In 30 years as a Harvard-trained brain surgeon, Dr. Allan Hamilton has not only seen disease and healing--he's also glimpsed the mystical side of medicine. After suffering a devastating back injury while serving in Desert Storm, Dr. Hamilton learned to be a patient. It infused his life with new purpose: While in a body cast, he invented a now widely-used method for treating tumors. As a medical professor at the University of Arizona, he teaches surgeons to avoid fatal mistakes. And he runs an equine-assisted therapy program for cancer patients and survivors at Rancho Bosque outside of Tucson.
Dr. Hamilton's new book is, "The Scalpel and the Soul: Encounters with Surgery, the Supernatural, and the Healing Power of Hope." He recently talked to Beliefnet about his most inspiring patients, how to stay positive in medical settings, and the spirituality they didn't teach in medical school.
What inspired you to write about your spiritual experiences as a surgeon?
I felt I had gone far enough in my career that I could say I was totally unprepared for the spiritual challenges that I encountered in taking care of my patients. When people are facing a severe illness or a major surgery, that may be may be one of the most significant opportunities for spiritual transformation that they will encounter.
So as a doctor, if you don't take that into account, you’re missing a big piece of the picture?
I tell residents, if you gave me two patients with identical problems and one of them had family at the bedside with a lot of laughter, plus photos and a quilt from home, and next door was another patient who was alone every time I came by—I’m going to be very nervous about the isolated patient's mental status.
Have you observed that affecting their physical outcome as well?
Well, there are plenty of studies that have shown that depression is associated with decreased immunity. So I want to harness all of the positive emotional energy I can in a patient to get better. If there’s not a lot of energy there, or if it's very negative, that’s going to make the task of getting them through surgery and having a good recovery much more difficult.
In the book you talk a lot about hope. There's one moving story about a patient named Donald.
That was one of the saddest experiences I have ever had as a physician, and probably one of the most insightful. This was a young man I got very close to. He was an avid fisherman. And he had a malignant brain tumor. He did very well with the surgery, chemotherapy, and radiation. This was a kid with an irrepressible spirit--it was exactly the kind of shining emotion that you love to see.
And one day he took me aside and looked me square in the eye and said, “When it’s time for me to 'go fishing'--and you know what I mean--tell me.” I gave him my word that I would.
Over several more years there were problems, but we fought them off. But, finally, the tumor was really invading his brain. One morning I said, "I promised you that I would tell you when it was time to go fishing. It is now time.”
He went home, and the next morning his mother called and told me that he had died. You could say he died of his disease. He didn’t. He died because I cut his string of hope. It taught me how powerful that is, and that nobody, no physician, ever has the right to take away somebody’s hope. As well as intentioned as it might have been, I literally just snipped it, and it was a mortal snip.
But you also want to honor a request like that.
Yes, you do. In retrospect, he was saying, “You tell me when you’ve given up hope, and then I’ll give up mine.” If the conversation had been in those words, I would have said, “I’ll never give up hope.”
Can you talk about the patient whose brain had to be shut down so you could repair an aneurysm?
This is a technique that’s used on a handful of difficult cases. They put the patient on a heart pump, then cool down the blood. The heart flutters and stops. There’s no blood flow to the brain, and no electrical activity in the brain. Now you can operate on a very significant blood vessel while no blood is flowing through it.
Once the procedure is finished and you realize you’re within the time limit of 20 minutes or so, everybody breathes a sigh of relief. And then the team gets ready to slowly warm the patient up. Sometimes there’s some banter. One of the nurses said she was getting engaged, and that they had gone to this restaurant, and had gotten the ring at this particular store, etc.
When the patient woke, she reported the entire conversation. While her heart was stopped, while her brain had no activity, she somehow remembered that conversation.
And that is scientifically impossible. If the brain is essentially dead, then how can it make a memory? A case like that shakes you up. You’re getting very close to the Holy Grail: "Is this what we mean by a soul? Is this what we mean by an entity that can exist separate from the physical body and the brain?"
