Dec 18, 2009

A Christmas Miracle

Herewith, the first true story I promised you. This one is short enough for its own single post. It was originally published in Moody (the seminary, not the condition) Magazine in December 1988. In re-reading it, I am struck by the level of medical care in 1947. Still, like even our most modern care, it is a byway on the way to a destination that is ultimately out of our control. I hope you enjoy it:

A Christmas Miracle
- by Dr. Joseph A. MacDougall as told to Douglas How

Finally, one day that December, I had to tell her. Medically, we were beaten. The decision lay with God. She took it quietly, lying there, wasting away, only 23 and the mother of a year-old child. Eleanor Munro (her name has been disguised) was a devout, courageous woman. She had red hair and had probably been rather pretty, but it was hard to tell anymore, she was so near to death from tuberculosis. She knew it now, she accepted it, and she asked for just one thing. "If I'm still alive on Christmas Eve," she said slowly, "I would like your promise that I can go home for Christmas."

It disturbed me. I knew she shouldn't go. The lower lobe of her right lung had a growing tubercular cavity in it an inch in diameter. She had what the doctors call open TB and could spread the germs by coughing.

But I made the promise. Frankly, I did so because I was sure she'd be dead before Christmas. In the circumstances, it seemed little enough to do. And if I hadn't made it, I wouldn't be telling this story.

Eleanor's husband had the disease when he returned from overseas service in World War II. Before it was detected and checked, they married. She caught the disease and had little immunity against it. It came on so fast and lodged in such a difficult place, it confounded every doctor who tried to help her.

To have a tubercular cavity in the lower lobe is rare. When they took her to the provincial sanatorium in Kentville, it became obvious that the main problem was how to get at it.

If it had been in the upper lobe, they could have performed an operation called a thoracoplasty, which involves taking out some of the upper ribs to collapse the lobe, and put that area of the lung at rest.

Unfortunately, this operation couldn't be used for the lower lobe. It would have meant removing some of the lower ribs, which her body needed for support. And in any case, it probably would not collapse the cavity.

With thoracopasty ruled out, they tried a process called artificial pneumothorax, which uses needles to pump in air to force the collapse of the lung through pressure. Although the doctors made several attempts, this process didn't work because previous bouts of pleurisy had stuck the lung to the chest wall and the air couldn't circulate.

Finally they considered a rare surgical procedure called a pneumonectomy--taking out the entire lung--but they rejected it because she was too sick to withstand surgery and steadily getting worse.

Their alternatives exhausted, they reluctantly listed her as a hopeless case and sent her back to her home hospital in Antigonish.

I was 31, and I hadn't been there very long. At St. Martha's Hospital I provided an anesthesia service and looked after a small TB annex, a place for about 40 patients, most of them with little or no hope of cure.

That's how Eleanor Munro came to be my patient in 1947.

She had weighed 125 pounds. She was down to 87 the first time I saw her. Her fever was high, fluctuating between 101 and 103 degrees. She was, and looked, very toxic.

But she could still smile, I'll always remember. If you did her the slightest kindness, she'd smile.

Maybe that encouraged me. I don't know. But I did know that I had to try to help her.

I first called a top expert in Montreal on the use of a new drug called streptomycin. he told me the drug wasn't available. When I described the case, he said he would advise against its use anyway.

I then phoned a doctor in New York who was experimenting with a procedure called pneumopertoneum.

It consists of injecting needles into the peritoneal cavity to force in air and push the diaphragm up against the lung. If we could get pressure against that lower lobe, we could hope to force the TB cavity shut.

If we could do that, nature would have a chance to close and heal the cavity by letting the sides grow together.

At the hospital, we considered the risks and decided we had to face them. We operated to pump air into Eleanor's peritoneal cavity.

It nearly killed her. It was obvious that the amount of air she could tolerate could in no way help. Every doctor in the room agreed we shouldn't try a second time. We were licked.

