Waiting for a Miracle? Perspectives From Health Care Providers

What do health care providers do when patients, families or other surrogate decision-makers talk of miracles or are waiting for one? It depends.
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Waiting for a miracle? Lots of people are. A national survey conducted in 2007 found that 79 percent of Americans believe miracles still occur today as in ancient times. Many hope for medical miracles -- almost 60 percent of the public and 20 percent of trauma professionals believe people in a persistent vegetative state (a coma) can be saved by a miracle. Talk of medical miracles surfaced again recently in response to a British study published in the Journal of Medical Ethics. Some deeply religious parents, the physicians and chaplain co-authors argue, subject their children to needless, invasive treatments as they wait for miracles to occur.

What do health care providers do when patients, families or other surrogate decision-makers talk of miracles or are waiting for one? It depends.

I heard family members and nurses talk of "miracle babies" during my research in a neonatal intensive care unit. These were babies that survived despite poor medical prognoses. Their healings were miraculous, some nurses told me, but the nurses differed in what they saw as the source of the miracles. For some, these were miracles of medical science. In the words of one nurse:

"I don't think it's a miracle like they talk about with the saints and all that stuff ... It is a miracle that our doctors and nurses and staff can do ... We're a very good hospital with a good reputation, and we can do miraculous things ... It's not like somebody came down and put a magical sprinkle on to make the baby go, you know, a certain way.

Other nurses were less sure of the source of miracles, and still others attributed these healings to divine sources. "I guess if anything, it always goes back to God," a nurse told me. One described a miracle that happened in another ICU. "I can't even tell you the whole story because it was a while ago. But some of the nurses actually went to Rome because this person [who facilitated the miracle] was a [Catholic] nun, I guess, and sainted or something."

Many health care providers, in this unit and in a medical intensive care unit where I spent time, were not very patient with talk of miracles. Many did what they could to encourage families to continue with appropriate standards of care, especially in end-of-life situations. "I don't challenge them [families] not to believe in a miracle," a social worker told me.

I challenge them to continue to work with the staff in what we understand to be best practice ... I also suggest that sometimes people who have been so ill before they even get here [to the hospital], maybe the miracle has come and gone. If you look back over the time period and see ... that they maybe had a miracle to be here.

As health care providers encourage patients, families and surrogate decision-makers to reframe what counts as a miracle and how they might know when one takes place, some call in chaplains. "I see miracles here [at the hospital] every day," one chaplain told me. "Whether others see them as miracles, I don't know. I think it's very subjective. I think a miracle is in the eye of the beholder."

This chaplain went on to talk about a young woman she met years earlier who was born with a congenital heart defect. She was not expected to live, but she did for more than 20 years. She had several successful surgeries, married, and lived a relatively normal life. This chaplain met her while she was waiting for a heart-lung transplant, which did not come in time.

After this young woman died, the chaplain explained, "Her mother felt like ... it had all been for naught. And you know, I said, well, I'm not so sure I agree with you." When her mother asked why, the chaplain explained, "I think you had a 25-year miracle. This was a child that you didn't expect to ever come home. You had her for 25 years. And not only did you have her for 25 years, but she was able to live and have a very functional life. She knew what love was about. She knew what kindness was about."

Turning from her story back to me, the chaplain said:

That's a miracle in my mind ... I think most people ... are looking for the big miracle. And I think most miracles are not big, they're small. They come in the minute facts of life ... Sometimes they all come together ... so that you get a big miracle, but it doesn't happen very often. Usually they're little things that happen. You know, a patient has a good day who has been absolutely miserable and non-communicative with the family, and the family doesn't think they're ever going to have a chance to say goodbye ... That's what I think of as miracles.

In the words of another chaplain, "I used to always think a miracle was -- they [a patient] would get cured of whatever it was ... But I think the true miracle is coming to some kind of an ability to live with the illness they have..."

Few of the families I heard about accepted the ways chaplains and health care providers tried to reframe miracles, at least not at first. Some moved in this direction gradually while others held fast to their conviction that a miracle would occur, frequently coming in to conflict with health care teams. Teams should recognize these beliefs, Dr. Eric W. Widera and colleagues argue in an article titled, "Approach Patients and Family Members Who Hope for a Miracle," and try to provide spiritual support while acknowledging that some differences about what counts as a miracle -- and more importantly in health care, what to do while you are waiting -- are difficult to impossible to bridge.

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