Words We Dread to Hear -
Coma,
Brain Death, and Christian Hope
by Kathryn
Butler
Medical Doctor
The paramedics rushed him
into the trauma bay, but sorrow muted their earnestness.
We received the patient
with swift hands, our motions crisp and automatic, and yet dread weighed down
our hearts.
He had sustained a gunshot
wound to the head. Paramedics found him unresponsive, not breathing. A stiff
tube jammed into his trachea elicited no response — not even a cough or a gag.
He was barely a teenager.
As I examined the entry
wound, I struggled to focus on protocol, rather than on the horror of it all.
When I reached his eyes, however, I broke down. His pupils had dilated to crowd
out all color. When I flashed a penlight into them, they remained fixed,
impervious to all glimmers of life.
A battery of tests
confirmed brain death. When we met with his mother, his blood pressure had
precipitously declined. His heart rhythm adopted an erratic and ominous pattern
on the monitor.
After her initial tears,
she leaned toward him and searched his face. The intensity of years of
laughter, fears, struggles, and joy illuminated her gaze. Most of all, her eyes
shone with tenderness.
She reached for his hand.
“God blessed me with the most wonderful child,” she said. “And now he’s called
him home.”
Her words echoed in my mind
months later, when another teenager arrived to the ICU with severe head trauma.
His exam and tests also pointed to brain death. Another boy we could not save.
Another heart-breaking conversation.
I sat with the patient’s
father, and leaned forward to narrow the expanse between us. My colleagues and
I delivered the grim news in measured beats. In contrast with the gentleness
and acceptance I’d witnessed months earlier, he glared back at me.
“No,” he said, “He’s going
to live.” He pointed an index finger upward. “From Jeremiah: nothing is too
difficult for God. With God all things are possible.”
The details of these cases
were equally harrowing, the impacts equally devastating. Clinically, the
patients mirrored each other.
In both instances, parents
spoke words demonstrative of faith. Yet their remarks reflected opposite ends
of a spectrum, ranging from unwavering acceptance of God’s sovereignty, to
fervent faith in the power of prayer.
How can we reconcile such
disparate responses?
Brain
Death or Coma?
Although these parents’ individual stories,
griefs, and relationships with God influenced their reactions, confusion about
brain death also contributes.
Popular media often uses
the terms “coma” and “brain death” interchangeably, despite marked differences
between these conditions. Tragic, controversial cases (such as that of Jahi
McMath) further confound understanding.
Perhaps most unsettling,
from the doorway, patients with brain death appear indistinguishable from those
with reversible injuries. Both types of patients may require a ventilator to
support their breathing. Their hearts still beat, and initially their skin may
feel warm.
Differentiating between
brain injury states requires neurological examinations and adjunct tests,
information few loved ones feel equipped to decipher in the midst of
devastating news.
When injury affects both
hemispheres of the cerebral cortex, or areas of the brainstem responsible for
arousal, coma results. In coma, patients are unconscious and unaware of their
surroundings.
They may breathe
independently, but they do not respond to any stimulation. Slightly less damage
may produce a vegetative state, in which patients have sleep-wake cycles, and
may open their eyes, but do not respond to the environment. They are wakeful,
but not aware.
Although coma and
vegetative state often carry a poor prognosis, patients have potential for
recovery. They may depend upon nursing and medical care for the rest of their
lives. Their recovered function may range from dramatic, to minimal, to nothing
at all. Yet with functioning regions of the brain, recovery is possible.
Patients with brain injury are very much alive.
Brain death constitutes
a different category. In whole brain death, injury is so catastrophic that all
brain tissue dies. Unlike coma and vegetative state, tissue injury is total and
irreversible. There is no potential for recovery.
Brain death is death.
Why
the Confusion?
Prior to advances in intensive care, brain
death and cardiopulmonary death happened concurrently. When the brainstem
dies, breathing ceases. Oxygen levels plummet, and the heart stops.
In modern ICUs, however,
mechanical ventilators interrupt this process. Brain-dead patients have no
functioning brain cells, but if a ventilator provides oxygen, the intrinsic
cardiac pacemakers — separate from the brain — drive the heart to beat for a
time.
In the majority of
patients, this time remains brief. As the autonomic centers within the
brainstem fail, derangement of blood pressure and heart rhythm occurs.
Failure of the hypothalamus
and pituitary gland, regions of the brain that regulate hormones, further
contributes to instability. Hypothermia ensues. Most brain-dead patients
develop cardiovascular collapse within hours to days, in spite of aggressive
ICU interventions.
For a parent at the bedside
of his beloved teenager, whose cheeks still sport the ruddy blush of
toddlerhood, this reality can seem impossible to embrace.
