Life As Precious

It wasn’t a typo. I’m pondering what makes one life as precious as another, or if there are instances where one life is valued higher than another.

In Africa, or at least in French, there is a term used for pregnancies that come after a period of infertility or recurrent miscarriage. Grossesse precieuse. Translated: precious pregnancy.

At first this drove me nuts. Every life is precious, I would tell our medical students. Every pregnancy is precious. We don’t treat labor and delivery differently just because it was difficult for her to get pregnant. We make calculated evidence-based decisions about when to use different medications and when to intervene with a C section. Risk vs benefit. Medicine as science, right? Or not. Never forget that medicine is also an art. And when someone has waited over 10 years and had a few infertility procedures and their baby is near term, it is so hard to treat their pregnancy the same as a teenage mom without support or the same as a momma with 4 kids already at home. In our human-ness, we cannot overlook the relative precious nature of the former pregnant woman’s baby as we make decisions.

Sydney gets early life lessons. This is a very small (living) precious premie baby
whose head just barely outsizes the suction bulb.

I had a new experience this week.* Ryan mentioned that I’d better be glad most days aren’t so exciting. Routine scheduled surgery for possible ovarian tumor vs normal mass. The general surgeon volunteered to scrub in on the case for an extra pair of hands, which I was grateful for. It was a complicated surgery, and got further complicated when she needed to be intubated because her spinal anesthesia had worn off. One attempt to intubate failed. Oxygen saturation recovered but not completely with a facemask of oxygen. Second attempt to intubate seemed successful at first, but the oxygen saturation just kept going down. The general surgeon broke scrub to assist the anesthetist to listen for breath sounds in the lungs. I waited next to the open abdomen, intestines spilled out but covered at this point with a white laparotomy sponge. And then I saw the flat line of no pulse. “Does she have a pulse?” I must have repeated at least 5 times. There was a search on her thick neck, her wrists, without result. I then broke sterility and tried to find a femoral pulse. Nothing. Start doing chest compressions. Her heart has stopped and she is dying. That tube went into the stomach instead of her lungs, so her heart stopped beating because it couldn’t keep doing the work without oxygen feeding that big muscle.

Photo credit: Rose Finley

Oxygen was being given by a facemask, but that was less than ideal. We still needed an airway. I switched off with the general surgeon who was doing chest compressions so that he could prepare to do a cricothyrotomy- an emergency airway cut directly into the cricoid cartilage (hard part by your voice box). As I was doing the work of circulating blood throughout her body with the chest compressions, I felt oddly calm. Watching the pulse on the monitor match my efforts- speed up when I increased the frequency of compressions, and slow when I fatigued- I pondered life. This woman had cancer. She was not very young. I didn’t feel panicked if we couldn’t resuscitate her. Was her life less precious? If she had young children relying on her, would that make this moment more terrifying? What about hypothetical situations where there is a prisoner or a very old person or someone with a chronic psychological problem and there is a bad outcome? Does that affect my value judgment on life?

Rhetorical questions. Important questions. (Further thoughts on triage and deciding how to use limited resources were brought up in an NPR episode called, “Playing God.” It recounts Hurricane Katrina and various war situation triage situations.  http://www.radiolab.org/story/playing-god/# )

The cric was finished in short order, and oxygen levels rose. Still I was doing the work her heart should have been doing. And then, puff, I was startled back to the present by the monitor suddenly reading a heart rate of 110, faster than my cadence. “Is she back?” I asked almost in disbelief. Sure enough, the surgeon nodded. She has a pulse! We gingerly returned to our operation, having left the sterile field and not knowing if we’d return. We regloved and regowned and washed what we could with betadine. We uncovered her intestines and returned them into her abdomen, closed the remaining open cavities as quickly as possible, and prayed as the blood transfusion was running in that she would not have significant bleeding after this and that she would fully recover.

She seized that night, and I actually winced as I walked by the morgue on the way in the next day, hoping against hope that I wouldn’t see that it had been used overnight to store her body. But she wasn’t in the morgue. She was alive. Her sister said what we were all thinking, “God wasn’t done with her, so He brought her back to us.” She improved very quickly, especially considering her wild operation experience. Her grateful smile was so wide, and she just wanted to walk and eat, even with a tube still in her neck. Over the next few days, she continued to make improvements, her tube was removed, she walked outside in the fresh air and I saw her look up into the sunny sky, so grateful for life. We discharged her less than a week after she nearly died. It isn’t the end of her story, though.

