I did two overnight in-hospital ICU call in a span of three days lately. This has obviously derailed my circadian rhythm. Normally in our group of intensivists, a doctor only do 24-hour duty once a week or less. But this is not normal times.
So on the day I was off after my back to back calls, I woke up in the middle of the night and cannot sleep anymore. My body was fatigued yet my mind was awake. Instead of tossing and turning in bed, I got up and went to another room so not to disturb my wife who was fast asleep.
I pulled up a chair and sat by the side of the window and stared outside. The night was still and the moon was halfway through the horizon in the sky. The warm glow of the moonlight bathes the whole surrounding and it was quite enchanting. It was after all the super pink moon – the biggest and brightest full moon of this year 2020.
Ah, year 2020. Who could have predicted that this year would be this challenging? At my work we have more than 30 ICU beds, but with the predicted patients surge from COVID-19, our hospital has a contingency plan that we could convert other parts of the hospital into temporary ICUs and that we could potentially take care of 90 critically-ill patients on ventilators. The good thing is we have not seen that kind of surge like what is happening in New York City and New Orleans. At least not yet. I hope we never will.
We do have several confirmed COVID-19 patients on ventilators though, and they are pretty sick. But they are getting better, and the truth is many of them are getting off ventilators after a few days. Even our first ever confirmed COVID-19 patient that ended up on mechanical ventilator improved and got off of it after almost three weeks.
There were deaths though from this virus, even in our ICU and we cannot deny that. In fact the other night that I was on call, there was one patient that was a COVID-19 suspect and I placed him on a ventilator that night. Of course I had my full protective gear when I intubated him. Yet despite of our best efforts he died. But testing came back later that it was not the novel corona virus, but he had positive blood culture for a bacteria and he died from an overwhelming sepsis. People die from other causes as well, not just COVID-19.
As I gazed outside the window, I uttered a prayer for strength and protection not just for me, but for all the healthcare workers that continue to fight this battle. I also prayed for my family and all the families of frontliners who are at continued risk of contracting this disease from us when we come home. More importantly I prayed for the patients and their families that are going through such a woeful and difficult time.
The saddest part of this pandemic is that patients in hospitals are going through their ordeal alone, as family and friends are not allowed to visit them. And for those people who succumbed from this COVID-19, they die alone with nobody to hold their hands even in their last dying breath. It is really heartbreaking.
I looked at the radiant full moon and it was glorious. I observed that the light of the moon cast long shadows on the lawn from the trees. I was unaware on how the trees around us had gone so big and tall now. The evergreens that stayed lush and strong through the cold months and had survived many bitter winters. The deciduous trees that were currently barren but the leaf buds were beginning to appear for it is spring time after all, reminding us that life begins again. I also noticed that there were faint stars in the sky, though their light were subdued by the bright moon, yet they were twinkling whether we see them or not.
All in all, it was a beautiful night.
Then a thought came to me as if God was answering me. Even if we are going through the night, if we don’t dwell on the shadows and focus on the light, there is still beauty around us. Many times darkness heightens our senses to appreciate the light and other lovely things that we may have taken for granted. Yet the most reassuring thought is that even how dark the night is, morning is surely coming and a new day will emerge.
Yes, we may have lost many in the night and we should remember them, but for most of us, we are going to be alright. Have a blessed and meaningful Easter everyone.
(The following discourse was prepared for a local congregation.)
Have you ever been pickpocketted? When I was in high school, I lost 200 Pesos on my way to school. I knew I passed through a crowd during my commute. I was supposed to pay something in school with that money. It either fell out of my pocket or someone picked my pocket.
In the past I heard that when you land in Manila International Airport, you would be greeted with something like this: “Welcome to the Philippines, the only Christian nation in the southeast Asia. Please beware of pickpockets.” I am glad that this had changed for the better.
A few days after I first arrived here in the US, I was walking alone in the streets of Morristown, New Jersey, a relatively quiet town, when a stranger greeted me, “What a beautiful day, isn’t it?” I was taken aback. First of all, in Manila where I came from, you don’t talk to strangers on the street. Secondly, nobody in the Philippines talk about the weather, for it is the same the whole year through. And lastly, when a stranger talks to you, check your wallet if it’s still there.
Our story today is about someone who pickpocketted Jesus of His power.
Jesus just arrived from the other side of the lake, and probably landed in the town of Capernaum. Perhaps his boat was still far from the shore when a crowd of people already gathered to meet him.
Have you ever been in a crowd? Maybe like in a sporting event, or a concert, or in a very crowded bus or train? During my time in Manila and also in New York City, when I rode the train it was so crowded that I could almost exchange faces with the people around me. And even if the train was moving I didn’t have to hold on to something, for I was propped up as we were packed like sardines.
