Story of the Month



Dear team,

My friends by sharing a living story about our current patient at Rush Copley Medical center, it deepens our sacred mission, surface our human nature and enlarge our family in earth and heaven. Please share this story with your staff. Perhaps, some of you wish to stop by and hold hands with Stephen and his family.

Today is Saturday and I walked to hospital after driving in a foggy weather. I was asked by a dear radiologist Technician about the story of taking a piece of skull out and why I put it in the belly for SS (ICU-4). I answered briefly and kept going to my rounds and I was stopped by again by another person. Soon after, I was asked by the educator that "doing that is a very poor sign of recovery". My mind kept wandering why the ICU rounds and neuroscience team asked me why no EEG was done. Then a smile came to my face, when a respiratory therapist and ICU nurse told me that "we remember when you have done similar case in Denise Ryan 5 years ago and no he is fully recovered and alive after being 6months in a coma"

I asked God, perhaps He has made today a foggy day so that I understand that SS case is becoming complex and foggy to many. So, I talked to the family and have given me the permission to share this story. Stephen, is a 25 years old just moved from NC. He is an active student and hard worker. eight days ago, 3/16/2007, his life changed and slept into a coma after
hitting a tree at 4am. The paramedics could not intubate him and lift a hole leaking air from an attempt of cricothyroidotomy at the field. Upon arrival, anesthesia was able to place ETT through the nose but it was size #6mm and he is a big athletic man like to wrestle and his wait is 85Kg. By 6:30am, he was in surgery for evacuating a large blood clot from his brain
by Dr. Ghaly and repairing the ruptured bowels by Dr. Baughman. Immediately after surgery, he became hypotensive and all the measures could not elevate his blood pressure. Three iv medications, the strongest, were being used. Two chaplains at the bedside and at the last hour the family were by his side kissing him good bye. The dad said; "my Lord, if you choose to take
him, be Your will". Six nurses and four physicians working hand in hand for at least two hours. "Give him fluids, this is what he needs" some felt strongly and others "These fluids will go to the brain and swell up more" another disputed opinion. Colloids and crystalloids were given and were not the answer. A Swan Ganze catheter was inserted to monitor inside the heart to help us understand. "The heart pressures are normal" said MD. A cardiac Echo was done and again; "it looks good, the heart is beating well and it is full" Can this be arterial injuries and unseen major vascular tear. The chest tubes were draining but not frank blood and the abdomen is not distended. God what is this mystery? We running out of options, please help
us! A voice came to get A TEE. How can we do a transeosphgeal echo in a patient with brain swelling and at the bedside? We could not believe it first. But the voice became more and more clear to go for it. Our cardiologist came, Dr. Sayeed. Dr. Sayeed was the main physician for Denise Ryan and he still amazed about his recovery. Immediately, the answer came
and it turn out that Stephen has a congenital heart lesion called IHSS. In IHSS, what is good for the heart is not good for IHSS. So, knowing that, the appropriate drips were used. "He made, thank you Lord, Stephen, Stephen, my son" the mother in joy and tear.

The brain pressure continued to be controlled by draining brain fluid out and some medications such as diuretics and hyperventilation. His brain continued to swell up and the coma got deeper. The ventilation was limited with the small nasal tube. So Stephen was taken to the OR for tracheostomy. For many, it appears as a major set-back. "A tracheostomy, how many surgeries this poor kid can handle?" a concerning voice. His mother is a head nurse, what is going in her mind. His pears are flying from all over. No one can believe what is happening to Stephen. He was a strong person and A-student. He was working two jobs to make his life in Illinois after living all his life in NC. His sister is expecting a baby. My friends, the only hope is the faith in their teary eyes,

We used every medicine and technique available and his brain pressure was barely controlled. If I have ignored that and waited, the brain pressure will have climbed up and he will have herniated or his brain would be forever damaged. The brain is getting swollen beyond the limits of the skull and the brain bruises are getting larger. An emergency family meeting and options have been presented. the option that was selected was to get the large piece of the skull out and save it in the belly in a later time. The skull can be nourished and protected in the belly until I put it back in the head within 3-6 months. The alternative is to place the skull in a freezer monitored and maintained -80C continuously. The Operating room has no set-up for that. The patient was rushed to surgery Thursday, 3/22/2007, and the procedure was done. Immediately, The brain pressure came down as the brain swelling shifted to outside the skull. The inside of the brain
can now breathe and go into healing. All the medical measures to control the brain pressure were discontinued. Two days later, the sedation stopped and awaiting his recovery.

