Miracles We Have Seen: America's Leading Physicians Share Stories They Can't Forget

INTRODUCTION

Physicians hold a privileged place in their patients’ lives, sharing times of great joy and times of great sorrow. To earn this special role, we prepare for many years. In college, we study the basic sciences: biology, chemistry, physics, and others. We move on to medical school for the clinically relevant sciences, including anatomy, biochemistry, pathology, physiology, microbiology, and more. Outside the lecture halls and labs, we shadow senior physicians on clinical rotations through all the medical specialties: internal medicine, surgery, pediatrics, obstetrics-gynecology, psychiatry, family medicine, neurology. But we’re still not finished. After choosing a field for our careers, we undertake a grueling apprenticeship called internship and residency that lasts several years, and we often follow that with further subspecialty training in a fellowship.

After all those years learning and training, digesting thousands of textbook pages and medical journal articles, listening to hundreds of lectures, and encountering countless real patients with real diseases and injuries, it would be reasonable to assume doctors understand just about everything there is to understand about the workings of the human body. Yet, in the daily practice of medicine, physicians are often surprised. Two patients with the same diagnosis each have nuances that distinguish them. Illnesses that are usually predictable take unexpected twists and turns. Treatments have unanticipated consequences. Patients and their families amaze us with seemingly impossible inner fortitude and resilience in the face of tragedy and grief. Physicians are accustomed to expect the unexpected, and we are usually well-prepared to respond.

But occasionally in the course of caring for our patients, we encounter events that truly stun us: unforgettable occurrences that defy all of our predictions and expectations, far exceeding the wide berth we are trained to allow for surprise. These are events for which there is no clear medical or psychological explanation, or if there is, the explanation itself is extraordinary. When these occur, we are rarely alone in our awe; medicine is a collaborative endeavor, so during these truly confounding and mysterious episodes, we seek advice and consultation from colleagues, specialists, and mentors. And when they, too, are at a loss to explain what we are seeing, the experience often deeply impacts everyone involved.

This book tells the stories of medical miracles in the words of leading doctors who witnessed them, physicians at the top of their fields. Contributors to this book include pediatricians, internists, surgeons, family medicine specialists, emergency medicine physicians, obstetricians, psychiatrists, and subspecialists in a wide variety of fields. They include leaders in the bedside care of individual patients, as well as in global health care where entire populations are affected. Among our essayists are dozens of preeminent educators, including deans and department heads, on the faculties of the top university medical schools in the country. All of our essayists also care for patients, spanning the broad clinical spectrum from community practitioners to highly specialized experts at major medical centers. The common thread among us is that we have borne witness to unexplainable, unforgettable, and profoundly unexpected events—medical miracles—in our patients.

These are not miracles resulting solely from heroic or high-tech medical interventions, situations for which we have a good explanation for the outcome—thoughtful, caring, and talented medical personnel applying state-of-the-art technology to save lives. Rather, the stories in this book are of patients whose outcomes amazed their doctors and nurses, perhaps despite their heroic efforts, because of the seeming impossibility of the events that took place. The stories recount spectacular serendipities, impossible cures, breathtaking resuscitations, extraordinary awakenings, and recovery from unimaginable disasters. Still other essays tell of physicians’ experiences in which the miracle was more emotional than physical, yet also left a lasting imprint. Doctors sharing in gut-wrenching decisions made by patients and families, and then in the resulting joy—or heartbreak. Discovering a silver lining of forgiveness or resilience, a child’s wisdom or a family’s generosity of spirit, evoked salvation and triumph in the face of sadness and tragedy. Over the course of a career, these emotionally stunning events occur more frequently than, for example, a patient coming back to life or recovering from a terminal disease after all hope had been lost, yet they are no less inspirational, no less miraculous to those witnessing them. As my colleague and friend Dr. Kevin Kalikow commented, it’s those essays that truly illustrate the difference between curing and healing.

The first medical miracle I witnessed was as a pediatrics resident-in-training. Two young brothers, ages three and seven, were brought into the emergency room and then the intensive care unit after near-drowning epi-

sodes. The recovery of one of the brothers was so unlikely, so astounding, that I was forever imprinted by the experience. This was not the last miracle I would see in my thirty-plus years as a pediatrics specialist. Many of my colleagues would agree that, despite being at the forefront of medicine and science, what we don’t understand often exceeds what we do understand. And even when we think we understand, we are frequently proven wrong.