That was how it must have been when the crowd gathered around Jesus, for the Bible said it almost “crushed” Him (Luke 8: 42). The Greek word used to describe it was sumpnigo. Interestingly, it is the same word that was used to describe the thorns “choking” the seeds that fell on the thorny ground in the Parable of the Sower.
One lesson for us is if we don’t have a deep foundation, the crowd and the cares of this world could crush and choke us.
Then a woman pushed through the crowd to get close to Jesus.
Who is this woman? We don’t know her name or her age. I would guess that she was not very old for she was still menstruating, and I will get into that. But we know that she’s been suffering for 12 years. Perhaps in the beginning of her illness she was seeing all the doctors that were recommended to her. From one doctor to another, were only met by disappointment after disappointment. According to the account of the Gospel of Mark, “she suffered a great deal under the care of many doctors.” In the end she used all her money and was broke, but still did not get well.
What was she suffering from? According to the Gospel writers she was “subject to bleeding.” I would surmise that it was some kind of vaginal bleeding like having menstruation. Yet this one did not stop, and has been going on for 12 long years! If you’re bleeding that long, you would be anemic, weak and fatigued.
As a doctor, I would speculate that her illness was most probably not cancer. Because she was still alive after 12 years. I think it was some kind of a benign uterine growth, like fibroids. This causes vaginal bleeding even between menses, and particularly can have very heavy menses. That’s why I think she was younger and not of menopausal age.
If you have uterine growth like fibroids, no medication can treat it. No kind of concoction would work. Only taking out the fibroid by surgery or doing hysterectomy will cure it.
Do you have an illness that no doctor can help? Have you been suffering despite all the medical interventions? Are you desperate for a healing? Maybe you can relate to the story of this woman. It is my prayer that this message is for you and that you find encouragement in this story.
Besides the physical ravages of bleeding for 12 years there’s another aspect of her suffering. She was socially exiled and emotionally isolated.
According to the Mosaic law, if you have bleeding, you are considered unclean.
“When a woman has a discharge of blood for many days at a time other than her monthly period or has a discharge that continues beyond her period, she will be unclean as long as she has the discharge, just as in the days of her period. Any bed she lies on while her discharge continues will be unclean, as is her bed during her monthly period, and anything she sits on will be unclean, as during her period. Whoever touches them will be unclean; he must wash his clothes and bathe with water, and he will be unclean till evening.” (Leviticus 15:25-27)
All she touched or sat on was considered unclean. People who had contact with her or with what she touched were considered unclean. This woman had been longing for human touch, and she probably had not received a hug for 12 years!
Why does being soiled with blood considered unclean? It is the Universal Precaution rule. If you work in the hospital today you will don on gloves, gown, goggles if you are handling blood or bodily fluids. This is to protect yourself from contacting disease or also from spreading the disease.
Before people discovered and learned about bacteria and viruses, or how a disease is spread, God already provided rules among His people, the ancient Israelites, on how to prevent spreading diseases. That’s why in the Mosaic law, you are considered unclean if you touch a dead person or an animal carcass, or if you touch an open sore. All pots that critters crawled on must be destroyed. God knows about the bacteria and how they cause diseases even before men discovered them! God is so wise.
A couple of hundred years ago, doctors who did autopsy in the morgue came to the hospital ward to examine patients without thoroughly washing their hands. They probably just wiped them. This was before the era of discovering the bacteria. Then they have observed that those patients nearer the door get sicker or die more frequently than those farther away from the door. Why? Who do you think the doctor touched first after coming from the morgue? The doctors were spreading the bacteria!
Let’s go back to our story. To be considered unclean for 12 long years was like an imprisonment, punished by banishment from humanity. Or she must have gone incognito, and became an invisible woman, that nobody recognized or noticed her when she went out of her home.
Then she heard about Jesus and His miracles of healing. And she learned that Jesus was coming in this part of town. So she decided to see Jesus. Even though she had no business of going out in a crowd, for all she would get contact with would become unclean. According to the law, if she touch Jesus, she would make Him ceremoniously unclean.
Yet this woman was determined to elbow, push and claw her way through the crowd. Though pale and weak, nothing would stand in her way. She was unshakable on her mission. She believed that if only she could touch Jesus’ cloak, she would be healed.
She finally reached Jesus. She approached Him from behind, typical of the modus operandi of a pickpocket. Then she stretched out her hand.
