Tell me what miracle means. by JPM Columnist Seema Nagpal, MD

August 11, 2012 |

Author Seema Nagpal MD, Neuro-Oncology, Stanford

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Tell me what miracle means.

From the first appointment I have with them, many patients tell me they are looking for a miracle. That they believe they will be in the tiny percent of patients who are long-term survivors of glioblastoma, one of the most deadly brain cancers. Or that their brain metastases from metastatic lung cancer will disappear. I rarely dissuade my patients from this hope, but I always offer the counter-balance, pray for the best, plan for what is more likely.

In the past 3 months, this phrase “I’m praying for a miracle,” has also come up during the days to hours just before death, when some patients and families are begging me (and their other oncologists) to give them incredibly toxic drugs that will likely hasten their deaths. I have found myself saying that a miracle will occur without my intervention. That God (or whatever divine power there might be) will do this without me, and without modern science.

The more I hear this phrase, the more I wonder “what exactly is a miracle?” Why isn’t it the fact that we can now stave of death for years after diagnoses of a terrible disease. Why isn’t it that we now have tools to help alleviate pain, anxiety and suffering as the end of life approaches? And, why is it that in the end, if there is a divine power capable of intervening on our behalf, we aren’t satisfied knowing that we are off to meet him?

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Expecting people with a dire prognosis to appreciate the ‘miracles’ of modern medicine and palliative care and death itself, before anyone has helped them make that transition; is like expecting an inexperienced clinician to handle an overwhelming emergency without preparation and support!

What clinicians need to do is help patient and family transition from the hope for a longer time to live to the hope that the time they have remaining will be spent according to their wishes.

Evidence suggest that hope is maintained, even with an honest discussion and that giving honest information helps patients and families cope better. In fact hope and well being increase when people know the truth. It’s not uncommon for patients and familes to settle in once they know what’s going on and get set up with hospice or palliative care. *Then* the miracles ensue.

It’s clinicians’ responsibility to learn how to have these transitional conversations that give people time to make choices about what they want to do with their remaining time.

These conversations, appropriately engaged, not only make everyone happier, they also have potential to save billions by avoiding unnecessary and even harmful interventions.

Honesty is what patients and families need and want. They wouldn’t be praying for a miracle if the medical industrial complex hadn’t lied in the first place about what is possible.

It’s okay for people to die. They know it and we know it. It’s not okay to avoid talking straight about it in ways that help patients and families to get their needs for information and comfort met.

Feel free to contact me for clinician training resources on this topic.

Journal of Palliative Medicine

Tell me what miracle means. by JPM Columnist Seema Nagpal, MD

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