The Therapeutic Baptism

by

Steven J Baumrucker, MD
Medical Director, Housecall Hospice

appeared in similar form in The American Journal of Hospice and Palliative Care
Recently, I had an interesting case that was a learning and growing experience for everyone involved. This case stretched the boundaries of medical care to the limits, and showed us all that good medical care is not limited to titrating doses of medicines and treating diagnoses.
Mr. G came into the emergency room for the last time several months ago. He was 55 years old and looked 80. His diagnosis was terminal carcinoma of the liver. He was not "my" patient, but I was on call and his regular doctors were out of town.
Apparently, Mr. G was well known for coming into the ER complaining of the "demons in my gut". He was generally humored and given a tranquilizer to calm what was felt to be hallucinations of a dying man. This time, however, his blood pressure was extremely low, and he was severely dehydrated. It was obvious to me at the time that he had only a few days left on the Earth.
Mr G. wanted to be admitted to the hospital. In fact, he wanted everything done to keep him alive. " I want to live, I have to live" was his mantra to me. I explained to him that we might have to put him on a ventilator to keep him breathing, and possibly have to shock his heart if it stopped and he expressed that he wanted it all.
Now, I personally felt that Mr G would leave this mortal coil no matter what we tried to do for him, but his expressed wishes were to be kept alive at all costs. He was not confused, nor did he seem psychotic to me; his thought processes, though somewhat inexplicable, were impressively clear.
When we arrived in the ICU and I started writing orders, I got a lot of questions from the ICU staff. "Why are we admitting this guy here?" they asked, "It's apparent he's going to die."
I explained Mr G's expressed request, and sympathized with their quandary. Unfortunately, the ICU is the only place wherein a dopamine drip can be administered, and his blood pressure was dropping fast. It was apparent from his white blood cell count that he was also septic--he likely had bacteria growing in his bloodstream.
We stabilized Mr G's blood pressure rapidly, and all the tubes and lines and monitors of the intensive care unit were in place. It was time to talk to his family.
"I'm not even a relative" his caregiver told me. "His only kin is a brother in Cincinnati" she said. Apparently, she had been hired to take care of Mr G by the brother, and she had stayed with him (above and far beyond her contract) to see to his every need, including waiting in the waiting room until he either died or was discharged to home. I was impressed by her loyalty. Unfortunately, she would not or could not comment on his feelings about death and dying, rather deferring such discussion to Mr G's brother, three states away.
In the meantime, Mr G had gone unconscious. He had been yelling "Lord, don't send me into that lake of fire" at the top of his lungs, repeatedly, for about an hour. He also prayed loudly and cursed the "demon in my belly". He sang gospel songs. After a while, he slipped over into a coma.
At this point, my gut reaction was to find a way to terminate the ICU process in favor of a more rational approach to his care. However, I was bound by the promise to "do everything" I made in the beginning, and had no family member nearby who could authorize me to change his care plan. I called his brother.
After explaining the situation to his brother (who was, thankfully, at home in Ohio) I began to bring up the question of decreasing our intensity of care. "I'll be right there, just as soon as I can!" the brother said, and hung up. Wondering how long it would take to find us in Tennessee from Ohio, I returned to the long night of keeping Mr G alive.
The next day, Mr G's brother arrived. I again explained to him that I thought his brother had but a few days left on the Earth, and that I worried they would be filled with intense medical care. He understood that he would possibly be happier, and more comfortable with home hospice care, but deferred the decision to Mr G himself. I took him to see his brother.
Amazingly, Mr G was awake when we arrived. After a few pleasantries, the brother asked Mr G if he wanted to live. "Yes! I want to live...I want to live..." was his reply. "Do you want to live like this?" I asked him. "No, hell no, I don't want to live like this," was his answer, " but I can't die, you see!"
I didn't see, exactly, but nodded my head sagely. After a few minutes, the brother and I departed his side for a private talk.
"He's never been saved, you know, " he told me, "and that's why he doesn't want to die."
I told him that I'd heard nothing but prayer and entreaties to the Lord since I'd walked into that room the first time, and if anyone was saved in this world, it was certainly Mr. G.
"No, you don't understand," he informed me, "he's never bothered to be baptized. Then he got so sick he just couldn't go to the church to have it done. He's afraid he'll go to Hell the second he dies. That's what the demon is all about. He thinks the pain in his liver is the demon trying to pull him down."
Suddenly everything became clear to me. No wonder this man wanted "everything done" for him despite the obvious fact that he was dying. In his spiritual construct, if he died now he'd be condemned to Hell forever--so therefore he must not die. The demon was not an hallucination--it was pain, real pain that he felt and interpreted within his cultural foundation. Mr G was as logical as any of us; we just didn't know enough background information to see it. His main problem, in my opinion, was problem solving.
"So you think," I wondered aloud, "if I could get him baptized right here, right now, that he would quit worrying about going to Hell?"
"Can you do that?" the brother asked, anticipation obvious in his eyes.
"Well, I don't see why not...we have a chaplain on call 24 hours a day. Let me call him."
I called the chaplain who was on call for the day. He was a young preacher, and I didn't know his denomination. He told me he could baptize anyone anytime they asked for it. He arrived in about 30 minutes.
He entered the room and closed the sliding glass door behind him. We could see in, but could only hear the occasional exclamation and singing of Mr G while the baptism proceeded. We saw our chaplain leaning over him, doing something. I heard a few snickers from the staff behind me, but was too engrossed in what was going on inside that room to comment. After a few minutes, the minister emerged. After a brief thanks, he turned and was gone. (In retrospect, I should have hugged him and thanked him profusely for what he'd done...I'm not sure to this day he knows the impact his efforts had on that family. I never did get his name, and afterward, no one could figure out which pastor from the list had been called. To this day I'd love to hear from him, and tell him the rest of the story, but I have no way to locate him.)
The brother, the caretaker, and I entered the room, and went to Mr G's side. It was weirdly quiet in there, after all the praying and singing that he'd done previously. I was afraid he had died between the time the preacher had left and we'd arrived. What I found was a complete surprise to me.
Mr G was indeed alive, calm, and with a peaceful look on his face. "How you doing, bud?" his brother asked. "I want to go home....I want to go home," was his reply.
Within an hour, we had the home hospice team on the case and Mr G was on his way home. The dopamine drips were discontinued, the lines removed, and an indwelling morphine drip was placed. Mr G lived for three days, and died at peace, at home, with his brother, caregiver, and the hospice team in attendance. "I couldn't believe it," his brother told me later, "he was happy for the first time in years."
In the months since, I have referred to this case as The Case of the Therapeutic Baptism. It showed me once again that taking a patient's cultural background into account during medical care is essential. In this instance, it was a bit harder to ferret out the specific cultural artifact that impeded his well-being, but it was worth the effort in the end.
Steven Baumrucker, MD