If you’re going to touch somebody in a crowd, isn’t it easier to touch the shoulder or back? Why stoop down and touch the hem of the cloak? We may think that like a pickpocket, she does not want Jesus to feel her touch, so the edge of the garment would do. But there’s more significance to this edge of the garment.
In the Mosaic Law, God instructed His people about the corners, or fringes, of their garments. In Numbers 15: 38-39 it says:
Speak to the children of Israel: Tell them to make tassels on the corners of their garments throughout their generations, and to put a blue thread in the tassels of the corners. And you shall have the tassel, that you may look upon it and remember all the commandments of the LORD and do them, and that you may not follow the harlotry to which your own heart and your own eyes are inclined, and that you may remember and do all My commandments, and be holy for your God.
It seems like a strange instruction for us but in the Ancient Near East culture, the corner of a person’s garment represented his identity; it was a symbol of who he was and what he stood for. It is like an insignia, or perhaps a monogramed initials on the shirt.
In the story of Ruth, when she was seeking marriage to Boaz, she asked him to spread the corner of his garment over her (Ruth 3:9). It was a request for him to identify with her. The same Hebrew word means “wing” or “corner of a garment.”
When God spoke of making a covenant with His people, He pictured Himself as spreading the corner of His garment over Israel (Ezekiel 16:8)—a symbol of identifying with her as His bride.
In the story of David when he was running away from Saul, one day Saul fell asleep at the mouth of the cave where David and his men were hiding. David sneaked in and cut off a corner of King Saul’s robe, but “afterward David’s heart struck him” (1 Samuel 24:5). These pangs of remorse seem strange unless we realize that he had defaced an important symbol of Saul’s identity and God-given kingship.
So important were the corners of a man’s garment for the Jews that the Old Testament closes with a prophecy of the Messiah that references the corners of His garment: “But unto you that fear my name shall the Sun of righteousness arise with healing in his wings” (Malachi 4:2 KJV. Again, the same word means both “wings” and “corners of a garment”). At the heart of the Messiah’s identity would be healing for all who have faith in Him.
So when this woman reached out to the hem of Jesus’ coat, it was more than just for healing, but she was identifying with Him and what He stands for. She was embracing that Jesus is the promised Messiah who has healing in His wings.
This woman was not the only one healed when they touched the edge of Jesus’ garment. In Matthew 14, when Jesus was in Genneseret, perhaps after people heard this woman’s story, sick people lined up by the road where He would pass, and all who touched the edge of His coat were healed.
When this woman touched Jesus’ garment, “immediately” she felt that her bleeding stopped. She was instantly healed! And she felt it. But somebody felt it too. Jesus felt it too.
Then Jesus asked around who touched him. The disciples thought that Jesus was being silly. Why asked who touched him when we knew that a crowd of people was almost crushing him. But Jesus said “I know that power has gone out from me” (8:46). The Greek word translated “power” (NIV) or “virtue” (KJV) is dunamis, from which we get our English words “dynamo,” “dynamic,” and “dynamite.” That must have been a power surge that left Jesus. And He was looking for the power pickpocket.
Why did Jesus want to confront the woman and make her secret known? I can think of two reasons. The first one was to release her from the burden of uncleanliness and to take away the stigma. It was to make known to her and to the people around that He accepted her, and that she does not need to be incognito or invisible anymore. Secondly, to let her know that it was not the magical power of His cloak, but it was her faith in Him that healed her.
Ironically there were many people around pressing upon Jesus. But they have only brushed and casually touched Him. Are we one of those people in the crowd? Always in church, sits in the pew every week, present in all the church’s activities, and yet we have not really reached out to Jesus with that touch of faith.
I pray that we be like that woman – who have that elbowing-and-clawing-my-way kind of faith, that nothing-can-stand-on-my-way kind of faith. And that we reach out to Jesus. Be identified with Him and who He is. And that we embrace the Messiah, our Savior, who has healing in His wings.
This is my prayer.
(*all photos taken during our visit in the Holy Land a couple of years ago)
It was the height of flu season. I was working that weekend, and I was in the hospital for 36 hours straight. We had several patients in the hospital that had complications from the flu. There were five on ventilators due to respiratory failure from Influenza A in our ICU. Two of them were on ECMO.
ECMO is short for extracorporeal membrane oxygen or also known as ECLS, extracorporeal life support. It is an intervention to provide adequate amount of gas exchange or perfusion in patients whose heart and lungs have failed to sustain life. It is done by placing a large bore catheter in the patient’s central vein or artery, where the blood was sucked out from the body, then ran through a machine to bathe it with oxygen, then flow it back to the body.
Saturday morning, I got a call from another hospital for a woman in her 40’s who had Influenza A and who was rapidly deteriorating. She went into respiratory failure and was placed on ventilator. They want to transfer her to our hospital for possible ECMO.