I searched for answer to try to put all these together and one day the mother, Cindy came to me and said; "did you hear the story?" She went on and said the police officer that saved Stephen life and pulled out the airbage and his wife that called 911 when she heard the crash, you have saved the life of their son. I certainly did not see the divine vision that was placed as the family has seen it. It indeed, continue to humble me and to know what God has placed upon us to care for our community people.

My day was ended by a beautiful smile in Dad, Mom and sister faces saying; "We know that God led you to do this to our son to help him,, his brain pressure now is normal and he is in his way to recovery. We know that God is healing him." This was followed by a teary mother, Cindy, a head nurse in Peoria, saying " Look he likes to shrug his shoulders and hold hands with fingers next to my fingers in order. This is my son. Thank you Steven, thank you God". The father, Bill, is busy writing the daily Diary of his son minute by minute, he took my advice because when his son wake -up, he will always search about the time lapsed while he was in coma and what I was doing. Our beloved 25 years old Stephen likes to wrestling and when you hold his arms, he appears that he was wrestling with you. Perhaps, he wants to teach us something: our lives are journeys of many wrestling journeys and we will win by keep fighting with power, faith, and hope. Do not surrender until the arm take the external arms down and remains down. Perhaps Stephen wants us to win our external and internal wrestling wars in earth and not to surrender and let the brain pressure climb-up and then order an EEG to see the brain waves are flat and the wrestling journey is over. Perhaps, now we can look forward for Sunday where our God be glorified in our prayers and in His patients.

Respectfully,
Ramsis F Ghaly, MD, FACS,
Ghaly Neurosurgical


Ten years after losing his small son to a brain tumor, Jim Boland calls upon HIS UNDYING FAITH as he finds himself facing his own lethal brain cancer

November 26, 2006
Sunday Beacon News

Story by Angela Fornelli
Staff writer

Jim Boland's eyes are closed, his head leaned back on the pillow. "The body of Christ," the woman said, lifting a wafer of bread in front of him.

Slowly, Jim opened his lips, just wide enough for the bread. He didn't have the strength to say "Amen" before taking his communion. Soon, he will only be able to swallow the tiniest of pieces, and the remainder will be given to Debbie, his wife of almost 27 years.


Debbie Boland tends to her husband Jim in their home in Batavia. Jim lost his long, spirited battle with cancer in October, two weeks before his 49th birthday.
(Craign Watson/Staff photographer)


Family members gather in the neurosurgical office of Dr. Ramsis Ghaly, where he explains the details of their father Jim Boland's relentless brain tumor.


But he would keep receiving it, every morning, just as he has for the past year and a half. It is what has kept him alive. It is his strength, his hope, his everything.

Jim and Debbie know what is to come. They've been through this before, with their 6-year-old son Mitch. The boy, too, was in a hospital bed in that same family room for months as an aggressive tumor slowly took over his brain. He, too, fought every morning to tell Debbie he loved her -- even if it was just with his eyes. He, too, pledged to stay alive.

As Jim's time drew nearer to the end, those memories of Mitch from more than a decade ago began repeating in Debbie's mind. She remembered that night she told her little boy he no longer had to hang on for her, and that God would take care of him in heaven.

Debbie remembered cradling her son for five hours after he drew his last breath -- until Jim told her it would be OK, that it was time for Mitch to be taken away.

This time, Debbie was afraid, Jim would be the one to be taken away, and he wouldn't be there to tell her it would be OK.

'Borrowed Little Angel'
In the year and a half since Jim was diagnosed, the sadness of Mitch's death has felt all too present for this Batavia couple, who had five surviving children. But they also knew Mitch was with them as their angel. They took it as a sign, on the day Jim was diagnosed, when they saw a statue of dolphins in the hospital courtyard: Mitch swam with dolphins shortly before he died, and the family adopted the animal as a symbol for the boy.

From then on, Jim and Debbie knew their "Borrowed Little Angel" -- as was inscribed on Mitch's gravestone -- would continue to be their angel in death. Jim and Debbie believe Mitch led them to Dr. Ramsis Ghaly, an Aurora brain surgeon known for his deep faith in God and his belief in doing everything possible to preserve life. Twice, during Jim's battle with his cancer, Ghaly performed radical procedures that many surgeons wouldn't do: Jim had the most cancerous, most aggressive form of tumors, and they were already showing signs of spreading. By the books, operating would only extend Jim's life for a couple months, at most.