And what do you do with that, personally?
People think of science as rolling back the mystery of God. I look at science as slowly creeping toward the mystery of God.
Here I have an example of consciousness existing outside of the body and any physical parameters that we associate with somebody being conscious. That really changes how I look at what happens when the functions that we associate with life disappear.
How can patients preserve their spirituality in a traditional medical setting?
1) First, hospitals do not like individuality. They’re trying to turn you into a number. That’s the last thing I want. So lose the hospital gown. A gown that opens up in the back with your butt hanging out, and that is how you’re supposed to walk down the hallway to get exercise after surgery is ridiculous. Get your sweats. Get your T-shirt. Get your sneakers and start thinking like an athlete. Start thinking like somebody who’s getting better.
2) If you have your favorite quilt, sleep under that. Surround yourself with things that remind you of the positive influences in your life. I tell patients they have to take responsibility for surrounding themselves with positive energy. If you have a special picture or positive music, bring those in.
3) Create your own healing ceremonies. If prayer is important, use it. Have a family circle. Very often I’ll say, "Let’s circle up and have everybody tell the patient how important that person is to them and how they’re looking forward to them getting better."
4) Hospital food is terrible. They cook everything vital out of it. Have your family make meals and bring them in. Eat food that’s organic and in its natural, potent state, with all the minerals and vitamins.
5) Get out as soon as you can. Hospitals are bad for everybody, but they’re especially bad for people who are sick. They’re toxic. Go home where positive influences are concentrated.
How can patients coach a doctor who is not interested in any of this stuff?
One, you’ve got to have a doctor you feel comfortable with. I’m always amazed that patients are turning their lives over to somebody, and then they go, "I don’t feel comfortable with them."
The second thing is that the patient has the right to say, “Here are some things that are really important to me.” For example, many people want to have specific music played during surgery, and a lot of doctors may pooh-pooh that. I don’t. That’s the patient’s prerogative.
And last but not least, you’ve got to hire a tough guy. You appoint a guardian angel, and their job is to make sure that you are respected as an individual. If you want crystals organized on your bedside table and they’re supposed to stay that way, then you put somebody in charge of saying, “This is very important, and we are going to respect that, and so is the medical staff.”
In 2004 you had your own surgery, how did that change your view of medicine?
One of the most important experiences a physician can have is becoming a serious patient. In this case, I broke my back and had 10 hours of surgery. I lost half my blood volume during the surgery and I wasn’t sure I was going to walk again.
For so long, my identity had been wrapped up in being a surgeon, in trusting my physical strengths. Then all of a sudden, you’re just one of the people in the hallway shuffling along with a cane and you realize that the hospital staff and doctors are not looking at you anymore as a physician.
But patients began to look at me differently too. They’d give me this little secret smile, that said, “We know what we’re going through, don’t we?”
And it really changed my feelings about medical errors. I had a couple [mistakes] happen. Here I am, a surgeon in the hospital, and I still can’t stop a mistake here, a mistake there. If I can’t, how can an ordinary patient? I realized this was something that I'd to dedicate myself to.
You’re still teaching?
Yes, and I spend a lot of time working with surgeons, simulating mistakes, and asking, “How could we do this differently?” I study how jet pilots are trained. The amount of people dying in the United States due to hospital errors is the equivalent of a 747 falling out of the sky every single day, 365 days a year. [Medical error] is becoming the fourth leading cause of death. We would never set foot on a jet if that was happening every single day. And yet, we have no choice.
Is there anything you want to add?
At some point, we are all going to face a severe challenge to our mortality. And that is a very frightening moment, but it is also a moment in which there is tremendous potential to change our lives. I have not met one cancer patient who said, “I wish I could go back and not have cancer." Their values and what they wanted to do with their lives changed.
So, as terrible as a severe illness or major surgery may be, it may be the great opportunity to find your passion, figure out what is important to you, and what you're going to devote yourself to. Ultimately, that’s what we’re all looking for.