MIRACLE AT ST MARTHA’S BY J.A. MACDOUGALL, M.D., AS TOLD TO DOUGLAS HOW
She seemed sure to die before Christmas. But then something extraordinary began to happen That December, I finally had to tell her. Medically, we were beaten. The decision lay with God. She took it quietly, lying there, wasting away, only 23, and the mother of a on-year-old child.
I will call her Eleanor Munro. She was a devout and courageous woman. She had red hair and had probably been rather pretty, but it was hard to tell any more; she was that near to death from tuberculosis. Now that she knew it, she asked for just one thing.
“If I’m still alive on Christmas Eve, “she said to me slowly, “I would like you to promise that I can go home for Christmas.”
It disturbed me. I knew she shouldn’t go. The lower lobe of her right lung had a growing tuberculous cavity in it, roughly two-and-a-half centimetres in diameter. She had what we doctors call open TB, and could spread the germs by coughing.
But I made the promise and, frankly, I did so because I was sure she’d be dead before Christmas Eve. Under the circumstances, it seemed little enough to do. And if I hadn’t made that promise, I wouldn’t be telling this story now.
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Eleanor’s husband had the disease when he returned home from overseas service in World War II. It was a mild case and he didn’t know he had it. Before it was detected and checked, they married. She caught the disease and had little immunity against it. It came on so fast and lodged in such a difficult place that it confounded every doctor who tried to help her.
To have a tuberculous cavity in the lower lobe is rare. When Eleanor was admitted to the provincial sanatorium, it became obvious that the main problem was how to get at it. When Eleanor was admitted to the provincial sanatorium, it became obvious that the main problem was how to get at it. If it had been in the upper lobe, hospital surgeons could have performed thoracoplasty, which involves taking out some of the upper ribs to collapse the lobe and put that area of the lung at rest. But this operation couldn’t be used for the lower lobe because it would have meant removing some of the lower ribs, which her body needed for support.
With thoracoplasty ruled out, the doctors tried a process called artificial pneumothorax. Air was pumped in through a needle to force collapse of the lung through pressure. Although several attempts were made, this process didn’t work either; previous bouts of pleurisy had stuck Eleanor’s lung to her chest wall, and the air couldn’t circulate.
Finally they considered taking out the entire lung – but rejected this procedure (rare at that time) because Eleanor was too sick to withstand surgery, and steadily getting worse. The alternatives exhausted, Eleanor’s doctors reluctantly listed her as a hopeless case and sent her back to her home hospital.
I was 30 when she arrived. I had graduated from medical school I 1942, gone into the air force, and then completed my training as an anaesthetist once the war was over. I then accepted a position at St Martha’s Hospital, where I was to provide an anaesthesia service and take care of the medical needs of the students at two local universities. I was also asked to look after the TB annexe at the hospital, with about 40 patients, most of them chronics with little or no hope of being cured. That’s how Eleanor Munro came to be my patient in 1947.
She had weighed fifty-six-and-a-half kilos, but was below forty the first time I saw her. Her fever was high, around 39 degrees. She was very ill, and looked it. Btu she could still smile. I’ll always remember that. If you did her the slightest kindness, she’d smile.
Maybe that encouraged me. I don’t know. But I did know that I had to try to help her. I phoned a doctor in New York who was experimenting with a procedure called pneumoperitoneum.
This procedure consists of injecting air into the peritoneal cavity to push the diaphragm up against the lung. If we could get pressure against that lower lobe, we might force the TB cavity to shut. If we could do that, nature would have a chance to heal the cavity by letting the sides grow together.
The operation took place the day after my phone call. We pumped air into the peritoneal cavity, but it nearly killed her. It was obvious that the amount of air she could tolerate would not help. Every doctor in the room agreed we shouldn’t try a second time. We were licked.
It was then that I told her medical science had gone as far as it could go. I told her that her Creator now had the final verdict and that it would not necessarily be what either of us wanted, but would be the best for her under the circumstances. She nodded, and then exacted from me that promise.
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Amazingly, she was still alive on Christmas Eve, but just barely. The cavity was still growing; she was so far gone that she had already had the last rites of the Roman Catholic Church. But she held me to my promise.
With renewed doubts, I kept it. I told her not to hold her child and to wear a surgical mask if she was talking to anyone but her husband. His own case had given him immunity.
She came back to St Martha’s late on Christmas Day, and she kept ebbing. No-one could have watched her struggle without being deeply moved. Every day her condition grew just a bit worse, yet every day she clung to life. It went on, to our continued amazement, for weeks.
Towards the end of February, her weight was down to or below 37 kilos; she couldn’t eat and new compilations developed. She became nauseous – even without food in her stomach. I was stumped. I called in a senior medical consultant; he was stumped too. But with a grin, almost facetiously, he asked me if I thought she could be pregnant.
I can still remember exactly how I felt. The suggestion was utterly ridiculous. Everything I know about medicine added up to one conclusion: she was so ill, so weak, that she couldn’t possibly have conceived. Her body just wasn’t up to it. Nevertheless, I ordered a pregnancy test. To my astonishment, it was positive. On the very out frontier of life itself, she now bore a second life within her. It was virtually impossible but it was true.
Legally, medically, we could have taken the child through abortion; it endangered a life that was already in jeopardy. But we didn’t do it. Eleanor and her husband were against it. We doctors at St Martha’s were against it, not only as Catholics, but because were certain that the operation would kill her. Besides, she was so far gone we were sure her body would reject the child anyway.
The struggle went on for weeks, and never once did we doubt that she was dying. But she kept living. And she kept her child. And in late June 1948 an incredible thing happened. Her temperature began to go down. For the first time we noted some improvement in her condition, and the improvement continued. She began to eat, and to gain weight. A chest x-ray showed that the growth of the TB cavity had stopped. Not long after, another x-ray showed why. The diaphragm was pushing up against the lower lobe of her diseased lung to make room for the child she was bearing. Nature was doing exactly what we’d failed to do. It was pressing the sides of that deadly hole together. The child was saving the mother.
The child did save her. By the time the child was born, a normal, healthy baby, the TB cavity was closed. The mother was markedly better, so much better that we let her go home for good within a few months. Her smile had never been brighter.
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Call it the will of God; call it human love; call it the mystical quality of motherhood, the turning in upon herself to fight still more because she had still more to fight for; call it what you will. It happened. And I still wonder at the unfathomable force it signifies.
I remember, too, with delight, the Christmas cards Eleanor sent me for years afterwards. They were just ordinary cards, with printed greetings and her name. But to me they were monuments to a miracle.
Copyright 1972 by Douglas How.