"These two beautiful people always had faith," Ghaly said of the Bolands. "They'd say, 'We're not going to give up.'"

Little more than a year after his first surgery in January of 2005, the cancer spread to the other side of his brain. Those tumors were then removed, and Jim survived for nearly another seven months. In his medical reports, Ghaly repeatedly called it "miraculous." He knew it was not his masterful surgery skills keeping Jim alive; it was Jim's faith.

Messages of support
Jim and Debbie came home after Jim's first surgery to find 43 messages from friends and family on their answering machine. "People from everywhere are just praying, and that's what he needs," Debbie later said.

In the year following that surgery, Jim grew even closer to the God he'd been faithful to his whole life. Every morning, when he woke up, he'd make a sign of the cross over a photo of Jesus, Mary and Joseph that hung in his bedroom. On his way down the stairs, he'd kiss the painting of Mitch that hung in the hallway.

He and Debbie went to 8 a.m. Mass every day. They went to a healing Mass every Tuesday night at Holy Cross Church in Batavia, and said the rosary with a group every Wednesday night.

Much of the time, Jim would focus his prayers not on himself, but on others. "He used to come pray for my son who had cancer," said Mike Riordan of Batavia, a friend from Annunciation Church. "That's the kind of guy he is."

On many days that year, Jim was able to make it to his job as a carpenter -- a vocation that 15 years prior allowed him to build his home in Batavia. He traveled as much as possible with the kids and Debbie, who works for U.S. Airways. Often, Debbie was able to get off work to take care of her husband.

That summer, more than 600 people showed up to a benefit held in Jim's honor.

Health, then new tumors
Every few months, Ghaly checked the progress of Jim's tumors. With each MRI, to Ghaly's surprise, Jim's brain was clear. At least for the first 14 months. But on Ash Wednesday of the next year, Jim found out two massive cancerous tumors now covered the majority of the right side of his brain, and another was growing on the left.

This time, Ghaly told the Bolands not to "waste a lot of time searching for the impossible." Jim could refrain from surgery and live another week or two in peace, or get the procedure -- at the risk of coming out without the ability to read, talk, write -- but live for about a month.

After they learned the news, Jim and Debbie left Ghaly's office to go to Mass at Annunciation in Aurora -- the church they've attended since they moved to the area about 12 years ago. Afterward, they got second and third doctors' opinions, and returned to the hospital in the afternoon.

Jim would have the surgery.

"He made it clear," Ghaly said. "He said, 'Dr. Ghaly, I want to live -- if even for two more weeks -- I want to be with my kids.'"

That night, in the hospital room, Jim and Debbie looked out the window as the sun set on the lake. "God, I'm not ready yet," Jim prayed, the ashes in the shape of a cross still on his forehead from the morning's Holy Day Mass. "Give me another year here."

He turned to his wife and told her he has always loved her and how he looked forward to renewing their vows later that month. "It's you and me forever, and I'll always take care of you," he told her. "Don't ever be mad at God."

Through all of this, Jim and Debbie have never asked, "Why me?" They've never blamed God. "We say so many prayers, and you just feel like they're going to be answered," Debbie said that evening.

By the time Jim was taken for his MRI that Ash Wednesday, the children had arrived at the hospital from Annunciation School. They, too, had ashes on their foreheads. "We can pray for Dad now," said Ryan, 7, as he climbed onto the now-empty hospital bed. Debbie joined him, cradling the child in her arms.

"I'll say the Our Father, you say the Hail Mary," 9-year-old Thomas told his brother.

And so they prayed, the two boys, their mother, and their three sisters. "God bless Daddy," Ryan said when all the prayers were completed.

Renewing their vows
Jim survived the surgery and, two weeks later, the Bolands -- high school sweethearts -- renewed their vows. The couple had grown closer than ever throughout the last year. They knew there wouldn't be much time left, but they tried not to think about it. "It hurts too badly to think about it," Debbie said. "I can't imagine my life without him."

That summer, Jim's memory slowly began to fade. He wasn't able to concentrate, couldn't always get words out. Sometimes he'd stand in front of the mirror and brush his hair over and over. Sometimes he would leave the stove on or the water running when he got out of the shower.

