you might wonder why because even though you have morphologic remission we want to induce the deepest remission possible molecular remission with no residual disease that we can detect so we went ahead and gave her the full dose of those chemo and she tolerated very well this time then on October 19 I saw her labs and I see circulating blasts in her c.b.c. Now this is causing concern for recurrent leukemia so I pick up the phone and I said this is the. I saw your lives from today and you tolerated chemo very well but you have circulating blasts on your c.b.c. and this might be indicative of underlying leukemia Ok Dr thank you for letting me know how are you doing. M m to create This is the but I hope you understand that we have to schedule an emergent bone marrow biopsy and just brace yourself you know this might not come out very good I understand. Praise God Either ways I'm doing very well enjoying time with my family give your wife a hug for me. I don't know if you're hearing me Mrs e. but I'll talk to you after the bone marrow all k. Dr Hsin thank you for calling hang up the phone again one of the 2 of us is in perfect peace and it's not mean so on October 24th we repeat the bone marrow biopsy. I hold my breath and when it comes back continues to be negative no evidence of the chemo so I pick up the phone and eye color I say Miss is eat your bone marrow is completely clean there's no evidence of leukemia although that's wonderful news thank you for calling doctor and how are you doing I. And so we continue on in this fashion. This is the last day of chemo she came in I really like the shirt and the message on the shirt. And. And this day her daughter writes on her blog she says you know mom met with Dr Park to getting admitted and as always he gave mom a sense of comfort with his words and today he told Mom that he spoke of her her miracle this past Sunday after church they thought I went to Sunday church he also told that human is why pray daily for her and that they've officially adopted her as one of their own and so so this was a very touching moment for me. Now how did this story end November 6th or December 12th she receives 2 more cycles of high dose sites here being consolidation generally 192800 she undergoes her bone marrow transplant and tolerates it very well and to the present day be manged leukemia free. Report. Is what I would have said when I was playing writing up this story earlier this year but as of July 29000. A repeat bone marrow showed that she had relapsed e.m.l. she went through more chemo but this time it was completely different it quickly became evident that this amyl was different and more aggressive than the 1st completely refractory to treatment were quickly running out of options she was hospitalized with many of the same symptoms respiratory distress in the hospital and nothing seemed to even slow down her her disease so we had to have the hospice talk with her very quickly now let me ask you Are you disappointed by this outcome. Well I know I was but there's this negate the miraculous events that took place earlier could it be that all of this was just a product of random chance and they were just being patterns in the sand because we really wanted to believe that God was working Could that be. I would say no and here's why this is the last picture I took with Mrs e. when I visit her in the hospital before she went to Hospice what was most remarkable to me throughout this whole process was that even though I felt terrible for her in her situation. She was still in perfect peace. In fact it was she who ended up encouraging me and comforting me and not the other way around and she told me that she was so thankful for God for the extra 2 years of life she was able to enjoy that she had no fear of dying she said she was ready and reminded me of the lyrics and I greet him when peace like a river attended my way when sorrow is like See below is roll whatever my lot that has taught me to say it is well it is well with my soul see she exemplified these lyrics to me she viewed the trials of life as a blessing because they enabled her to draw near to Christ and her example preached a powerful sermon to my heart because I think whether we're aware of it or not we as physicians we tend to focus on the wrong outcomes we tend to look at the physical outcome to determine whether or not God has been faithful but if we allow Christ to open our eyes and we can see a spiritual dimension of healing that's far more important than the physical and we see this inexplicable peace and we can be convinced that although in her case the disease was back in her body was dying that she was victorious in Christ. So Mrs He ended up passing away on September 15th last month. But you know she developed the faith the kind of faith the child described where he said though he slain me yep I trust in him. So as we go forth to minister to our patients I pray that God will make instilling this kind of faith our ultimate goal. Sometimes God is willing to sacrifice the body to save the soul and we leave the outcome to him whether he heals our patients in this lifetime or on Resurrection morning let's leave that to him but may we be 1st and foremost healers of the soul that's always point their eyes heavenward to Christ so that they may experience is perfect peace and in so doing we can know that. Christ truly has been working and us a man let us pray Heavenly Father I thank you so much for giving us these wonderful moments of experience with our patients who teaches so much about your love about what faith really means and now the Lord help us to have this kind of faith it gives us a perfect peace and you may we leave all outcomes to you and may we be the thread in your hands that you weave together for the outworking of your great design all these things we think you may be praying in Jesus' name amen this media was brought to you by audio verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse if you would like to listen to more servant leader visit w w w audio verse or.

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