Why are you in despair, Oh my soul? And why have you become disturbed within me? Hope in God, for I shall yet praise Him, the help of my countenance and my God~Psalm 42:11
Albeit not the most pliable question, the attending physician’s response turned my mouth sour. He said, “What do you mean how serious are you? Are you trying to get me to tell you how much time you have left?”
I thought in my head, “I don’t think that’s what the patient is actually asking.” But the attending went on, “I cannot tell you how much time you have left. You’re asking me for something impossible.” He then turned away from the patient to see the results of the pulmonary function test, turned back and spilled out the words, “You have severe COPD. Your numbers are critical. You’re never going to get any better than this.”
What takes a person who once committed himself to the ministry of healing to stoop to this point and utter such a prognosis? I have heard stories in my previous years of medical school where residents or attending physicians have said or done something that, even to the ears of a lay person, could easily sound unprofessional, not to mention inhumane. It was not the shock of the moment that I found so gut wrenching, but rather the treacherous process of such an attitude. After all, it is a subtle and insidious propensity.
A question was raised at a small group gathering I attended, “What do you say to a patient who asks, “How hopeless is it?” From consult to consult we sometimes encounter this exchange of opinions. And the immediate reaction may be to peruse the numbers, the facts, or the “reality”. But the answer that followed gave me a sigh of relief: “I always have hope for the patient. It just may not manifest in the way I intend it to.”
Can we practice a ministry of healing without the outlook of hope? After all, we will often encounter situations that demoralize us. If we allow ourselves to become callous to the secular “reality” of a terminal disease, then the patient indeed has a “terminal prognosis.”
Later in the day the intern received a phone call from the patient’s nurse telling us that the patient was very agitated. She added, “He told his wife that he was going to die.” As I started toward his room I thought of what to say. I did not think it was appropriate, nor opportune, to negate the attending physician’s words. And more than anything I sensed that what the patient needed to grasp was hope–not a wish that his lungs could be normal again or that he could garden with his wife without feeling out of breath. Rather, he needed hope that reassured him, in spite of his debilitative condition, that he could live to the best of his potential. This was not something that I, nor anyone in the hospital, could grant him.
If I am correct, prognosis means “to see” or “to know ahead” (pro–before; gnosis–to know). Without being pretentious, I wonder if part of our healing ministry requires us to be prophetic for the sake of our patients. And that requires us to engender hope.
I think I will choose that path.
-Keeban Nam, LLUSM class of 2014, is from Riverside, California. He graduated from University of California, Los Angeles with a BS degree in psychobiology.