How can Scripture guide us,
when a physician utters the words we dread to hear? Modern medicine may make it
clear that brain death is death, but only God can give us real
hope.
Sanctity
of Life
The Bible teaches that life is God’s sacred
gift to us. “He himself gives to all
mankind life and breath and everything” (Acts
17:25).
As our Creator, he formed
our humanity from the dust, and fashioned us in his own image (Genesis
1:26; 2:7; Psalm
139:13).
He charges us to protect the
life he has created (Genesis 2:15; Exodus
20:13).
A brain-death determination
often requires families to trust the assessment of a physician whom they have
never met. Given the stakes, they should feel empowered to ask questions. Their
loved ones are God’s handiwork (Ephesians 2:10).
As those who cherish God’s
workmanship, families have every right to understand the death of their beloved
in detail.
Physicians, in turn, must
guard against misdiagnosis, particularly as the United States has no national,
evidence-based standards of brain-death determination. Brain-death
determination practices vary across regions and institutions.
With God’s sacred gift in
the balance, we must do better. And when questions have been asked, due
diligence has been done, and the diagnosis is accurate, we can receive brain
death as clarity from God about what he is doing.
Death
Comes to All
Death is a necessary consequence of the fall,
and God ordains the manner and timing.
From Romans, “just as sin came into the world through one man, and
death through sin, and so death
spread to all men because all sinned” (Romans
5:12).
Even when news of brain
death threatens to crush us, as we cry out to God for mercy, we cannot forget
his sovereignty. God puts to death, and brings to life (Deuteronomy
32:39;1 Samuel 2:6; Psalm
90:3).
The psalmist writes, “In your book were written, every one of them, the days
that were formed for me, when as yet there was none of them” (Psalm
139:16).
Although God answers
prayer, if he does not issue a life-saving miracle, we must accept his will (Psalm
31:15; Matthew
26:36–45).
In
Death, New Life
Even death does not mark
the end. In the wake of the cross, we find an everlasting hope.
Even while we mourn, and
while we wrestle with anguish, we rest assured, that Christ has already
overcome and has swallowed up death in victory (1
Corinthians 15:54–55).
Those who fall asleep in
Christ will rejoin Christ in resurrection (1 Thessalonians
4:13–14).
Paul writes that “neither death nor life, nor angels nor rulers, nor
things present nor things to come, nor powers . . . will be able to separate us
from the love of God in Christ Jesus our Lord” (Romans
8:38–39).
And that truth sustains us,
beyond the horror, beyond the tears, into the arms of our Savior.
If you are walking
through the valley right now because of a death, an accident, a serious medical
condition, a financial crisis, the loss of a job or any other tragedy, stand on
God's immovable promises and let His words bring security to your soul.
Death is not final
when the person who dies is a Christian.
Jesus removed the
sting of death; it has been swallowed up in Christ's ultimate victory. Do not
let death or the threat of death steal your hope.
Let God's promises
guide you like signal lights through your dark valley.
The future is
bright on the other side.
Are you struggling
with a big decision or wondering how your eternal future will play out?
Why not talk to the
God of the universe and let Him work in your behalf?
He says, “I will instruct you and teach you the way
you should go; I will counsel you with my eye upon you" (Psalm 32:8).
Ask God to show you
what to do. Pray the following prayer:
“Heavenly Father,
I admit that I am a sinner and my sins
have separated me from You. I now want to turn away from my past sinful life
and begin a new life with You.
Please forgive me. I now receive your
Son, Jesus Christ as my Savior, my Master and my Lord. I believe and confess
that Jesus Christ died for my sins, was buried, and rose from the dead.
I want to receive all that Jesus
Christ has provided for me as my Savior. Your Word says, ‘Whosoever shall
call on the name of the Lord shall be saved’ (Romans 10:13).
I believe and confess that Jesus
Christ is the Way, the Truth, and the Life, and no man comes unto the Father,
but by Him.
Lord Jesus, I pray and ask You, to
come into my heart and be Lord of my life. I thank You that you have given me
eternal life, and according to Your Word, I am born again.
Heavenly Father, thank You for the
gift of the Holy Spirit Who is in me now. I surrender my life to You. I promise
to study Your Word – the Bible.
Use me for Your glory.
In Jesus Name. Amen.”
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Kathryn
Butler is
a trauma and critical care surgeon who recently left clinical practice to
homeschool her children. She teaches at Harvard Medical School, and has
contributed to the literature on surgical critical care and medical education.
She and her family live in the woods north of Boston.
http://www.desiringgod.org/articles/words-we-dread-to-hear
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