We rarely have two ECMO patients at the same time in our ICU. Even one patient on ECMO makes us busy, so two was really demanding. But a third one at the same time? That never happened before.
I made some phone calls to verify if we have a machine for a third patient and if we have enough resources and staff to handle a third ECMO. After confirming, I was given the green light to accept the patient.
Additional ICU and ECMO staff were called to come in. I called the interventional cardiologist-on-duty who would assist us to put the Avalon catheter, a dual-lumen catheter half as big as a garden hose that goes from the jugular vein and through the heart. The cardiologist in turn called the cath lab to prepare for the arrival of this patient.
The patient was flown in via helicopter to our hospital and went straight to the cath lab where me, my ICU and ECMO team, as well as the cardiologist and his cath lab team were waiting.
We were ready for the challenge and eager to make it happen.
While we were doing all this, our patient’s oxygen saturation was only in the 70-80% (below 90% is perilous) despite maximum ventilator support, so we knew we needed to work fast.
However problem struck. Working for more than an hour, we had difficulty placing the Avalon catheter in good position. We tried different approaches with different instruments, but cannot get the ECMO flow going.
I called my other partners over the phone and I probably disturbed their quiet Saturday afternoon off, but I needed some opinion of what else we could do.
After deliberation, we decided that we cannot sustain this patient on ECMO. Perhaps it was her vascular anatomy, or perhaps there was a big clot in her vein. Whatever the reason, we could not proceed.
I went out to the cath lab’s waiting room, and gave the sad news to the patient’s family that we couldn’t do the ECMO. All I could say was that we tried and gave our best, but it was unsuccessful.
I felt that we betrayed this patient and her family. After I thought I moved heaven and earth to get this patient to our hospital, only to end up like this was really deflating.
The worse part was, I knew that without ECMO, this patient had little to no chance of surviving and possibly could be dead in a few hours.
We transferred the patient to the ICU, but we left the big neck catheter in place even though it was not hooked to the machine. We have to wait for the heparin (anticoagualant) we gave when we attempted to start the ECMO, to wear off before we can pull the catheter out.
After about half an hour in the ICU, I was informed that the blood test showed that the heparin had worn off and I can remove the catheter with less risk of bleeding.
When I pulled the Avalon catheter out, I applied direct pressure in the patient’s neck to control the bleeding. I did this for 30 minutes. I was alone in the room with the patient most of that time, with the nurse intermittently coming in and out of the room to adjust the IV pumps or to check on the patient.
All along while I was holding pressure, I was watching the monitor which showed that the patient’s oxygen saturation was staying in the low 80%. I thought death was imminent.
During the time when I was alone with the patient, I felt helpless and defeated. I failed her. We failed her.
Then a thought came to me: I don’t save lives. It was not up to me. Only a higher power determines who will live or die. That’s when I fervently prayed.
With my hands on the patient’s jugular holding pressure, I turned my thoughts to heaven: “God I am nothing, but an instrument of Your healing hand. I failed. But You never fail. I don’t know this patient personally, but I am personally praying for her. Please heal her in my behalf, and let me witness Your awesome power. Amen.”
How many times have we prayed for a sick loved one? But do we really believe God would heal them? Do we add the phrase, “if it is Thy will,” so we wouldn’t get disappointed?
As a doctor, sometimes, I put more faith to the medical intervention than God’s healing. Like when I was bedridden earlier this year due to a bad viral infection, it seemed I had more faith in the Tylenol that I took than in God to take away my fever.
After 30 minutes of holding pressure the bleeding stopped. I left the room and went to see other patients, especially the new ICU admission, a young man in his 20’s who had a bad asthma attack, so bad we had to place him on a ventilator.
As I was busy attending to other patients, I was just waiting to be called back to that particular patient if she goes to cardiac arrest or expires.
More than an hour later, I went back to the room of our failed ECMO patient. I looked at the monitor and her oxygen saturation was 100%. I was amazed! The respiratory therapist told me that she even titrated down the oxygen level on the ventilator to almost half as the patient was really doing good.
I had no other explanation but one: God heard my prayer.
I went down to my call room to be alone. With tears welling in my eyes, I uttered a prayer of thanks. Never would I doubt the power of God again.
He healed my unbelief.
Mark 9: 23 -24: Jesus said to him, “If you can believe, all things are possible to him who believes.”Immediately the father of the child cried out and said with tears, “Lord, I believe; help my unbelief!”
*Post Note: Our failed ECMO patient survived. She even did better than the two patients we had on ECMO.