“Wherever a thought goes, a chemist goes with it.” –Deepak Chopra
Life-threatening disease is more than a crisis of the body; it is a crisis of the soul. In thirty-five years as a hospital cardiologist, I have seen countless ways patients react to a medical catastrophe. Initially, most feel overwhelmed and feel as if they have been attacked by some alien force, as if the body, mind, and spirit are under siege.
Many patients are paralyzed by fear. All resistance collapses, replaced by passivity and resignation. Some go into denial, unintentionally or unable to face the enormity of what is happening. Yet others face the crisis by challenging it head-on and, in the process, discovering within themselves the resources to face and overcome the most dire circumstances. Sometimes these patients succeed, not because of the medical care they receive, but in spite of it.
There is in all of us a life force: the foundation of organic existence. In some, this drive is powerful and passionate. In others, there is ambivalence about continuing the onerous task of living. When disease strikes, many are too prepared and even willing for their lives to end. But passivity or resignation are not immutable reactions to a life-threatening disease. My patients have taught me that the will to live can be awakened at any point in its course.
Medical science has been largely blind to the power of a patient’s mind to determine the outcome of a disease. Doctors are taught to see patients as the sum of their bodily parts and to treat diseases by relying almost exclusively on the wonders of medical technology. Your unspoken communication with patients is unmistakable: we will mobilize our array of wonderful procedures and medications to save you. If they don’t work, you are beyond help.
Having spent much of my career as an academic physician directing medical research programs, I have been involved in developing technological advances that have led to this new paradigm of patient care. While today’s medical arsenal is invaluable in the fight against life-threatening diseases, it has brought about one major side effect: far-reaching changes to the time-honored doctor-patient relationship.
That bond, once an invaluable component of the healing process, has weakened. In teaching rounds, I have always found it important to point out the ways in which clinicians inadvertently discourage patients from mobilizing their inner resources to overcome an illness by implying that these elements play no role in the outcome. . I emphasize how powerful these resources can be. Experience has taught me that they are comparable to any cutting edge pill or procedure.
This was dramatically demonstrated to me many years ago by a patient named Vivian, who suffered from progressive heart failure. Cumulative heart damage caused by several previous heart attacks had forced me to admit Vivian to the hospital three times in four months. Her heart had weakened to the point where she no longer responded to maximum doses of intravenous diuretics and other powerful medications. Edema fluid had accumulated in both her lungs and her legs.
In the previous twenty-four hours, Vivian’s kidneys had begun to fail, making it impossible to treat the massive accumulations of water in her body. Her liver and other organ systems were also being affected. All therapeutic options had been exhausted. Vivian’s chances of survival were slim to none.
After suffering for ten days in the Intensive Care Unit, Vivian had had enough. “Look, doctor,” he said, “I am seventy-two years old. My husband died fifteen years ago, and my daughter has not spoken to me since the day he died. I am in constant pain, and I have nothing to live for. Please, let me go.” “.
Despite their estrangement, Vivian had listed her daughter Janet as the person to be notified in the event of her death. When I asked if Janet knew how sick she had been, Vivian shook her head.
“My daughter doesn’t know, and I’m sure she doesn’t care.”
“If you don’t mind, I’d like to call her.”
“I don’t see the point. What good would it do?”
“It may not help, but I think your daughter should know what’s going on with her mother.”
“Frankly, I think it’s a waste of time.”
Two nights later, Janet arrived at the Unit with her ten-year-old son, whom Vivian did not know.
The next morning, a different woman greeted me at the Unit. Vivian looked at me with sparkling eyes and said, “My daughter is getting married in three weeks. She wants me to walk down the aisle with her.” Tears welled up in Vivian’s eyes, and she took my hand and whispered, “I want to be there, doctor.”
Within days, Vivian’s kidneys began to open. The same dose of intravenous medication that had been ineffective now caused a substantial decrease in Vivian’s edema fluid. After a week, her lungs were clear. By the end of the second week, we were able to switch from intravenous to oral medications and get Vivian out of the ICU.
Three days before discharge, Vivian began to walk gingerly down the hospital corridor with the aid of a walker, the same one she used to walk down the aisle with Janet at their wedding.
Vivian not only attended her daughter’s wedding, she also lived to attend her grandson’s bar mitzvah three years later.
Every doctor has seen patients with a life-threatening disease make a miraculous recovery after they were thought to be hopeless. But because medical science is unable to explain these extraordinary occurrences, their significance is often ignored. Medicine is so enamored with the apparent infallibility of science that it has become blind to other possibilities. But remarkable recoveries like Vivian’s are possible for all of us. As Emily Dickinson wrote: “We never know how tall we can become until we are asked to rise.”
