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Old 12-24-2023, 06:12 AM
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mojo1986 mojo1986 is offline
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Default A Christmas Story

AND MILES TO GO BEFORE SHE SLEEPS

By J. A. Macdougall, M.D.

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 (the name has been changed) was a devout and courageous woman. She had red hair and had probably been rather pretty, but it was hard to tell any more, she was that near to death from tuberculosis. She knew it now, she accepted it and she asked 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, roughly one inch in diameter. She had what doctors call open TB, and could spread the germs by coughing. But I made the promise and, frankly, I did so because I was sure she'd be dead before Christmas Eve. In the circumstances, it seemed little enough to do. And if I hadn't made it, I wouldn't be telling this story 37 years later.

Eleanor's husband had the disease when he returned to Nova Scotia from overseas service in the Second World War. It was a mild case and he didn't know he had it. 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 that it confounded every doctor who tried to help her.

She had been assessed at the leading chest hospital in the province and been turned down for pneumothorax, because of pleural adhesions; thoracoplasty, because of the location of the cavity; and pneumonectomy.

Eleanor Munro 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 then that I had to try to help her.

I first called Dr. I. Rabinovitch in Montreal, because he was a top expert on the use of the then-new drug streptomycin. Dr. Rabinovitch 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 pneumoperitoneum.

This 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. The operation took place the day after my phone call. We pumped air into the peritoneal cavity, but 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.

It was then that I told her medical science had gone as far as it could go. I explained why in detail and she appreciated it. She listened with a quiet dignity and an amazing resignation. I told her that her Creator now had the final verdict and that it would not necessarily be what either of us wanted, but would be the best for her in the circumstances. She nodded and then exacted from me that promise.

Amazingly, she was still alive on Christmas Eve, but just barely. The cavity was still growing, her condition still worsening. She was so far gone that, as I recall, she had already had the last rites of the church. 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 Christmas Day, and she kept ebbing. No one could have watched her struggle without being deeply moved. Every day her condition grew just a bit worse, yet every day she clung to life. It went on, to our continued amazement, for weeks.

Toward the end of February she was down to or below 80 pounds. She couldn't eat, and new complications developed. She became nauseous, began to retch and 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 facetiously, he asked me if I thought she could be pregnant.

I can still remember exactly how I felt: the suggestion was utterly ridiculous. Everything I knew about medicine added up to one conclusion: she was so ill, so weak that she couldn't possibly have conceived. Her body just wasn't up to it.

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

When I told her, she smiled and sort of blushed.

Legally, medically, we could have taken that child through abortion because it imperilled 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. The doctors at St. Martha's were against it, not only on religious grounds, as Roman Catholics, but because we were certain the operation would kill her. Besides, she was so far gone 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 her 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 happened. 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, and the improvement continued. She began to eat, and to gain weight. A chest X-ray showed that the growth of the TB cavity had stopped. Not long after, another X-ray showed that the diaphragm was pushing up against the lower lobe of her diseased lung to make room for the child she bore. Nature was doing exactly 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 and her name. But to me they were like monuments to a miracle of Christmas.

Dr. J. A. Macdougall was an anesthetist at the Saint John Regional Hospital in Saint John, N.B., Canada.

Last edited by mojo1986 : 12-24-2023 at 06:27 AM.
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  #2  
Old 12-24-2023, 07:04 PM
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Earl Earl is offline
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Indeed a miracle. That had to be a teaching moment for that doctor to see just how strong the human will to survive can be. A reminder to all of us to never say never.

Thanks for sharing.

Earl
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Old 12-24-2023, 09:46 PM
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Oh myyyyy.
What a touching miraculous story.
Faith.
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Old 12-25-2023, 08:29 AM
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What a beautiful story! This old sea dog is broken up.
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