“Make a Joyful Noise unto the Lord”
In October 2007, the ER called me for yet another emergency. A thin, elderly man lay on the stretcher with his anxious wife at his side. “He’s been more and more confused, Doctor. This is just not like him!” she said. Sure enough, on examination, he had no focal deficits, but he was clearly disoriented. No history of trauma, no blood thinners, just chronic treatment for myelodysplasia (which was stable). His CT scan showed the reason for his confusion: a large subdural hematoma extending over the entire right hemisphere of his brain. Yet another elderly patient with a subdural.
I took him to the OR emergently that night. I removed a large window of bone from his skull and opened the tense, bluish dura. A large blood clot lay on top of his angry-looking cortex; once the hemorrhage had been removed, his brain began to gently reexpand. Successful surgery, but how would things go over the next few days? So many irritated, elderly brains begin to seize postop. The mortality rate for subdural hematoma is 50%. This is one reason many budding physicians avoid neurosurgery; we see a lot of terribly sick patients, and a lot of them don’t get back to a functional life.
Back in the ICU, the nurses told me, “We’ve been getting a lot of phone calls about this patient! How did he do?” Evidently, he was a Ph.D., a professor emeritus of fine arts at Bob Jones University, beloved by hundreds of students and alumni around the country. He conducted their orchestra and had been composing all kinds of opera and classical music for more than 50 years. His children was all bright and successful, some of them accomplished vocalists. In short, my patient was a brilliant, artistic man.
His first 2 days postop were encouraging. He began to eat and joke a little. I transferred him to the floor and gave a sigh of relief. That evening, however, the nurses called me. “He’s not looking so good.” When I arrived at the bedside, he was minimally responsive, pale and diaphoretic. A workup, including a CT head, was suggestive of infection. I transferred him back to the ICU and aspirated fluid from his wound; clearly he had developed meningitis. I started him on IV antibiotics and began to really worry.
He was very sick for a long time, but he recovered and actually did very well. I got to know him and his family a little during his illness. They were delightful, cultured people with a great sense of humor. The first time I saw him stand up, I realized he was at least 6’6”! We talked about his passion for music and his love of God, among other things. I told him, “When you are completely recovered, and you are ready to conduct again, let me know. I want to come.” He laughed and promised. Privately, I wasn’t sure that would ever happen, after what his brain had been through.
About 2 months after he left the hospital, he came back to my office. “What do you think about this spot?” he asked, pointing to his head. The wound was infected again. Over the next few weeks, he had 2 more surgeries and IV antibiotics to remove the bone flap, clear the recurrent infection, and implant an artificial custom-made bone flap in the defect. Finally, finally, he was better, this time for good.
The months went by, then a year; no news from him. I thought of him every so often, hoping that his cognitive function was still improving. By this time, he was 78 or 79 years old.
Just before Christmas 2009, my phone rang at home. “Hello, Doctor! Remember me?” Of course I did! “Remember my promise? I am conducting Samson et Dalila in March, and I want to know how many tickets you need.” What a wonderful Christmas present!
So my husband and I took my 12-year-old son with us to my friend’s opera that weekend in March. I can’t remember ever enjoying opera so much. It was stunning. A cast of 200, including 3 nationally acclaimed guest performers, and a wonderful orchestra took a simple Bible story and cast a spell that lasted 3 hours. As the stars of the show escorted my patient onto the stage at the end for a long standing ovation, the supertitle proclaimed, “This will be the final major performance of his career.” I stood with his family in the audience, hoping my eyes wouldn’t overflow.
I could feel in the thunder of applause the impact he had made on so many of his students, and the love and respect they have for him. I could feel the force of his personality and the persistence that brought him back to his baton at almost 80 years old. And I could hear clearly the Almighty whispering to him, “Well done, good and faithful servant.”
Professor, I was blessed to have played a tiny supporting role. Bravo, and bravo!
About my patient: Dr. Dwight Gustafson was the longest-serving Academic Dean in the history of Bob Jones University. Samson et Dalila took 2 years of intensive preparation and rehearsal; it was the biggest such production done at BJU in the last 20 years. Dr. Gus says of his illness and recovery, “Through it all, I kept saying to everyone, ‘God is good at all times.’” I continue to be inspired by his faith and his example. This is printed with his permission.