A Little Learning
by Mike Litrel, M.D.

acknowledgement that modern medicine has failed the patient, that we can do nothing - that death is coming.

But Ife and his siblings were not ready to let go of their mother. Already, they were bitter from the loss of their father, who had died earlier that year. The looming loss of their mother was more than could be borne.

Desperate, Ife's sister took it upon herself to search deeper. A friend of a friend of a friend was reputed to be a "healer" - someone who could save life, where others had failed. Ife's sister flew the healer to America from Nigeria, keeping it secret from her family until the healer arrived at Bethesda. A student of medical science, Ife especially among the family was agitated and unbelieving. Agreeing that there was nothing to be lost, Ife and his siblings permitted the healer's presence.

The healer directed them all to hold hands around the dying woman's bed. They prayed in silence for five minutes. Then the healer announced, "It is done." And with that, he took a taxi to the airport.

Twenty minutes later, Ife's mother awoke. She smiled and greeted her family, and got up to take a shower. As Ife told it to me, there were no words to describe how dumbstruck were her physicians. And Ife himself, now exuberant and believing and full of unadulterated joy, raced and leaped down the hallways in his white coat, yelling so that all could hear, proclaiming in his deep voice "A miracle has occurred! Here, at Bethesda! A MIRACLE!"

Within a few weeks of this incident, Ife's mother had again succumbed to her disease, and died. But not before she had left the hospital and spent precious days with her children at home, saying good-bye. Her explanation of what had happened was unforgettable and profound. "I came back," she said to her children, "so you would have faith."

Ife's story left me dumbstruck. I spent a long moment considering what it meant.

The power of modern medicine is an illusion - my swaggering sense of mastery as a Chief Resident, the gratitude of the patients and their families - it is all a thin veneer over what is really happening. The substance of that is something that is forever beyond our reach. It is in the realm of the Unknowable, of God - the Source of Life.

The other day a patient expressed to me that she was confident in her upcoming surgery, "because I have faith in you." A decade ago I would have enjoyed that kind of comment. The trust and respect of patients is a blessing, and the physician has a charge to assume responsibility for healing his patients, as much as is humanly possible.

But the truth is that we are all participants - patients and physicians alike - holding hands in a circle of healing, and praying for a miracle. And we are blessed with this miracle of healing everyday that we live.

Ife ended his call to me with his own revelation. And although he had recently lost his mother, his tone was not one of grief, but of excitement.

"Michael," Ife said to me, his voice trembling, "how many hours did we spend in the lecture hall? How many books have we read? How many operations have we performed? We think we are doctors so we must know something about life and death?" He paused for a long moment. "I tell you this, Michael - we know nothing. Nothing."

I told him our conversation had changed my life.

Ife laughed a long time. "And well it should, Michael. And well it should."

Dr. Litrel is in practice at Cherokee Women's OB/GYN in Woodstock and Canton and is a Clinical Assistant Professor at Emory University School of Medicine. He lives in Towne Lake with his wife Ann and their two sons Tyler and Joseph. (mikelitrel@attbi.com)

A single surgical clamp, placed on the bleeding vessels of a ruptured fallopian tube, can save a patient's life.

I know this because I have placed these clamps myself. Ten years ago, a patient arrived in the emergency room of Grady Hospital, in shock from such a rupture and loss of blood. I was the Chief Resident on call for the surgical emergency. After placing the clamp, I instructed my pretty, wide-eyed Junior Resident to suction the half gallon of blood and clots from the patient's abdomen and pelvis. I remember keeping my voice calm, to emphasize our achievement of total control - "Just another day in the emergency room, ma'am."

I tried not to swagger as we walked to the waiting room to reassure the patient's family and give them the good news. But afterward, alone in the call room in my blood-stained scrubs, I allowed myself to bask in the full power of my accumulated years of study and training - and I felt the Cheshire Cat smile of self-congratulation steal over my face.

Always a mistake.

The superb textbook Gynecologic and Obstetrical Surgery, edited by Dr. David Nichols, opens with Alexander Pope's famous refrain,

"A little learning is a dang'rous thing;

Drink deep, or taste not the Pierian Spring;

There shallow draughts intoxicate the brain,

And drinking largely sobers us again."

So many times I had flipped to that quote before diving into my studies. It was a warning to the overconfident. But on that day toward the end of my eighth year of training, I fell into the deep sleep of the self-satisfied. At last, I knew exactly what I was doing.

A phone call later that month proved how wrong I was.

The caller was Ife Sofola. Ife (pronounced Ee-fay) was one of my classmates from medical school. A tall, muscular Nigerian, Ife was not only a brilliant student, but a man of deep compassion and undeniable charisma. His easy smile, booming laugh, and lilting Nigerian accent were a comfort and delight to both friends and patients. At the time, he was a flight surgeon at the renowned Bethesda Naval Hospital - where our Presidents receive their medical care.

Ife had called to let me know that his mother had died. But it wasn't the tragedy of her death he wanted to share with me. He wanted to talk about the miracle.

Months earlier, Ife's family had found out that his mother was dying from liver failure. Brought to the Bethesda Naval Hospital, she fell into a coma. She was put under DNR orders - "Do Not Resuscitate." These orders are reserved for patients who cannot be saved. The words area kind of final