‘I Shall Not Want’

On July 24, Dr. Norman Bravo returned home from work in time for his son Adam’s ninth birthday celebration. Bravo usually organizes games for such events, but in the heat of summer, with a hint of solace in the evening, he decided to take the children on a hike down the hill from their Lake Arrowhead home.

He grabbed his walking stick and led them down, telling a ghost story about a family from long ago that still lived in the woods. The father of six always had stories to tell, always had ways of entertaining children.

Near the bottom of the hill, Bravo felt his throat and lungs tighten from asthma, but when he reached into his pocket for an inhaler, he discovered it was nearly empty.

The attack was fierce and fast. As he struggled back up the hill, he sent daughter Rachel, 13, and son Andrew, 11, for help. Bravo’s wife, Heidi, preparing ice cream and birthday cake, grabbed inhalers and rushed down the hill, while the children called 911.

Bravo, his face a pale gray, tried screaming for help, pacing and leaning forward trying to open his airway. He took an inhaler from Heidi and for a brief period it seemed the attack was easing its grip, but then it clamped down hard again.

“Help me. Somebody help me,” he moaned. It was getting dark. Panic filled him.

“Hang on,” Heidi told him. “The medics are coming.”

“I’m dying,” he said, barely able to get the words out.

Alan Mackay, an engineer for the San Bernardino County Fire Department, was one of the first rescue workers to arrive. He climbed down the wooded hill and heard Heidi’s cry for help, recognizing her and her husband. Bravo was his doctor, his mother’s doctor.

“God please help me,” he said to himself as he made his way down the hill. Over and over he repeated it, “God help me.”

An ambulance arrived, and medics hooked Bravo up to a heart monitor and tried to place an oxygen mask on him. It became increasingly difficult for him to breathe, and then it became impossible. In his panic, he resisted the medics’ efforts until he finally collapsed.

They got him up to the driveway and tried to intubate him but couldn’t get the tube placed properly. Mackay looked down at the heart monitor and saw a flat line. At that same moment, 15-year-old Thomas Bravo, the oldest son, also looked at the monitor and became scared. He had seen this before on television and understood that his father’s heart had stopped. Dr. Norman Bravo, 39, was dead.

A Struggle to Restore What Had Been Lost

Miracles are hard to see at the Robert H. Ballard Rehabilitation Hospital in San Bernardino. But they are here, sometimes hidden beneath tragedy.

A man with tattoos on his arms and a thick, serpentine scar on the side of his head sits silently, his grip awkward and tight as he pushes a crayon against a coloring book. Nearby an elderly woman, her left leg amputated above the knee, stares without emotion into the distance. And next to her, Dr. Norman Bravo sits in a wheelchair unable to see or walk.

They are here for the same reason: Something terribly wrong has happened in their lives. Their hope is to someday restore what has been lost or taken from them, to dispel the emptiness rooted in their eyes, to color once again between the lines.

It was summer the last time Bravo was home, and now it is late October. How many times have there been during the last three months when it appeared there was no hope? The first time was in his driveway when his heart stopped beating. Emergency workers were able to revive him, but for six to 10 minutes, his brain received critically low levels of oxygen.

Dr. Anthony Retodo, a physician in Bravo’s practice, Bravo Medical Associates, was at home when he received the call to report to the emergency room at Mountains Community Hospital.

“It was very hard,” he says. “This is a guy I had seen earlier in the afternoon when he was perfectly fine. He was going home to celebrate the birthday of his son, and then the next moment he’s struggling with every breath and almost near death.”

At Loma Linda University Medical Center, doctors painted a grim picture. Bravo remained in a medically induced coma for two, three, four days. Each time they tried to bring him out of it, his vital signs dropped.

“It was the darkest dark,” says Bravo’s father Rene Bravo, 68, a retired welder who came to the United States in 1956 from Ecuador. He and his wife, Grace, born in Cuba, had three children. Their two sons became doctors. Their daughter married a doctor.

“I thought I was seeing him for the last time,” Grace says of the day she first saw her son in the hospital. “I was dealing with many emotions, and one day some anger arose in me. ‘God hasn’t given me two children, he’s given me three,’ I told myself. That helped me pray and helped me hang on.”

Heidi Bravo kept believing her husband would pull out of it, but a few days after arriving at Loma Linda, she was told that he probably wouldn’t make it.

“That’s when it hit me hard,” she says. “It was like somebody just pulled my heart out, threw it on the floor and stomped on it.”

