A well-known surgeon talks about that miraculous red river within us as an emblem of life.

Throughout history, blood has been a symboland, in a real sense, the source—of life. On the following pages, physician Paul Brand continues the contemplation of blood that he began in the last issue of CT and will conclude in the next.
God’s wrath, his eternal recoil against everything unholy, is for the believer turned aside by Christ’s blood. This meaning of blood, one aspect we contemplate at Easter, has no medical counterpart today. But what follows, blood as the source of life, is central to both the Bible and medicine.
Brand’s thoughts were gleaned and expressed on paper by writer Philip Yancey.

Blood spatters the pages of mythology and of history. Drinking it gives strength and new life: to the ghosts of the dead in The Odyssey, to the Roman epileptics who dashed onto the floor of the Colosseum to quaff the blood of dying gladiators, to Kenya’s Masai tribesmen who still celebrate feast days by drinking blood freshly drawn from a cow or goat.

In early history, blood assumed a mysterious, almost sacred, aura in human relations. An oath held more power than a person’s word, but blood made a contract nearly inviolable. The ancients, unashamed to act out the physical literality of their symbols, would sometimes seal blood contracts by cutting themselves and mingling their blood.

We moderns inherit quaint symbolic tokens of the intrinsic mystery of blood: a wedding ring on the “leech finger,” which was believed to contain a vein that led directly to the heart, or perhaps a child’s game of “blood brothers” in which two participants solemnly and unhygienically act out their undying loyalty. We echo misconceptions, too, when we use such terms as “pure blood,” “mixed blood,” “blood relations,” harking back to the days when blood was assumed to be the substance of heredity.

Even after blood has been analyzed in laboratories and demythologized, it still retains some power, if only in the queasy feeling it evokes when we see it shed. There is something horribly unnatural—to some, physically nauseating—about watching the juice of life seep uncontrollably out of a living body. No wonder religions throughout history have exalted blood to sacral status. A ravaging plague, a minor drought, a desire to triumph over enemies, a decoy for the gods’ anger—anything of major import may prompt a bloody sacrifice in a primitive religion.

Although worshipers feel increasingly uncomfortable with the thought, Christianity too is inescapably blood based. Old Testament writers describe blood sacrifices in painstaking detail and their New Testament counterparts layer those symbols with theological meanings. The word “blood” occurs three times as often as the “cross” of Christ, five times as frequently as “death.” And daily, weekly, or at least monthly (depending on denomination), we commemorate Christ’s death with a ceremony based on his blood.

As a surgeon, I come into contact with blood almost daily. I read it as a measure of my patients’ health. I suction it away from critical areas when I’m cutting. I order neatly labeled pints of it from a refrigerator when a patient needs an extra supply. I know well the warm, sticky, slightly acrid substance pumping around inside each of my patients—flecks of it stain every suit and lab coat I own.

But as a Christian, I instinctively wince at the blood symbol that suffuses our religion. We do not grow up in an environment stocked with mystagogic religions and animal sacrifices. As our culture moves further and further away from the culture of Bible times, the blood-linked concepts of expiation, atonement, sacrifice, and propititation lose their meanings; or worse, they repel people from the faith. A challenge arises. Can we discover meanings behind the biblical symbolism of blood that fit more naturally within our culture while preserving the essence of the metaphor?

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Because I am a surgeon and not a theologian, I must restrict my discussion to qualities of blood I know something about. In exploring the meaning of blood, I must keep in mind the warm and sticky fluid I wash off my hands each day. Blood was chosen as a symbol because of what it is, and the more we know about literal blood, the better we will grasp the meaning behind it.

To a surgeon, blood is the emblem of life. That is not just a philosophical or historical concept, but a deeply rooted awareness. Blood is life. Loss of blood is loss of life.

When performing surgery, I must continually control bleeding as part of my routine. As I cut, most of the bleeding comes from some of the millions of tiny capillaries, and I leave them alone, knowing they will stop of their own accord. Every minute or two a larger spurt of bright blood tells me that an artery has been cut and I must clamp it or burn it with a cautery. The slow ooze of darker blood shows me a punctured vein and I pay even closer attention because a vein has less muscle in its wall than an artery and cannot close itself off easily. During surgery, I strive to locate each significant vessel before cutting. Then I can clamp it twice and cut between the clamps without the loss of a drop of blood. All this routine proceeds without stress or emotion after years of practice.