Let’s go to another patient briefly. One who initially presents with her water broken and a very premature baby inside. She does everything we ask of her, making the hospital her home for almost 2 months, undergoing frequent tests to ensure the baby is growing and doing well despite the lack of fluid. And then just two weeks before our ideal timing for delivery, she starts bleeding, needs an emergency C section, and gives birth to a premature infant with a good chance of living. But despite oxygen therapy and intensive care, the baby dies, its lungs underdeveloped for how old the baby is because the amniotic fluid which normally fills the lungs in the womb has been lacking. I went to her bedside the day after, and I put my head next to hers and we just cried. Why? Why didn’t she just deliver 2 months ago and mourn and move on? Instead, there was hope and waiting, then emergency surgery and intensive care and death. Is life as precious when a lot of effort has been put forth to avoid a death as opposed to a sudden death? I suppose if death were the enemy, I would never make sense of this. But death is not the end. During her time with us, she and her family learned a lot more about a historical figure that she has grown up respecting as a prophet, but not known fully—Jesus. She now has heard about Him and what He has done to defeat death, pain, and separation from God. If it took a little life inside of her to introduce her to her Savior, then that life was as precious as heaven itself.

Is life as precious when it is unplanned? Or when that unplanned life risks the life of one (more) precious? A very young teenage girl who was forced to undergo an abortion in her own house came in with sepsis. Pulse racing, blood pressure low, fever raging, and belly very tender, we rushed her to surgery. “Smells like they perforated her bowel,” a visiting surgeon mentioned as we were prepping for surgery. “Or necrotic [dead] uterus,” I mentioned, thinking of advanced cervical cancer patients. When we opened her abdomen, there was no stool, thankfully, but almost half of her uterus had to be removed because it was dead. It had been perforated with the instrument used for abortion, and then infection had set in and was killing the uterus slowly. Thankfully her bowel was all healthy. It had escaped the instrument used for abortion. I’m unsure if she’ll ever be able to have a child safely; only time will tell. But she is alive.

Pic to the left is the uterus- the black part is all dead, the hole near the bottom left where the instrument poked through. The remainder of the uterus is pink and in my hand.


Back to our ovarian cancer patient. She was doing well as an outpatient for a few days, getting daily dressing changes. But she took a turn for the worse, had shortness of breath, started vomiting, and eventually was readmitted for a second surgery to reclose her abdomen as the infection had made our first closure weakened. She came out of the second surgery, still smiling, still grateful for another day of this precious life. And that’s all she was given. She died suddenly less than 24 hours after her second surgery. Again, why? Why did she survive the initial surgery and seemingly do so well? Her family all knows and loves Jesus, and they were praising God for healing her just as we pray before each surgery- because we know that God is the one who heals and who gives us wisdom when we ask. And each person who is healed or baby whose life is saved we pray that their healing will be used to glorify God.

I don’t have the answers. The fact of the matter is that God chooses to heal, sometimes miraculously, sometimes despite us, sometimes directly because of our actions. Sometimes God allows life to be extended, and sometimes God allows life to slip away. I don’t have answers, but I do know that God watched His own Son to suffer and die, precisely because He found our lives so precious to Him that He would give up heaven to conquer death. As we are making decisions, unfortunately sometimes feeling as if we are “playing God,” as the NPR episode mentioned, we need to give ourselves the grace that God has so freely given to us, and to treat all life as precious.

*I write these stories and don't necessarily publish right away. I try and get patient permission to take photos.  I also try to use a random picture that is similar to what I'm talking about, but usually isn't the particular person. This protects patient identity a bit. Although there are no laws as in the US, there is certainly common sense and I'm not blind to the fact that internet is available in most places of the world. 

Our favorite moments of the day are when we walk home at lunch or after work and our precious kids run out to greet us with a big hug. (Sydney was pretending to be shy... or she just woke up. She's rarely cuddly, but I'll take it!)