But on Day 5, she walked into her husband’s room, and his eyes were open. She said hello, and he tried to respond. The sounds were inaudible, but she understood his words: “Heidi, I love you.”

It was the first step on the road back, but along the way there were other setbacks: pneumonia, severe drops in blood pressure, kidney failure. Through it all, Bravo says, when the medications were tossing him between confusion and nightmares and he could not form words, he repeated to himself the 23rd Psalm. “The Lord is my shepherd, I shall not want . . .”

That he is alive and making significant progress, Bravo says, is a miracle, and as he works his way through an intense eight-week program of physical, occupational and speech therapies, it is coming to bear that he may need a couple more.

A Place to Practice Medicine and Faith

Bravo attended medical school at UC Irvine, where he often searched through buildings for stairways leading to roofs. It was, he says, a vantage point that made him feel closer to God. From high above, life seemed uncontained and timeless. He could see clearly his faith.

The same is true of mountains, he says. He has fond memories of childhood outings while growing up in Bell, weekends in the San Bernardinos, where he could roam and climb, feel the wind on his face as he pondered the horizon and a boundless sky. Even now he can close his eyes and feel childhood return.

When the opportunity came to practice in Lake Arrowhead he knew it was right, and in his eight years there, he has come to love the people and the land, the silence that snow brings to the woods and the warmth of a hardwood fire on a winter day.

He was somewhat of a throwback in terms of how he practiced medicine. He views himself as a country doctor, and in an era when pressures to increase efficiency and reduce costs sometimes clash head-to-head with patient care, Bravo is the kind of doctor who made house calls, gave patients his home telephone number in case they need a doctor or a friend. He argued with insurance companies about treatments he believes are necessary.

“He’s one of those old fashioned guys who will spend hours with people on the phone,” says his brother Rene “Rick” Bravo, a pediatrician in San Luis Obispo. “He really loves being a doctor.”

Norman Bravo believes that practicing medicine was a calling from God and that someday he will return to it. Faith tells him that. Yet, that so much has been lost--for now and, perhaps, forever--weighs heavily. He tries not to dwell on it.

“Make the best of it,” he tells himself. “I’m alive. Hallelujah.”

His rehabilitation focuses on decreasing the tightness, or “tone,” in his upper muscles. The waves of painful spasms that once paralyzed him are becoming more rare. The stretching is painful, but it is paying off. At first, there was very little range of motion in his arms. His hands were locked into fists. He could make only sounds.

He now speaks in complete sentences. His vision has improved but remains limited. His left arm is nearing full extension. Both hands are open, and each week brings progress. Bravo knows that in cases like his, the disabilities that remain after six months are likely to be permanent.

“I don’t despair,” he says. “I know it will come back.”

“We know physically he’s going to have definite permanent deficits,” says Dr. Van Chen, medical director at the hospital. “He’s going to have ongoing spasticity in his upper extremities at least. We can predict that he probably will at least have some ongoing cognitive impairments even after his complete recovery.”

But that doesn’t mean he can’t continue his work as a doctor.

“If he were a surgeon, there would be absolutely no way for him to return to his previous practice,” Chen says. “There are many physicians in practice today with very severe disabilities, and they can make adaptations so they can continue to work. He’s a family practitioner, so it’s possible that he could return. We’ll just have to see ultimately how much impairment he has left with his judgment, his reasoning and his higher level problem solving skills. It’s difficult to predict at this point.”

Bravo says his experiences during the past three months will only make him a better doctor. He knows now what it’s like to be the patient. The first thing he would change would be hospital bathrooms. “I would get rid of them,” he says. “They don’t have the right toilets.”

Then there are the HMOs.

“We must get back to people,” he says. “Too much emphasis is placed on money. We must look at the patient first, not the pocketbook.”

Perhaps the most important lesson he has learned has to do with hope, the importance of always leaving room for it.

“They told my family that it was hopeless, that I was hopeless,” he says. “They gave us zero chances of recovery.”

He says he is living proof that as long as there is life, there is hope.

“When I’m in a situation where a family is losing hope, I can tell them,” he says, “look at me. Look what I went through. I made it.”

It has always been clear in Bravo’s mind the role of medicine and the role of faith. Doctors cannot do the healing, he says, only God can do that. What doctors can do is prescribe a medical course of treatment.