A different level of bleeding may occur during surgery that no surgeon ever really gets used to. Sometimes, through an error of judgment or loss of manual dexterity, a really large vessel tears open and the wound gushes with blood. In the critical cases that every surgeon remembers, the blood wells up in a cavity like the abdomen or the chest and totally obscures the rip in the vessel from which it comes. The surgeon shouts for suction and for gauze sponges, and, following Murphy’s Law, this is when the suction nozzle gets blocked or the lights go out. No surgeon ever goes through a whole career without some such incident. If a surgeon panics at such a time, he or she should move into another branch of medicine.

I had a wonderful teacher in England who did his best to prepare our reflexes for just such an emergency. Sir Launcelot Barrington-Ward, surgeon to the royal family, taught me pediatric surgery. As his assistant, I would hear him ask each fresh student, “In case of massive bleeding, what is your most useful instrument?” At first the newcomer would propose exotic surgical tools, to which the old teacher would frown and shake his head. There was only one answer: “Your thumb, sir.” Why? The thumb is readily available—every doctor has one—and it offers a perfect blend of strong pressure and gentle compliancy. Then he would ask, “What is your greatest enemy when there is bleeding?” and we would say: “Time, sir.” He would ask our greatest friend and we would give the same reply.

Sir Launcelot drilled into us the fact that as long as blood is being lost, a surgeon is losing the battle. Life is leaking away as the patient gets weaker and approaches the point of no return. But once I have my thumb on the bleeding point, time is my friend. There is no hurry; I can stop and plan what to do next. The body is busy all the while doing what it can to help. Blood is clotting. I have time to clean up and arrange a transfusion, or to send for a special instrument, or to get an extra assistant, or to enlarge the incision to get a better view of the situation. All this can happen if my thumb is pressing firmly on the area of bleeding. Finally, when all is ready, I slowly remove my thumb, while my other hand and my assistants are poised to take action—and I find that no action is needed. The bleeding has stopped.

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At such a moment, in the rush of adrenaline brought on by the emergency, the crisis often brings to me a kind of exaltation of spirit. I know that all my life has prepared me to mobilize reflex, training, and skill to do whatever is necessary to preserve life. I feel at one with all the millions of living cells in that wound fighting for survival. It is an incredible feeling to realize that the common thumb is the only thing keeping my patient alive.

After hundreds of such experiences in the electric atmosphere of the surgical room, every surgeon learns to identify blood with life. The two are inseparable: you lose one, you lose both. Why, then, does the Christian symbol of blood seem to contradict what I learn at such moments?

I must admit at the outset that I find the usual applications given the symbol of blood in Christendom distasteful and sometimes repulsive.

I switch on my radio on a Sunday morning while driving from my hospital in Carville to New Orleans. A heavy-breathing pastor is conducting a Communion service in some church in the bayous. He gives a maudlin, second-by-second commentary on the final agony of Jesus on the cross. With a raspy tone and sing-song inflection he vividly describes the sensation of having a cross strapped to a back bloodied by whips. The congregation murmurs as he evidently holds up a four-inch thorn to illustrate how barbarously the soldiers jammed such a crown onto Jesus’ head. Every mention of the word blood, which his accent stretches into a two-syllable “bluh-hd”—the nailing, the thud of the cross in the ground, the spear in the side—seems to give this preacher a fresh burst of energy.

The theme of death hangs darkly over the entire hour. I drive along in bright sunshine, glancing at the stately egrets, white as clouds, bobbing for food in the canals lining the highway. The preacher asks his parishioners to think of all their recent sins, one by one, and to contemplate the horrible guilt that led to such a bloody death on their behalf.

A ceremony follows, the sacrament itself. Since this is a Protestant church, the congregation remains seated while ushers distribute the elements. I try to imagine the servers, decorous in their three-piece suits, fanning out with military precision, stepping sideways down each row, ending on exactly the right pew, taking care not to clink their wedding rings on the aluminum trays.

The elements themselves hardly resemble the components of a meal: a thimbleful of grape juice and a cube of crustless bread bearing no sign of the fire that made it, or a pale, tasteless wafer embossed with a holy monogram. Everything has changed from the actual event when Jesus gave loose instructions for the sacrament to follow him. The Lord’s Supper has moved from a meal in a home to a ritual in a church, from a simple procedure to an elaborate ceremony, from the concrete to the abstract. And I wonder: Has something else changed along the way, something foundational? Has the entire intent and meaning of the service vanished?