Tumors had now spread to all corners of Jim's brain. But Debbie made sure her husband stayed active. A couple of times, he tried to play catch in the backyard with Ryan and Thomas. "He couldn't get up off his knees," Debbie said. "But he tried; he tried."

******

As summer drew to a close, Jim talked a lot about heaven.

"He said, 'It's going to be beautiful,'" Debbie remembers. "'I'm going to see Mitch, and I'll give him a big hug and tell him how much his mom loves him.'"

Debbie could sense Jim knew his time was coming. One morning after church in mid-August, while the couple was at the Waffle House in Batavia, she asked Jim if he felt his condition was worsening.

Jim told her, "Just like summer is going to end soon, this is going to end."

Soon after, they visited Ghaly, and together, they decided it was time to bring hospice care into their home. The hospital bed was placed in the center of the family room, where Mitch's once stood. Lying there, his vision failing him, Jim would face the spiritual candles, statues of dolphins and family photos that decorated the fireplace.

On the first Wednesday evening after he came home, Jim was motionless as 30 people from his rosary group gathered in his home. Tim McLean kneeled next to his dying friend and told him how inspiring he has been to everyone, and how powerful an example he set when he came to Mass last Sunday.

With a strong gasp for breath in between each word, Jim replied, "I'm thankful that I can be here."

Debbie sat next to her husband, holding the rosary made from the roses that had been at Mitch's funeral. Quietly, she said the prayers as she twisted the beads between her finger and thumb. Jim remained still, holding the crucifix in his palm, his eyes watching the beads dangling from his hand.
'Lord hear our prayer'
The prayers for Jim continued.

Annunciation Church's annual Luminary Mass, held in honor of all those who've been "a light in our lives," was dedicated to the Bolands. Although Jim was unable to make it to the Mass, hundreds of people gathered around a large, illuminated crucifix that stood between two tall trees in the church's cemetery on a chilly early-October evening. In front of that crucifix was an altar adorned with two candles -- one with Jim's name on it, one with Debbie's.

"We offer this to the Boland family, who have been lights in our lives because of their faith despite their heavy cross," the priest said. "We pray to the Lord."

"Lord, hear our prayer."
Wearing his ring
Eventually, Jim was only able to speak a few words a day: They were always "I love you." On the day before he died, Jim could only squeeze Debbie's hand three times to signify those words.

After he took communion the following morning, Debbie told him it was OK to let go, that she knew he fought hard and she didn't want him to suffer. A few hours later, Jim took his last breaths, just two weeks before his 49th birthday.

Just like with Mitch, Debbie stayed in the bed next to him for five hours before even calling anyone. "I put my arm around his head and just looked at him and looked at him and looked at him," Debbie said.

When it was time to go, Debbie removed her husband's wedding ring and put it on her finger. She planned to wear it forever, just as she still often wears the ring Mitch found for her on the beach of Lake Michigan a couple weeks before he died.
'He wasn't angry'

Annunciation Church was packed to capacity at Jim's funeral Mass. The Rev. Mario Pedi told the story of how, at one of the last masses Jim was able to attend, he knelt and touched the statue of Jesus that sat on the altar. "He knew Jesus suffered more for him and you and me than anyone else," he said. "We need more people like Jim, and we can be, because we heard his words."

Later, at the cemetery, the sun shone brightly despite the weather reports of rain on that mid-October afternoon. "I think all of us know people that help us see God, and Jim is one of those people that helped me see God," said the Rev. Tom Paul, who Jim and Debbie have known since high school. "He wasn't angry even though he suffered and was hurt, but Jim just gave. He gave deeply and sincerely ... He is now our saint."

Debbie wiped the dirt away from Mitch's gravestone, and swiped her hand across the words, "Our Borrowed Little Angel."

"You've got company now," she told her boy as Jim's casket was lowered into the ground.

