What's the best response to patients who express hope for a miracle? When I was in practice, I usually said nothing. My tongue was tied with fear of saying something that might foster false hope or come across as demeaning. Besides, my training made clear that faith was beyond the scope of medicine.
In retrospect, I wish I'd found a way to acknowledge patients' references to miracles, especially in cases where patients had bumped into the limits of modern medicine. Surely I missed opportunities to guide patients toward healing hope—realistic hope that helps patients live their best life. That leaves me with the challenge of finding a response that can help and not harm the patients who now reach out to me as a co-survivor (and not as their physician).
My search for healing words begins, as usual, by typing "definition miracle" in the Google search bar. The various definitions only create more questions. Do patients who talk of miracles mean they believe in outcomes contravening natural laws and the order of nature? If so, are those patients telling me they believe in magic or supernatural beings? Or are they taking a more biblical stance, sharing their faith that miracles have a clear explanation: God swoops in with acts that supersede natural law, His divine intervention shaping human affairs.
Then again, people often use "miracles" in more earth-bound terms, such as when someone says, "The traffic was so awful, it's a miracle I arrived on time." Patients who mention hope for a miracle may intend nothing more than hope of achieving an unlikely—but possible—good outcome.
Lastly, patients may simply be referring to the wonder of life. Everyday "miracles" surround us, from sunrises and sunsets to icicles adorning tree branches in the winter and crocuses popping through hard earth in the spring.
To complicate matters in tough situations, a variety of reasons (often subconscious) may prompt patients to tell you they're hoping for a miracle. For some, "I'm hoping for a miracle" is a way to ask for validation they heard you right...that the likelihood of the unwanted outcome is as they feared. They're pitching you a chance to clarify any misunderstanding: "No, no, we don't need a miracle. Many patients recover with the recommended therapies."
Other patients know they heard you right. They're just not yet ready to believe the unwanted news. For them, the language of miracles may serve as a stepping stone through the transition to acceptance. It's emotionally easier to say, "I'm hoping for a miracle" than to say, "Cancer treatments can't help anymore" or "I need treatment that will likely cost me my fertility."
Still other patients accept their new reality but may be struggling with "What can I hope for now?" Talking about hope for a miracle helps them hold on to their overall hopefulness while grieving the loss of specific hopes and working their way to new hopes, such as hope to become a parent through adoption or, at the end of life, hope to make the best of each day.
The good news for clinicians is that whatever patients mean by "miracle" and whatever the impetus for their comment, they generally need the same three things from you: 1) sound information about their condition and options, 2) your assessment of both the prognosis and the best possible outcome, and 3) guidance in their efforts to find healing hope. At times (not always), patients' reference to miracles may offer an opening to fulfill all three needs.
If magically I were back in practice and patients mentioned their hope for a miracle, I'd consider responding by...
- Acknowledging their comment. I'd try to find some way to let them know, "I hear you."
- Sharing my wishes for them. I might follow up with, "I wish I could write a prescription for a miracle" or "I wish I had a magic wand to speed up today's research." The image of fantasy wishes provides a gentler way to clarify and reinforce upsetting facts, and to do so with compassion. Wishing reflects disappointment, an emotion that shows I care. And the focus of the wishes on the limits of available therapies may help prevent patients' regret about past decisions.
- Highlighting the uncertainty. I'd open the door to realistic hope by saying, "On occasion, things happen in medicine that we don't expect and can't explain." To minimize the risk of fostering false hope, I'd spell out the difference between expectation and hope, and then remind patients "You can accept the likely outcome while hoping for the best possible outcome."
- Reassuring patients of my commitment. I'd offer a variation of "prepare for the worst and hope for the best." Here's an option that avoids the directive while sending the same message: "I'm prepared to care for you, whatever happens. While expecting the likely outcome, I'm hoping for the best possible outcome for you." If appropriate, I'd add that I'd be thrilled if their cancer proves my prognosis wrong.
A huge challenge in oncology is the frequency with which you care for patients in heartrending situations, from patients with options that, while curative, will likely cause permanent life-altering losses, to patients whose only option is a Hail-Mary intervention, if they have any options at all. Without a magic wand, the best you can do is prescribe the best therapies for each patient and hope for the best.
Meanwhile, those patients need hope, which may seem elusive. Patients' mention of hope for a miraculous recovery may be your cue to offer information and inspiration. What you say—and don't say—matters. A caring response may help them adjust to their new reality and move forward with hope that helps them get good care and live as fully as possible today, tomorrow, and every day.