Holland Lowe of Lake Arrowhead credits Bravo with saving her life three years ago. She was wrestling with her 4-year-old son when he accidentally stepped on her chest. The next day, she had trouble breathing and thought she may have cracked a rib or punctured a lung. She went to the hospital and Bravo diagnosed pneumonia. By that night her temperature had reached a dangerous high, and she was spitting up blood.

“He took my hand and asked if he could pray for me,” Lowe says. “He asked for a miracle, and that’s what it was.”

Two years ago, Lowe gave birth to another son. Bravo came by the hospital to check on them and upon examining the baby, detected severe jaundice. He immediately called for a helicopter to transport the baby to Loma Linda for treatment.

“He saved both of our lives,” Lowe says. And now they pray for his.

A Wall Covered in Inspiration

The length of an entire wall of his hospital room is covered with cards and letters. Each one, Bravo says, gives him hope. One of them is from Catherine Krall, a fourth-year medical student at Loma Linda University. Krall completed a one-month family practice rotation in Bravo’s office last summer.

“I left my family practice rotation realizing that I went into medicine to be the person you are,” she wrote. “You have touched my life forever.”

During her rotation, Krall says, she learned lessons about being a doctor that had more to do with life than about medicine. One statement in particular stayed with her.

As important as medicine was to him, he told her, as much as he loved his work, if his family, for whatever reason, asked him to quit, he would do so without hesitation or regret. Family always came first.

But that’s not how it happened on July 24. No one asked him to quit being a doctor. So he tries now to battle back--through pain, frustration and brief moments of despair--to find a way to return to his practice; or if he is unable to return, to find a way to live without it. He must find new balance.

Going home will help. Bravo says he looks forward to spending more time with the children, who visit him at the hospital on Sundays. They have learned important lessons from their father and other patients.

“It makes you realize there are things that could happen to you, and life isn’t always that easy,” Andrew says, “but no matter how hard life is, just stick to it.”

As November wanes, Bravo looks forward to attending church the Sunday before Thanksgiving and spending a few hours at home before returning to the hospital. The dogwoods are turning bare, once-golden leaves now scattered into a brown blanket on the ground. It is Bravo’s favorite season.

He looks forward to speaking at church, because he has much to say this holiday season.

“Who has more to be thankful for than me? I was dead, and now I’m alive. Praise God.”

Perhaps, he says, this is a new calling, to tell his story about how his heart stopped beating, about how he saw heaven. And about how he spoke to God.

Back in the Arms of His Community

Traffic is slow on the Rim of the World Highway. Heidi is running late as she drives her husband from the hospital to Lake Arrowhead. Riding in a vehicle and being unable to see is unsettling for her husband so she repeatedly describes their location as they make their way to the church.

They turn off the highway at the Blue Jay exit, and suddenly tears come to his eyes.

“I can’t believe I’m home to my mountains,” he says.

He arrives at the Church of the Woods near the end of the first service. More than 200 people have come to welcome Bravo home. As Heidi helps him from the Blazer to his wheelchair, music pours from inside the church.

As she pushes him to the front of the church, the people stand and applaud. Bravo is lifted to the stage and begins to speak of the day he died and how he saw heaven.

“Angels put drops in my eyes so I couldn’t see clearly,” he says. “Otherwise, I wouldn’t want to go back.”

And when he met with God, he was told he must come back.

“He said I had to go back to take care of my family, to take care of my parents and take care of my patients.”

So here he is, home again. He speaks at both services. Seated in the audience is Alan Mackay, the fire department engineer who last saw Bravo as he lay still without a heartbeat. Seated in back are John and Carol Hussmann of nearby Twin Peaks.

John is a patient of Bravo’s who has had two surgeries to correct a dangerous infection that at times made it difficult for him to breathe. For him, too, Bravo has prayed.

“The past year with him being so sick we’ve had some pretty dark days . . . and Dr. Bravo told him at any point to call him at home as a friend,” Carol says. “I don’t know of too many doctors who would do that.”

Bravo is tired by the time he and Heidi arrive home, where he lived and died and where a new life now awaits him. The children have missed him, his jokes and ability to make it fun even when things go wrong. Sarah, 8, has had bad dreams about dragons lately. Maybe he can make them stop.

It’s almost time to pick out a family Christmas tree. They always bring home a tall one. Heidi and the children, all but Thomas, will be in “The Nutcracker” again this year.

“I can’t believe I’m finally home,” Bravo says again. There is a stack of wood by the fireplace. The mornings are cool, and it won’t be long before snow falls on the mountains. For Bravo, this, too, is heaven.