A STRANGULATING BRAIN OF A MOTHER CRYING FOR HER BABY:
AN EMOTIONAL JOURNEY I WISH TO SHARE
It happened that in one Sunday morning while walking into the patient room, I saw a day for God to be glorified. My patient looked awake and helpless. Her blood pressure is still out of control. Her family was by the bedside. I wondered what is going on in her mind. She is looking around but not talking or complaining. But when she was asked to do simple task, she will do. "Moley, are you in pain? Her husband called her by the nick name. She moved her head indicating "No". I still search by looking at her and try to go inside her brain. "The mother brain is still bruised and it is trying to recover. The neural wires are trying to find its circuit and its position in the millions of network" I answered myself. "What do you think, she will do if we put her in a cardiac chair and drove her as a team to her baby in the NICU" I asked. My mind continued to think; "If the theory is true that the mother brain is seeking her child but because her brain is not able to communicate yet. The sacred union and spiritual connection is still in place between the mother and the newly born infant, regardless. Then, some of the bruised circuits will see it as an opportunity to get re-oriented in the right connection. The mother's heart is searching for her lost and distant newborn". We put the mother on a relaxing cardiac chair and the team went with mixed feeling to the NICU (neonatal intensive care unit). The husband and Ghaly pushed the wheels of the cardiac chair straight ahead to the elevator going through the hospital ward. A respiratory therapist saw us and came along. Emotional expressions were seen from all the staff and nurses faces in the ward while waiving for the miraculous mother" I could see the love and care in all the nurses and staff but I also could see the hidden tears in their eyes. In the NICU with all the secure doors, the cardiac chair carrying the mother that she just recovering from near death experience with her  head where the angry brain was strangulating and boiling from the hemorrhage and the tremendous high pressure. The respiratory therapist looked at her and could not believe that this was the patient laying in the ICU comatose with many tubes in her face and lines in her body. My mind said to my brain "many neurosurgeons have given up to salvage well documented herniated brains and go for withdrew life support. How many miracles that God could do if we just do our best and let God the rest" a quote from the book written by Ghaly "Christianity and the brain". Immediately, kind nurses from the NICU opened their arms to the Mom and she entered as a queen and the neonatal intensivist came running to us. The hallways were cleared and we got guided by warm hands to the baby. The beautiful nurse with a motherly smile looks at the mom and said "Here is you baby. Let me place for where she belongs; over the chest of her momÄù What scenery! My eyes as well others had some tears. "Is this the mother that was struggling with her life and barely survive last Sunday." The mother looked at the baby and holds her tight in her hands while the baby had the bottle of milk in her mouth". "Let us take the mother while carrying the baby in her chest back to the Atrium in the hospital ward" Ghaly asked the NICU nurse. The kind nurse said with courage and happiness; "Let us go where the mother is cared for". The NICU bed came along and the journey now has two cars one for the mom and one for the baby. The doctor of NICU came running open the doors rapidly and happily. The nurses wished the mom the speed recovery. Some even volunteered to come along and work to clear the hallways and set the alarms. My heart along with many other hearts was beating for joy. We were all thanking the Lord for joining the family; the mother to the 9 day old infant. The NICU director said; "thank you and we will work together we need your neurosurgery assistance" it was an emotional for me to see the close family we have at the human level. The journey is coming to an end, but the mom and the patient did not want to end. She asked her husband "Where is my 6 year old daughter? I need to see her" What a view at the Atrium, from the hospital window, the mother and the baby and the grand father around. Her father was surprised yet was happy when he found himself not alone in the NICU with the baby. He was just checking in his grand child before he left to go home from the overnight shift with his daughter in the hospital. I asked; "What do you think the blood pressure now for the mother while carrying the child?" I got the machine and I found the electric plug and was hurrying to put the monitor around her arm could not wait to see the blood pressure. It was 140/88, the lowest that ever been recorded for the mother. My Lord who created the mothers and the newly born how can the mother blood pressure know to regulate itself if the distant newborn comes to the chest of his mother" My mind wonders. "Did the journey helped connect some of the circuits together to her brain?"  Absolutely Dr. Ghaly, her neurosurgeon said. Look, an hour later, physical therapy came and walked her for the first time 200 feet. Is this the same mother that her blood pressure is barely controlled yesterday and everyone wants to leave her in a quit room, undisturbed, because of high blood pressure. No one came to think, it is the heart of the mother crying to see her distant 9 day old child by her.Do not you ever make a mistake about the name of her child, she will correct you said the husband. What an education to me and others. The bruised brain even if he can not communicate, but still connected to the main universe and getting its life from the Almighty. While the mother brain is suffering with major bruising, her brain never stopped crying for her child, even if the mother's brain is in the depth of coma. The mother's brain is connected with child brain through the spiritual world with no physical boundaries. I wish that everyone worked hard with her to know this story. Thank you for letting be part of this miracle.

I turned and waived; "I am going to the church of the Lord to praise Him for all His Grace.

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