Death, unconditional love, and a really bad case of enlightenment


You know, it’s not that I pried,

 But Bob said, “Last night I died,

    It wasn’t a frightenment

    But a bad case of enlightenment

I was willing to take it in stride.”

My friend Bob almost died last night

Bob controlled his diabetes well for the last ten years, before a disc in his mid back exploded and necessitated surgery about ten days ago.  He faces a very real possibility of paraplegia. Standard of care in these cases includes steroids.  I’ve been in California for the last few days visiting him in the rehab hospital.

Doctors throw the term steroids around more carelessly than two-year-olds throw rice at a Chinese restaurant.  The word refers to any molecule built on a cholesterol skeleton, including testosterone (the main male hormone) and estrogen (the main female hormone).  In this case, “steroids” mean things like cortisol or cortisone or prednisone, properly called corticosteroids.  They’re widely used in dermatology, asthma, emphysema, and cancer chemotherapy.

They are the body’s main stress hormone; we use cortisol levels to measure the stress of an episode.

My personal experience with the class of drugs goes back twenty years, when my rheumatologist decided to treat my flaring ankylosing spondylitis (spinal arthritis related to rheumatoid arthritis) with prednisone.  My back felt great, I felt even better: creative, energetic, and invulnerable.  I talked so fast that my wife and daughters had to tell me to slow down.  I slept four hours a night and awakened rested.  I wrote another novel.  But steroids exact a price, I started to get irritable, I could hear repetition in my speech, and I lost so much strength in my shoulders I couldn’t string my bow.  My rheumatologist tapered the dose down and started methotrexate (a very nasty drug); I’ve not been on prednisone since—I found it too seductive.  In retrospect, it put me into hypomania (a state near mania, part of bipolar disorder), a known side effect of the drug. 

Steroids like prednisone powerfully inhibit the body’s inflammatory response.  Post-surgical swelling in the area of the spine can put enough pressure on the spinal cord to strangle it; thus the corticosteroid therapy.  Predictably, they wreak havoc with blood sugars, but not in a linear fashion, and physicians play a balancing act trying to avoid the adverse consequences of sugars too high or too low. 

Bob has been on Decadron or dexamethasone; compared to prednisone it’s a steroid, well, on steroids.  The doctors on the case have been appropriately prescribing insulin, but corticosteroids bring chaos to diabetes.  His sugar crashed last night.  His blood pressure, blood sugar, and oxygenation fell below levels that sustain life.

He doesn’t remember seeing white light or darkness, and he calls the experience “a really bad case of enlightenment.”  He no longer fears the pain of death.  He loves his freedom.

But he’s alive today and better than he was yesterday.  He has minimal movement in the left leg and a trace on the right.  Between the steroids, motion in his legs, and his new-found freedom, his spirits are soaring, his thoughts are racing, and he relishes the feeling of unconditional love he has for the people around him.

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