The word miracle is often used in religious contexts, and while faith and prayer certainly play an important role in many of our patients’ lives, as well as in some of the vignettes in this compilation, this is not a book about religion. I will leave it to the reader to determine what, if any, role those factors play in the outcome of these stories. Rather, this is a book about optimism and inspiration, and the realization that what we don’t know or don’t understand isn’t necessarily cause for fear, and can even be reason for hope.

The experience of inviting physicians to contribute essays to this collection has, in and of itself, been enlightening for me. There have been three general categories of responses, all very thoughtful in their own way. Some colleagues knew right away that they hadn’t had miraculous experiences, and politely thanked me for asking. A second group said, Nothing comes to mind right away, but I’ll keep thinking on it and try to come up with something. With only a few exceptions, those physicians didn’t have a belated epiphany despite pondering it. The third group of responses was most exciting for me. These colleagues immediately replied with, Oh my goodness! I have an amazing story I’ve been waiting for the chance to tell. Not all of us are fortunate enough to encounter unexplained, unexpected, deeply moving and mysterious moments in medicine. But when a medical miracle—physical, emotional, or both—does occur in a physician’s career, it’s unforgettable, in the forefront of our minds, and ripe for telling. In the telling of the inspirational stories that fill this book, we learn as much about the physicians as about their patients. My editor at HCI Books, Christine Belleris, said it beautifully: Emerging through all of the moving personal testimonials from physicians in this collection is a compelling glimpse into the lives and souls of doctors—their compassion, humanity, and determined devotion to their patients and their patients’ families.

The other striking observation for me regarding the essays is how many of the events occurred decades earlier—often in the early stages of a physician’s training or practice. This is another testament to the powerful impact these experiences have on those witnessing them—unforgettable, still affecting physicians’ personal and professional lives. In these decades-old cases, the essayist-physician often recalls the concomitant astonished reactions of his or her senior and supervising physicians, expressed on rounds and in case con-

ferences. It was the astonishment of the senior physicians, highly trained specialists and experienced mentors, as much as the amazement felt by the young physicians, that kept those memories alive all these years. In many cases, physicians describing events occurring years ago noted that those early memories served to give them hope as they encountered new, seemingly hopeless cases in subsequent years. Some contributors wrote that the miracle experience actually directed them in their choice of specialty and has influenced much of their professional decision-making throughout their careers. Others draw on those miraculous moments at times when they themselves feel helpless in the face of adversity and tragedy. Powerful stuff.

Another unexpected and quite magical outgrowth of this project has been the reconnections that some of the physician-essayists have now made with the patients and patients’ families with whom they shared the miracle years earlier. Either in the course of tracking down the individuals for permission to tell their story, or simply reaching out to learn what has become of them, writing these essays has renewed old bonds. These reconnections have been moving and gratifying for everyone involved—including me, when I’ve been privileged to be included in the conversation.

Finally, three especially noteworthy responses to my invitation to submit an essay deserve special mention:

Several colleagues responded by saying that their memories of patients whose outcomes were unexpectedly bad are more vivid and haunting than those with miraculously good outcomes. That is only natural—we all relive and replay the horrible stories, asking ourselves, What went wrong? and What more could I have done? We must accept the inevitability of bad things occasionally happening to our patients over which we have no more control than we do over mystifyingly good outcomes like some of those described in this book. And among other essays herein, particularly those in the Silver Linings chapter, a mix of good and bad can occur with potent outcomes. Over the course of our careers, we can only hope that the positive results outweigh the negative, sustaining us in the good works we hope to accomplish.