My mind, jarred from the solemn ceremony still continuing on the radio, returns to the literal substance of blood—not the watery purple in the glass but the rich, scarlet soup of proteins and billions of cells. To any medical person, blood signifies life and not death. It feeds every cell in the body, sustaining it with its precious nutrients. When it leaks away, life is endangered; perhaps someone else’s transfused blood can restore life.

Has our modern interpretation of the symbol, as exemplified by the radio preacher’s fixation on death, strayed so far from the original meaning? We must take our decisive clue on meaning not from medicine but from Jesus and the authors of the Bible who introduced those symbols. To them, the trope of shed blood often stood for death (“[Abel’s] blood cries out to me from the ground,” Gen. 4:20). And yet, rooted deeply in every Jewish person’s consciousness was a primordial association of blood with life. God had given it that meaning, as a new era of world history began, in a covenant with Noah. God commanded, “But you must not eat meat that has lifeblood still in it.” Later, in the formal legal code with Moses and the Israelites, God reiterated his command as “a lasting ordinance for the generations to come.” He explained the reason: “For the life of a creature is in the blood …” (Lev. 3:17; 7:26ff.; 17:11, 14; Deut. 12:23ff.).

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Jews were not squeamish about blood. Violent death and capital punishment were familiar public spectacles. Israel had no aseptic slaughterhouses for their sheep and goats, and each family member must have seen the bloody deaths of many animals. But, before eating, any good Jewish housewife checked her meat to see that no blood remained. The rule was absolute: do not eat the blood, for it contains life. “Kosher” cuisine developed, with elaborate techniques to assure that no blood contaminated the meat.

So deeply was the prohibition against ingesting blood etched into Jewish consciences that, centuries later, when the apostles distilled which Jewish customs must be honored by the new Gentile Christians, two dicta against drinking blood made the list of only four taboos (Acts 15:29). Jewish Christians were flexible on such long-held practices as circumcision, but they clung to strict prohibitions against ingesting blood, “For the life is in the blood.”

In view of Jewish assumptions about blood, consider the shocking, almost revolting, message Jesus brings to that culture: “I tell you the truth, unless you eat the flesh of the Son of Man and drink his blood, you have no life in you. Whoever eats my flesh and drinks my blood has eternal life, and I will raise him up at the last day. For my flesh is real food and my blood is real drink. Whoever eats my flesh and drinks my blood remains in me, and I in him. Just as the living Father sent me and I live because of the Father, so the one who feeds on me will live because of me” (John 6:53–37, NIV).

Blood Cells: Red, White, And Delicate

What the telescope does to nearby galaxies, the microscope does to a drop of blood: it brings us closer to the staggering reality. A speck of blood the size of the dot over this letter “i” contains five million red cells, 300,000 platelets, and 7,000 white cells. The fluid is actually a population, a teeming ocean of living matter.

Red cells, the most visible and numerous, strictly speaking are not cells at all, since they have no nuclei. They had nuclei at one time, in their early days in the marshy nursery of bone marrow, but the loss of a nucleus frees red cells to use less oxygen for themselves and therefore carry more for other cells. In early stages they also had a pale color and amorphous shape. As a rite of passage, into the bloodstream, red cells take on a clay color and conform to a standard, machine-stamped shape. If laid side by side, red cells in a single person would carpet an area of 3,500 square yards.

For every 700 red cells, one larger, more elegant white cell appears. Transparent, bristling with chemical defenses and Houdini-like ability to slip between other cells, the white cells act as the body’s militia. Flattened on a microscope slide, a white cell resembles a fried egg speckled with pepper, each black dot representing a deadly chemical arsenal. As they circulate in the body, they assume rough spherical shapes, like detached eyeballs floating through the blood vessels. Their relative scarcity reveals an important principle of the body’s health: nourishment, not combat, is the chief method of defense.

