Perspective: The Miracle of Medicine

Samuel Da-seng Kao, MD

During the dark days of general surgery residency, I always liked to point out to my junior residents and medical students that the ornery, irascible elderly patients that they found annoying were exactly the ones that seemed to bounce back best from major surgery. A little complaining and grousing from them on morning rounds was music to my ears. The ones that caused me the greatest concerns were the ones who were passive, flat, flaccid and without spirit. They seemed to be ready to quit, to give up the fight. Those we would order out of bed, mandatory activity and assign medical students to go back throughout the day to get them moving. Even then we did not, could not, always save them.

I have since often wondered about that nebulous relation between a patient's spirit-spunk, fight and other intangibles-and their medical/surgical outcomes. With the passing years, I have had the unfortunate opportunity to watch the terminal illness of several family members to the bitter end. It is the story beyond the last hospital admission, the last clinic appointment, when they were at home with pain medication and visits from the hospice nurse. I have seen a similar but more desperate fight, and I had to wonder why a person lives that one extra day or week or month. Or, why, when the pain dosing is increased to finally give them relief, they're suddenly gone, as if somehow the pain and suffering was keeping them alive. Yet others have rebounded and lived far longer when they finally received adequate pain relief, as if the pain itself had been killing them faster.

At these moments, it is as if one sees a glimmer, a glimpse and a shadow beyond the limits of our medical science. I believe that our knowledge in medicine is not infinite. I think we should not be afraid to tell our patients that there are limits to what we understand and can treat with western medicine. The truth is that most research funding and scientific endeavor is geared towards solving the most lethal problems: heart disease, cancer, trauma, etc.-as well it should be. But patients' complaints and problems do not neatly fall into these most treatable categories.

Often after all the tests have been done, all the diagnoses ruled out and all the medicine tried, we are left without an answer. That is precisely the time to give a patient the good news ("you have no terminal, life-threatening illnesses") with the bad news ("but you're still suffering"). Some physicians may disagree with me, but I will often encourage patients to seek their answers elsewhere, somewhere beyond western medicine. I would be perfectly happy to have the patient come back to report that some other therapy did wonders for them and that they are symptom free and happily going about their lives. Ultimately, that is the goal, isn't it? Whether we were able to achieve it, using our western medicine or not, is hardly the most important point.

Perhaps this is the point that is most often confused by physicians and patients alike when it comes to transcendent healing experiences (a.k.a "miracles"). Patients may exceed our expectations, occasionally far beyond the norm. They may accomplish this with means beyond accepted scientific medicine. But that does not in anyway impugn the validity of the science of medicine. Science is about epidemiology and statistics, and we all know that for every bell curve there are outliers on either end.

And perhaps that is the marvel of the practice of medicine: not only that we can treat illness and injury and make people better, but that they can give us a glimpse of the vast universe of human experience. We are sometimes allowed to marvel at the amazing human mind and body as it performs to its best capability, far beyond what we might expect.

Dr. Kao is a father of two, husband of one, plastic surgeon and hand surgeon, "miraculously" practicing in San Francisco, and active member of the SFMS Editorial Board.