Two essay contributors asked me to caution readers that patients’ dependence on miracles can be detrimental. While retaining hope in seemingly hopeless situations is emotionally and sometimes even physically healing, hope alone will not cure disease. When proven medical treatments are avail-able and beneficial, but declined in favor of waiting for a miracle, the patient will likely be disappointed. The takeaway message from the essays in this book cannot be to rely solely on a bolt of lightning from above. I received no essays for this collection of miraculous outcomes describing patients who refused proven medical therapy. My grandfather used to tell a joke about the saintly but impoverished old man who prayed and prayed and prayed to win the lottery so he could live a better life in his last years. After years of having his prayers unfulfilled, he finally threw up his hands and asked, Dear Lord, I have been a good servant for many years, doing good for others while sacrificing my own needs. Why haven’t you granted my wish to win the lottery? In a booming voice from heaven, the response came, My son, you have to buy a ticket! Hoping for the best outcome possible in a time of medical crisis is natural and uplifting, but you have to buy a ticket—if established and effective therapies are available, don’t ignore them while waiting for a miracle.

And in the third notable response to my invitation, two colleagues expressed nearly identical sentiments, quoted here with their permission. Although neither had a singularly miraculous patient experience to relate, Nathan Rabinovitch, MD, Professor of Pediatrics at the University of Colorado School of Medicine, said, Doing what we do as doctors, and seeing all that can go wrong, I’ve come to appreciate that every healthy day is a miracle. And Allan Gibofsky, Professor of Medicine at Weill Cornell Medicine, answered, The longer I live, the more convinced I am that every breath, every heartbeat (and yes, even every bowel movement) is itself a miracle. We spend so much of our professional lives as doctors dealing with what is wrong in our patients (and ourselves), that I fear we have become inured to appreciating all that goes right. Amen to both of them.

Thank you for giving audience to the stories we’ve been waiting to tell about the miracles we’ve been so fortunate to see.

—Harley A. Rotbart, MD

1

Spectacular Serendipity

When an inconceivable event takes place, sometimes it’s hard to know if the event itself is miraculous or if the timing of the event is the true miracle. Did the Red Sea miraculously split or were the ancient Hebrews miraculously at its shore precisely when a naturally occurring phenomenon began?

The essays in this chapter describe extraordinary medical outcomes that could only have occurred exactly when and where they did.

Date of event: 1988

Father Karl’s Miraculous Timing

Dale S. Adler, MD

It was a Saturday afternoon at an urban academic medical center. I’m a cardiologist, and was on call for the coronary care unit (CCU, the intensive care unit for heart patients) and the cardiac catheterization laboratory (commonly known as the cath lab) where we do dye studies to evaluate the blood vessels of the heart. As beautiful a day as it was outside, I knew I was not likely to enjoy much of the blue sky and sunshine. I had just finished an emergent case in the cath lab and I was happy for the nurses and technician there, who were hurriedly putting away equipment and making their computer entries. They might still be able to enjoy the waning hours of sunlight with their families. I let them know that all seemed quiet and they should try to get out of the hospital.

I was waiting for an elevator on the second floor that housed both the cath lab and the CCU, on my way upstairs to see a hospitalized patient. I intended to return to the CCU later to finish rounding on the patients I had admitted there earlier that day.

The elevator doors opened and, to my utter astonishment and great dismay, a body rolled forward over the threshold. Gray hair, overweight, black suit. Entirely unconscious based on the roll. I turned the man over, face up. Others who were also waiting for the elevator helped me. Priest’s collar,

pulseless, sweaty, clammy—drenched, in fact—cold, pale. We started CPR (cardiopulmonary resuscitation), and someone notified the hospital operator to broadcast a call mobilizing the emergency response team, but we didn’t wait for them to arrive. We dragged the lifeless body, while still doing CPR, toward the cath lab. More help arrived, with a gurney and defibrillator machine—the paddles for shocking the heart back to life that you see on all those hospital TV shows. Quick check of his heart rhythm: fine ventricular fibrillation, the most ominous heart pattern—his heart was doing virtually nothing. Shocked him with the paddles. No help. Quick lift onto the gurney, and we rolled him into the cath lab.

Fortunately, the cath lab nurses and technician had heard the call for the emergency response team and had not left the hospital. They were at the ready. Like a well-trained orchestra, everyone did their job. We learned that our patient was Father Karl, a popular seventy-year-old priest whose church and followers were about a thirty-minute drive from the hospital. Father Karl had been dutifully visiting his hospitalized parishioners, offering prayers of healing. We knew none of his medical history. We had no idea how long he had been pitched up against the elevator door. We didn’t know on which floor he had entered the elevator, nor why it stopped on our cardiac floor. We only knew he was cold and clammy and pulseless when he rolled forward from the elevator. His pupils were fixed and dilated, a very bad sign of impending death and/or brain damage. This was in an era long before we knew about cooling to protect the brain.

