Same Old Seventeen-Dollar Lamps

I was a medical intern in 1976 when I met The Reverend, a fundamentalist African-American preacher. The Reverend had no faith in medical technology or its practitioners and had vowed never to enter the hospital. Life and death, in his opinion, should be left exclusively in God's hands. Until now, his strategy had worked well. However, at 85 years of age, The Reverend had embarked on the third 40-day fast of his life as a way to cleanse himself and become closer to God. Midway through this fast, he stopped drinking as well as eating. As he drifted into a deep coma, his parishioners became uncomfortable with what they were witnessing.

The church elders brought The Reverend to the hospital. Although they were acting against his express wishes, the elders could not bear to watch him die. If he recovered, they were willing to bear his disapproval. Together, faith and medicine might be more powerful than either could be separately.

The Reverend was brought to us neatly dressed in a starched shirt and pressed pants. Underneath, dry skin hung loosely from his shriveled body; his tongue looked like a sliver of dehydrated fruit. He was unresponsive, even to painful stimulation. His blood pressure was 70 over 40 mm Hg, his blood urea nitrogen was 150 mg/dL, and his serum sodium was 180 mmol/L. It was possible that he would not survive. I felt uncertain about imposing treatment against The Reverend's will, but given the potential reversibility of his condition, we reassured ourselves that his prestated wishes might not apply to this particular circumstance.

We vigorously replenished his fluids and gradually corrected his electrolytes, trying to avoid damage to his severely dehydrated brain. We invaded his body with needles and catheters, drawing his blood every few hours to monitor the changes. …