Friday, June 6, 2008

Access (Part III)

There is an important feature about access that I failed to mention – one that I learned with much consternation during my years of medical training. While access to a bodily compartment is often critical to make an accurate diagnosis or to provide appropriate intervention in an acute injury or illness, it is also typically quite restricted.

I was happy to tell you about the successful subclavian vein catheterization that proved to be life-saving for my patient with the heroin overdose, but I did not mention the failed and perilous attempt at the same procedure just a few days earlier. Again it was an emergency situation, this time with significant intra-abdominal bleeding from blunt trauma. The small peripheral IV running in the left arm was insufficient to provide adequate fluid resuscitation, so the surgical resident directed me to perform a subclavian stick.

The point of entry, angle of approach, and depth of penetration must be precise. Start at the wrong place and all efforts will be futile. Too shallow an approach and you simply cause pain with no gain; too steep and you can puncture the lung; too deep and you may cause an arterial bleed. Well in this case my approach was too steep and I aspirated air instead of blood. Fortunately, the resulting partial lung collapse was minor and did not require a chest tube, but the experience taught me that successful access is gained through a very narrow window.

This proved true whether I performed a simple venipuncture, a spinal tap, a joint injection, or almost any other invasive procedure you can name. It is also true in many other life endeavors. Think about it: To sink a 20-foot putt and cinch the championship, Tiger Woods must envision and execute a very precise path for the ball on the green. The launch of the space shuttle requires rigorous attention to a set of very narrow parameters including timing, direction, acceleration and duration of rocket burn to achieve proper orbital insertion. Safe re-entry demands just the right angle of inclination. And we all have experienced the frustration of not being able to access some important financial information due to one misplaced letter or digit in a password. Not every mountain path leads to the summit.

Brian Clark knows all too well about limited access. An executive vice president of Euro Brokers, he was one of only four survivors working above the point of impact in the South Tower of the World Trade Center during the 9/11 attack. As the plane sliced through the building on an angle, causing enormous devastation from the 78th to the 84th floors, two of three available stairwells were completely destroyed. Brian, serving as a volunteer fire marshal on the 84th floor, led a group of seven to the one remaining portal of escape (“Stairway A”).

Brian relates what happened next: “So we started down that stairway and we only went three floors and… we met two people that had come up from the 80th floor – a heavy-set woman and a rather frail male. She said, ‘Stop, stop. You’ve got to go up… You can’t go down. There’s too much smoke and flame below.’ "

Brian was skeptical of placing their hope in a roof-top rescue. A heated argument ensued, but he could not convince the group. They proceeded back up the stairs. Brian meanwhile heard cries for help coming from a nearby office and left the group to rescue Stanley Praimnath, a banker trapped on the 81st floor. Together they made their way down the stairs to safety, escaping the building just minutes before it collapsed.

All those that chose to ascend the stairwell perished. In spite of passionately held beliefs to the contrary, the one and only route to safety was down Stairway A.

Earlier on this journey of faith (while still in post-graduate training), I wrestled with the possibility that there may be alternate paths to truth… that competing world views were equally legitimate, and perhaps my view of how one could know God was too narrow. Having become a “sophisticated” physician, I chaffed at the image of a Bible-thumping believer, labeled as “narrow-minded” or, worse, “intolerant” of those who embraced an alternative lifestyle.

Then I was confronted with Jesus’ own words: “I am the Way, the Truth, and the Life. No one comes to the Father but through Me.” (John 14:6) And again: “For the gate is small and the way is narrow that leads to life, and there are few who find it.” (Matthew 7:14) Far from unforbearing, if indeed there is only one way to safety, one path to eternal life, compassion would dictate the effort to convince others to follow you on this path.

Through this experience with cancer, I have seen the smoke and the flame and am convinced that, narrow and difficult though it may be, the one way to save your life is to lose it in Jesus Christ and follow Him (Luke 9:24). He is not simply a fire escape – He is truly the way to an abundant life (John 10:10)

Celebrating each step of the Way,

PS – The wound from the central venous access port is healing nicely. We are currently in Charlottesville awaiting final results of a battery of tests performed at UVA to determine the current status of the cancer. I will provide another update soon.


  1. We still check daily and eagerly await updates on your progress. You are in our prayers and those of our friends.

  2. Dad, this was briliantly stated! Praying for you today as you undergo the "knife".
    Love you,