With ongoing CPR, we performed a catheterization procedure to find the cause of his cardiac arrest in hopes of reversing it. The procedure involves inserting a catheter (tube) into a large vein that runs directly to the heart. Dye is then injected into the arteries of the heart to find the problem. The large main artery on the front of the heart was occluded by a clot. That was the cause of his heart attack—that main artery is colloquially known as the widow maker because when it’s blocked, there’s big trouble.

While visualizing the catheterization procedure on the video monitor, I was able to reach his blocked artery with the catheter and slide a wire, and then a balloon, across the soft clot. I dilated the balloon to open up the artery, and then deflated it. Blood flow in the vessel was restored. This was at a time before stent devices, which these days are left in the opened arteries to keep them open, but the flow through his artery continued to look strong after the balloon procedure. He was still without a heartbeat. Another shock with the paddles, now to a heart getting adequate blood flow, was followed by return of a more normal heart rhythm, and then a weak but definite pulse. We boosted his blood pressure with another type of device, this one inserted into his aorta (the main artery leaving the heart), and with multiple medications.

I was told that people were in the waiting area, wanting to know about Father Karl’s condition. I arrived there, my scrubs soaked with Father Karl’s blood and sweat. Some of my own sweat, I presume, as well. I was greeted by a sea of black and white, a roomful of priests and nuns, every seat taken. They had heard about their beloved Father Karl and had come to see him and to pray. They all stood up as I arrived.

I told them that the good news was that Father Karl was alive, at the moment, and in our CCU with a heartbeat and a blood pressure. The blood pressure, of course, was being helped by many medications and the intra-aortic device. The bad news was we had no idea whether Father Karl’s brain had survived this dramatic insult. We didn’t know if he had been out for sixty seconds or five minutes before the elevator doors opened and we started CPR. The loyal legion said that they would pray for Father Karl and for the physicians. One after another expressed profound gratitude for what we had already done.

A mere four weeks later, after a full recovery, Father Karl addressed his congregation. He expressed gratitude to God and, graciously, to his physicians.

I, too, was very grateful. Grateful that a kind and revered man who had just been bringing good wishes and prayers to patients had the good fortune of having his potentially fatal heart attack in a hospital. More precisely, in a hospital elevator, which opened to the hospital floor where I was standing waiting for that elevator. The same hospital floor where the cardiac cath lab and CCU were located, and where I and others, trained and experienced in just this type of cardiac emergency, were still at work on a weekend day. Grateful that after literally falling at my feet, as if delivered to me, his heart finally responded to our treatment. Treatment that would have been impossible to receive in such a timely fashion had he collapsed almost anywhere else that day. Grateful that the prayers he said for our patients earlier that day were repaid many times over by the prayers of his community who had gathered in our waiting room that afternoon, and subsequently in his church during the harrowing days that followed.

As the saying goes, timing is everything. I will always be grateful for Father Karl’s timing.

Date of event: February 2013

An Unlikely Discovery by the Unlikeliest Person

Ryan Jones, MD

Claudette Dalton, MD

Gilbert Upchurch Jr., MD

Editor’s note: This remarkable story is separately told by three different caregivers, each from their unique vantage points. The roles of the medical student (Dr. Jones), teacher (Dr. Dalton), and surgeon (Dr. Upchurch) were each essential—without any one of them, the miracle would never have happened.

Part 1. The student

In all honesty, I was just trying to pass my exam. Once a week or so for the first two years of medical school, my fellow students and I donned our short white coats and had contact with patients as part of our Clinical Performance Development course. The contact ranged from watching trained physicians interview and examine patients, to doing the same ourselves under the supervision of our physician teachers. On the day that led to this essay, I was at the end of my third year of medical school, feeling fairly relaxed because the worst of my difficult rotations were behind me. I was generally comfortable with my skills in obtaining a medical history from a patient and performing a physical examination, and the exercise that day was designed to test those skills in preparation for the national licensing examination I would take in the near