I told her that medical science had gone as far as it could go. As I explained why in detail, she listened with a quiet dignity and an amazing resignation. I told her that her Creator now had the final verdict. It might not be what either of us wanted, but it would be the best for her under the circumstances.

She nodded and then exacted from me that promise.

Amazingly, she was still alive on Christmas Eve, though just barely. But she held me to my promise, and with renewed doubts, I kept it. I told her not to hold her child and to wear a surgical mask if she was talking to anyone but her husband. His own case had given him immunity.

She promised, and off she went by ambulance, wearing that smile I can't forget.

She came back to St. Martha's late on Christmas Day and she kept ebbing.

No one could have watched her struggle without being deeply moved. Every day her conditin grew just a bit worse, yet every day she clung to life.

Toward the end of February, she was down to 80 pounds; she couldn't eat--and new complications set in. She became nauseated and began to vomit even without food in her stomach.

I was stumped. I called in a senior medical consultant, and when he examined her, he was stumped, too. But with a grin, almost jokingly, he asked me if I thought she could be pregnant.

The suggestion seemed utterly ridiculous. Everything I knew about medicine added up to one conclusion: She was so ill, so weak, she couldn't possibly have conceived. Her body just wasn't up to it.

Nevertheless, I did take a pregnancy test. To my astonishment, it was positive. On the very outer frontier of life itself, she now bore a second life within her. It was as close to the impossible as you're ever likely to get, but it was true.

When I told her, she smiled and faintly blushed.

Legally and medically, we could have taken that child through abortion because it imperiled a life that was already in jeopardy. At that time, TB was the number one medical reason for doing so.

But we didn't do it. The patient and her husband were against it. We doctors at St. Martha's were against it, not only on religious grounds, but because we were certain the operation would kill her. Besides, she was so far gone that we were sure her body would reject the child anyway.

So we fed her intravenously and watched her fight to sustain two lives in a body in which only some remarkable strength of character or divine intervention had allowed to sustain even one.

The struggle went on for weeks, and never once did we alter our conviction that she was dying. But she simply refused to die. And she kept her child.

And then an incredible thing began to happen. By late March, 1948, I was confounded to find her temperature beginning to go down. For the first time, we noted some improvement in her condition. She began to eat and to gain weight.

A chest X-ray showed that the growth of the TB cavity had stopped. Soon after, another X-ray showed that her diaphragm was pushing up against the lower lobe of her diseased lung to make room for the child she bore.

Nature was doing what we'd failed to do with pneumoperitoneum--it was pressing the sides of that deadly hole together. The child was saving the mother!

The child did save her. By the time it was born, a normal healthy baby, the TB cavity was closed.

The mother was markedly better, so much better that we let her go home for good within a few months. her smile had never been brighter.

I still remember with delight the Christmas cards she sent me for years. They were just ordinary cards, with the usual printed greetings. But to me, they were like monuments to a miracle of Christmas.


CGHill said...

I am literally tearing up over this.

Thank you.

Sparrow said...

What a wonderful story! Thanks for sharing it.

Ex-Dissident said...

What a great story. The way TB causes its damage is through the body's reaction to that Tuberculous bacteria. This reaction can be overwhelming in some young people with a very healthy immunity. Even though the body destroys a lot of tissue, the TB bacteria is very hard to kill and it remains alive. Pregnancy actually lowers one's immunity and we often see asymptomatic mothers who give birth, and then develop symptoms from TB. Sounds like this woman survived long enough to have benefited from effective drugs becoming available. Just another take on this truly miraculous story.

julie said...

Fantastic story, Joan! Thanks for sharing it.

Jean said...

Geez. there are tears here.

Beautiful story.

PeggyU said...

That was absolutely amazing! Thanks for that, Joan :D

robinstarfish said...

Great story, the kind nobody prints anymore.

I still remember the Moody Science films when I was a kid.

patti said...

Beautiful, and a gift - thank you.

Lance said...

What a beautiful story to read, and so touching to think about the miracle of life!

jck said...

Thanks for sharing - perfect timing.

pamibe said...

Goosebumps! What a great story... thank you!