I am a critical care physician who on a daily basis “doctors” the sickest of the sick in our large Medical Center. I have enjoyed reading “Light One Candle” for years. In your recent column entitled “In God’s Good Time,” you described a scenario which is overwhelming familiar. Specifically, you told of a comatose patient who was removed from mechanical life support with the expectation that she would die. Despite the doctor’s prediction, she regained both her mental and physical capacities and was discharged to a nursing home. As a practicing Catholic who considers patient care a vocation, my inability to predict a patient’s course is always humbling for me. The wonder of God in such “miracles” is an important daily consideration.
I would like to reflect on a few issues which you touched on in your column. In stating that a patient has a very low likelihood of meaningful survival (i.e., walking out of the hospital or obtaining what the patient would consider a good quality of life), physicians have to make presumptions based on the population as a whole. It is imperative that we always realize that there are exceptions to the rule. I recall informing one family nearly daily for a couple of weeks that their father had virtually no chance of survival due to his coexistent heart, lung, brain and kidney failure. Playing the odds, his chances of walking out of the hospital were certainly much less than 1%. Despite these dark statistics, he did improve and nearly one year later I passed him walking in the halls of our Medical Center.
I know that the grandeur of God was involved in this patient’s recovery. At the same time, God is no less present during the waning hours of the majority of similarly ill patients in whom the removal of life support leads to a more peaceful and less “prolonged” death. Often the peace that God brings can be heard best in the silence of the buzzers, alarms, and machines as they are removed from our severely-ill loved ones on the last day that they are with us. Families must remember, in the midst of their fear and anxiety, that physicians have no option other than to come to them for an approximation of what the patient would want under these dire circumstances. In these discussions there is a gathering of loved ones, a physician, and the Holy Spirit to determine “what is best” for the individual person. Each time it is a different set of circumstances.
Many days I begin the process in our hospital’s tranquil chapel. Prayer continues throughout the day and hopefully steers me on a course consistent with the oath of primum non nocere. During a moment of clarity, I will remember to pull from my wallet the prayer that Father Catoir (your predecessor as the author of “Light One Candle”) sent me years ago:
“Do not fear
What may happen tomorrow.
The same loving Father
Who cares for you today,
Will care for you tomorrow
And every day.
Either He will shield you from suffering,
Or He will give you unfailing strength to bear it.
Be at peace, then,
And put aside all anxious thoughts and imaginings.”
St. Francis de Sales
Regarding the ability of seemingly comatose patients to hear our discussions, numerous studies have confirmed that it is extremely variable how much patients actually hear and remember from all of the events that take place during their period of illness. Anecdotally, I would like to tell you of one instance in particular. As an intern years ago, I was examining a comatose patient much as I had done for the previous two weeks. Never considering that she might have any ability to understand questions or communicate, I was shocked to hear her mumble some words. As I drew nearer to her, I noticed that the nurse had just opened her curtains and a ray of sun was shining on her face. I shielded her eyes from the sun and listened closely as she whispered to me, “Remember, Doctor, all that is light is Jesus Christ.”
Ad majorem Dei gloriam,
Wesley Ely, M.D., MPH
Assistant Professor of Internal Medicine
Pulmonary and Critical Care Medicine