We all know that the doctor's mission is to save lives and help the injured, so when a patient who has little chance of saving suddenly has a miracle, should the doctor be happy or worried?
Recently, Daniela J. Lamas, a doctor in the Department of Pulmonary Disease and Intensive Care at Brigham and Women's Hospital in Boston, wrote a story about her own experience in the New York Times. The following is a compilation of its original text.
Just before dawn, something unexpected happened outside the intensive care unit.
One of my COVID-19 patients has been deteriorating for several weeks and we finally recommended to his family that all positive interventions be stopped. Everyone knows that his time is running out.
That night, however, my team watched in amazement as his oxygen concentration began to rise, first slowly, then steadily. Standing outside his room, I was wondering, could it be that a miracle happened? But I had a feeling that I couldn't say.
As an intensive care physician, I feel nervous at the thought of the word "miracle." As soon as I hear the word, I think of tense family meetings and some impossible hopes.
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I can imagine the patient's family and lover waiting at the bedside, hoping that the situation will turn around. Miracles are often prayed for by the patient's family, and I cannot guarantee that the miracle will happen.
Doctors have encountered some shocking cases, and more than once, especially in this outbreak. These cases are often patients that we thought could not be saved, but in the end they stubbornly survived, proving us wrong.
I've been thinking hard about how to look at these results and how to deal with them. The longer I spent in intensive care, the more I wondered: What does it mean to have a miracle in an intensive care unit?
Although the word "miracle" has religious overtones, I am not preaching god or supernatural things. Indeed, many families place their hopes in God to bring back their loved ones from the brink of death.
When we were trainee doctors, we attended all the training courses to learn how to have a conversation with these families. I'm interested in how we deal with one-in-a-million "miracles" and how we deal with patients who are surprising and humiliating.
There is one such patient, a young father, suffering from COVID-19 with a range of complications including pneumonia, sepsis and severe bleeding. By the time I met him, he had been using deep sedatives for more than a month, and he was still alive with a ventilator and a cardiopulmonary bypass machine.
Day by day, week by week, with one medical disaster after another, all of us in the intensive care unit realized that the damage to his lungs was irreparable and that he was dying.
His family also started preparing to say goodbye, but they told us to wait a few more days before taking down all the machines.
Today, a year later, I was deeply shocked to see the photos they sent me, and he is still recovering at home and with his family.
Although his story is wonderful, there are some things in my heart that I don't want to share with you. This is not because our prejudgments are wrong, I can admit it freely, but because most people secretly believe that they may also encounter miracles when they face illness.
Even in the face of overwhelming adverse evidence, they feel that the situation may improve. Doctors also want miracles to happen to our patients.
That's why oncologists offer several chemotherapy regimens and the last hope clinical trial for dying patients, and why surgeons rush back to the operating room again and again.
Sometimes, the drive to overcome difficulties makes doctors great. But if too much hope is pinned on miracles, it will not only lead to patients and families having false hopes and suffering unnecessarily, but also prolonging intensive care hospital stays and futile surgeries.
After all, most of the time, in an intensive care unit, the doctor's initial prediction is correct.
Doctors don't want to deprive patients of the chance to surprise us, but we must also ask ourselves whether such a great "rescue" only means prolonging the patient's waiting for death to come.
Because successfully saving a patient is complicated. There is a big difference between surviving and true recovery.
Even if the clinical outcomes of those patients who come out of the intensive care unit do take us by surprise, they may never recover to the point where they can do their favorite activities again.
If a person's life is "saved" but he will have to suffer for months in a long-term care hospital, delirious, and dependent on a ventilator, it is not complete success.
Of course, there are some cases in which the patient's condition is completely impossible to improve. For example, the cancer has reached an advanced stage, or sepsis has developed to an uncontrollable stage. But in other cases, for better or worse, I've found that I'm more willing to try now than I used to, and I'll give patients one more round of antibiotics or one last high-dose steroid trial.
I try not to let this process go too long so as not to cause pain to the patient or family because I am unwilling to acknowledge the reality in front of me. But I may give myself a few more hours or days while mentally preparing the patient's family and myself: Their loved one may not be getting better.
Last weekend, one of my patients was a woman in her 60s who had cancer and triggered organ failure of the lungs and liver. For a week, the doctor who had been caring for her told me about the plan: If she didn't get better by Monday, her family would take her ventilator off, but they wanted to stick with it for the weekend.
Why? I asked. My colleagues explained that they wanted to give her the time to do miracles.
When I went to visit the patient early Saturday morning, she was still intermittently awake, her eyelids shaking. I hope she is pain-free. By the evening, her blood pressure was still beating up and down.
Before I left work, I walked into the room again and found her children gathered by the bed.
"She's not getting better, is she?" The daughter asked. I explained as euphemistically as possible that despite our best efforts, she was still not getting better.
Her daughter began to cry because she realized that Mary Van Fu had not come to save the old man, and there was no reason to wait until Monday. Although no miracle happened, perhaps the old man would walk peacefully and it was time to say goodbye.
Original source: The New York Times
原文标题：What Should Doctors Do When We Experience a Miracle?