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A third type of blood cell, the platelet, adds an aesthetic touch to blood with its delicate flower-like shape, but its function remained hidden until recently. Now scientists recognize that platelets, which live only two to four days, play a crucial role in the complex and vital process of clotting; they serve as mobile first-aid boxes. This amazing liquid that flows in pipes detects leaks and, with no outside interference, repairs them and tidies up the debris. When a blood vessel is cut, the fluid that sustains life itself leaks away. Tiny platelets begin to melt, like snowflakes, spinning out a gossamer web of fibrinogen. Red blood cells begin to collect in this web, like autos crashing into each other when the road is blocked. Soon the tenuous wall of red cells thickens enough to stanch the flow of blood. The body cannily gauges when a clot is large enough to block the loss of blood without dangerously impeding the flow within the vessel itself.

Red cells are merely swept along with the currents, their bi-concave shapes making no allowance for locomotion. The body provides the energy for their travels by employing the heart, an organ so remarkable it deserves a book exclusively devoted to it. I would like to see a government design specification sheet for the heart:

Bids Accepted For:

• Fluid pump with 75-year life expectancy (2,500,000 cycles).

• No maintenance or lubrication required.

• Output: must vary between .025 horsepower at rest and short burst of 1 horsepower determined by such factors as stress and exercise.

• Weight: not to exceed 300 grams (10.5 oz.).

• Capacity: 2,000 gallons per day.

• Valves: to operate 4,000–5,000 times per hour.

A call for gross immorality by Jesus would hardly shake his followers more severely. His words, coming at the peak of his popularity just after feeding the five thousand, signal a drastic turning point in his public acceptance. The Jews become so confused and outraged that a crowd of thousands, who had pursued him around a lake in order to forcibly crown him king, silently melts away. Many of his closest disciples desert him; his own brothers judge him insane; plots to kill him suddenly spring up. Jesus has simply gone too far.

Whereas the modern church errs by missing the true import of the blood symbol—the custom now seems sterile and archaic—at least those first hearers catch the dramatic sweep of what Jesus does. He takes the word blood and siphons from the image thousands of years’ deep-felt Jewish associations. No Jew ingests blood—only savages and primitives do that. Blood is always poured out before God as an offering, for life belongs to him.

Against that background, Jesus says, “Drink my blood.” Is it any wonder the Jews are shocked and his disciples slink away? A question looms. Knowing—as he must have known—the offense his words would cause, why did Jesus say them? Why not draw a parallel with Jewish sacrifice that would have been understandable to everybody? If he had said, “Eat my flesh and pour out my blood,” or “Eat my flesh and sprinkle my blood,” his hearers would have grasped Jesus’ intent of sacrifice. That appropriate symbol would have offended no one. But Jesus said, “Drink it.”

Jesus spoke on that day not to offend, but to introduce a radical transformation in the symbol. God had said to Noah, if you drink the blood of a lamb, the life of the lamb enters you—don’t do it. Jesus says, in effect, if you drink my blood, my life will enter you—do it! The Communion service pulls together both his sacrificial death aspect and his resurrected life. I believe Jesus intended our ceremony today to include remembrance of past death and also realization of present life.

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The tension between death and life builds to a climax in the event of the Last Supper, surely the most poignant and intimate glimpse of Jesus in all the Gospels. In setting the scene, the gospel writers carefully weave together parallels, freighted with symbolism, between Jesus’ last days and the entire Old Testament sacrificial system. The Last Supper occurs in the midst of one of three major Jewish feasts, the Passover. Jesus enters the city on a donkey, cheered by a throng of admirers, on the very day when passover lambs are being selected by Jewish families. Blood is everywhere, slapped on the doorposts of Jewish homes in an unintended cross shape to commemorate the fateful night in Egypt.

Shut away from the cacophony of festival Jesus and his disciples partake of a meal replete with imagery that Christians still imitate. John recalls the emotional tone of that meeting: “It was just before the Passover Feast. Jesus knew that the time had come for him to leave this world and go to the Father. Having loved his own who were in the world, he now showed them the full extent of his love” (John 13:1, NIV). Something is brewing on planet Earth this night; Judas’s abrupt departure confirms it. All the disciples can sense the magnitude of that last meal.

At that scene, Jesus speaks the words that have been repeated so many millions of times: “This is my blood of the [new] covenant, which is poured out for many for the forgiveness of sins” (Matt. 26:28). A death would occur the next day, the death of the Son of God. Thousands of Passover lambs would be slaughtered in accordance with the old covenant; this one death would singularly introduce the new covenant.

