I spent my career caring for desperately ill patients with serious cardiovascular disorders. And I immensely enjoyed talking to the families of these patients and providing updates on the medical progress of their loved ones. Sadly, all too often, I entered the waiting room prepared to deliver somber news. Surrounded by family members, I carefully described the sequence of medical events. On many occasions, I had to tell them that -- despite all our efforts to help -- the immediate prognosis was truly bleak. The family often asked: What are the chances that she will make it? My response: We are doing everything that we can do. But events are not unfolding as we would like. I wish I had better news. Another family member's reply: Is there still hope? No matter how many times I heard the question, it always crashed upon me. It is at once both the core dilemma and the supreme opportunity of the human condition. We know that our lifespans are not infinite, and that best wishes for a good outcome are not predictably granted. But despite these realities, human beings often survive based on hope. It is our greatest strength. This question tests a physician's humanity. Any experienced and compassionate practitioner understands that the question is not asked with the intent of eliciting a medical or scientific answer. The possibilities afforded by hope are not to be measured with objective precision. Is there still hope? My answer: Hope is really critical right now. If you believe in prayer, this is the time to pray. If there is soul-searching that you have postponed, this is the time to do it. And if you have the capacity to believe in miracles, this is the time to embrace that. Many young physicians were puzzled by my response. They wondered why I didn't deliver the cold hard facts. My response: The facts do not preclude the possibility of the improbable. More importantly, no human being should ever be deprived of hope. Hope is not a passive response. It provides strength, and it mobilizes the best in us. For some, hope is the vehicle that allows the improbable to become actionable. Unfortunately, most of the time, my expectations of a dire outcome for the patient came true. But not invariably. On occasion, I would return to the waiting room, and announce that -- for inexplicable reasons -- the course of events had gone much better than expected. I was amazed, surprised, and delighted. The family might say: We knew you could do it. We were counting on you. We really believed it was possible. My response: I did my best, but your hope made all the difference. Your good thoughts really mattered. Whenever I gave that response, I meant it. If the patient had a 95% chance of dying, that meant they had a 5% chance of surviving. It may not seem like a high probability, but it is meaningfully greater than zero. I do not know why some people survive despite the odds. I cannot attribute it to medicine or science. I am confident that future scientists might discover a mechanism that accounts for the outliers. Statisticians, invoking randomness, do not even seek an explanation. For me, the magical power of human hope suffices. I have been witness to many miracles during my life. Each of them taught me the limits of science, while at the same time reinforcing my belief in the boundless possibilities created by positive human emotions. A skilled physician does not make therapeutic recommendations based on the opportunities afforded by hope, but every realistic clinician welcomes any help they can get. I think that people misunderstand miracles. In my view, a miracle does not depend on the absence of a "natural" explanation. Instead, it is defined by the human wonderment and exaltation that follows an exceptionally unlikely event that had been hoped for but not realistically anticipated. From this perspective, identification of an event as a miracle is inherently subjective. This view of miracles was severely tested 30 years ago when I received a telephone call from a representative of the Vatican, who was charged with the oversight of a canonization investigation. A person who died nearly 200 years ago was being considered for sainthood, based on testimony that her bones had interceded in several miracles. On two previous occasions, a severely ill person who prayed at her grave site had recovered from an illness for which no cure was known. The cure was spontaneous, complete, and enduring. However, to be recognized as a saint, the Church needed confirmation of a third miracle, and I was asked to be the official adjudicator for the third candidate event. My response: I am not a member of the Catholic Church. Does that matter? The representative chuckled: No, it doesn't matter. We just want your expertise. My response: I have never adjudicated a miracle before. I do not have any experience doing this. Again, he gave a warm and kind response: No one we contact has ever done this before. So don't worry. So I was sent the records of a person who was given the diagnosis of a cardiomyopathy. Apparently, following a visit to the burial site of the candidate for sainthood, his cardiac function normalized, and he was now healthy. A week later, I delivered a verbal report over the phone. Some people with cardiomyopathy undergo spontaneous resolution of the disease. We do not know why, but it is a predictable occurrence in a minority of patients. The representative from the Vatican listened carefully: So what happened to this man sometimes happens even in the absence of a saintly intercession; is that what you are saying? I was speechless. Yes, it was true that a meaningful proportion of patients with a diagnosed cardiomyopathy recover spontaneously. But did I really know that all instances of spontaneous recovery had taken place in the absence of some inexplicable force, divine intervention, or intense human hope? I felt this enormous weight on my shoulders. Could my opinion stand in the way of someone who might otherwise be elevated to sainthood? I really did not want my view to matter that much. I did not sense that I was standing on firm ground. With great hesitation, I told the representative from the Vatican that -- in my view -- I did not think that the medical course of events qualified as a miracle. But that did not negate the possibility that it was a miracle for the specific patient. He replied: In these proceedings, it is your view that is important to us. But don't worry; time is on our side. The third miracle may emerge 20, 50, or 100 years from now. But the proper time will come. I was just about to say goodbye, when the voice on the phone asked one last question: Doctor, not that it matters, but I am curious. Do you believe in miracles? My reply: I was raised to believe in what I think. I was trained to trust what I see. And I live in ongoing wonderment of the capacity of positive human emotions to be rewarded by the improbable and inexplicable. Miracles? Yes! Source