Yet even in the next sentence, Jesus hints that his death, unlike others, would prove temporary: “I tell you, I will not drink of this fruit of the vine from now on until that day when I drink it anew with you in my Father’s kingdom.” In John’s fuller account, Jesus clearly predicts his resurrection, citing the analogy of childbirth as an illustration of the way in which their grief will turn to joy.

Death and life come together in that meal. But in one respect this new sacrament differs from all Old Testament ceremonies that prefigured it. Here too, as in John 6, Jesus commands his disciples to drink the wine, standing for his blood. The offering is not poured out, rather taken in, ingested. He repeats those shocking words, “Drink from it, all of you.”

That same evening Jesus uses another metaphor that may shed light on the meaning behind shared blood. “I am the vine; you are the branches,” he declares. “If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing” (John 15:5—note parallel wording to John 6:56). Surrounded by the vineyard-covered hillsides of Jerusalem, the disciples could more easily comprehend this metaphor. A grape branch disconnected from the nutrients of the vine is withered, dry, and dead, useless for anything except kindling. Only when connected to the vine can it grow, prosper, and bear fruit. The metaphor is precise: wine was called the blood of grapes (Gen. 49:11; Deut. 32:14).

Even in the doom-shrouded atmosphere of that last night, at the meal from which Eucharist derives, the image of life springs up. The disciples drink the wine, symbolic of his blood, which can vitalize them as the sap does the grape. Spiritual life is not something ethereal, outside us, that we must work hard to obtain. It is in us, pervading us, as blood is in every living thing.

If I read these accounts correctly, they correspond exactly to my medical experience with blood. We come to the table to partake of his life. “For my flesh is real food and my blood is real drink. Whoever eats my flesh and drinks my blood remains in me, and I in him”—at last those words make sense. Christ came not just to give us an example of living but to give us the life itself.

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The earliest Christians seemed to get the message: their Eucharist feasts invariably celebrated the risen Christ, memorializing not so much the Last Supper as the Easter meal when Jesus shared fish and broke bread with the disciples. Works of art lining the 100 miles of dank corridors in the Roman catacombs vividly illustrate that point. Among 20,000 frescoes amateurishly painted on those stone walls, not a single death theme or cross appears. Whenever the Eucharist is portrayed, fish, a symbol of life, is always present on the table.

Theologian Oscar Cullmann, in Early Christian Worship (Westminster, 1978), presents a fresh interpretation of a miracle that has often puzzled Bible scholars. John alone records Jesus’ first miracle, at a wedding banquet in Cana, when he turned water into wine. The miracle itself is straightforward; what is puzzling is John’s pattern in every other instance to link Jesus’ miracles, called “signs,” with some symbolic spiritual teaching (such as joining the feeding of the five thousand with the passages on the Bread of Life). The wedding miracle alone offers no such apparent symbolism.

Cullmann offers the view, supported by some church fathers, that this miracle too has symbolic teaching. Relying on key phrases such as “My time has not yet come” (John 2:4), he concludes that the Cana story points to the death of Christ. As the bread in chapter 6 connects to the bread of the Last Supper, the wine here may point to the wine of the Last Supper.

John clearly mentions one element of symbolism: the water Jesus transformed was the kind “used by the Jews for ceremonial washing.” If Cullmann is correct, the miracle signifies the passing of the old covenant based on purification rites to the new covenant of Christ’s shared blood, abundantly available to all.

I will leave to Bible scholars the judgment on Cullmann’s interpretation. If true, the setting could hardly be more appropriate to introduce this great symbol: a wedding feast, filled with joyous music, the laughter of guests, the clink of glasses and pottery; the sounds of excitement as two families permanently join. Sharing the wine that stands for Christ’s blood fits in much better with that tone than with the mawkish sounds I heard from my radio in Louisiana. Eucharist is, if you will, a toast, to the Life that conquered even death and that is now offered freely to each of us.

Paul Brand is head of rehabilitation at the U.S. Public Health Service leprosy hospital in Carville, Louisiana. Chicagoan Philip Yancey is a free-lance writer and the editorial director of Campus Life magzine. Their article, seccond of three parts, is adapted from In His Image, a work in progress, to be published this fall by Zondervan. The two also coauthored Fearfully and Wonderfully Made (Zondervan, 1980).

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