[T594]The Mind And Body

Life-threatening illness is more than a crisis of the body; it is a crisis of the soul. During thirty-five years as a hospital-based cardiologist, I have seen innumerable ways in which patients react when faced with a medical catastrophe. Initially, most are overwhelmed, and feel as though they have been attacked by an alien force'as if body, mind, and spirit are under siege.

Many patients become paralyzed by fear. All resistance crumbles, replaced by passivity and resignation. Some go into denial, unwilling or unable to confront the enormity of what is happening. Yet others meet the crisis by challenging it head on, and in the process, discover within themselves the resources to confront and overcome the gravest of circumstances. At times, these patients triumph, not because of the medical care they receive, but in spite of it.

There exists in all of us, a life force: the foundation of organic existence. In some, this drive is powerful and passionate. In others, there is ambivalence about continuing the burdensome business of living. When disease strikes, many are all too ready and even willing to have their lives end. But passivity or resignation are not immutable reactions to a life-threatening illness. My patients have taught me that the will to live can be awakened at any moment during its course.

Medical science has largely been blind to the power of a patient's mind in determining the outcome of an illness. Doctors are taught to view patients as the sum of their bodily parts, and to treat diseases by relying almost exclusively on the marvels of medical technology. Their unspoken communication to patients is unmistakable: We will mobilize our array of procedures and wonder drugs to save you. If they don't work, you are beyond help.

Having spent much of my career as an academic physician directing medical research programs, I have participated in the development of technological advances that have led to this new patient-care paradigm. While today's medical arsenal is invaluable in the combat against life-threatening illnesses, it has brought about a major side effect: far-reaching changes in the time-honored patient-doctor relationship.

That bond, once an invaluable component of the healing process, has become undermined. On teaching rounds, I have always felt it important to point out the ways in which doctors unwittingly discourage patients from mobilizing their inner resources to overcome an illness by implying that these elements play no part in the outcome. I emphasize how powerful these resources can be. Experience has taught me that they are comparable to any avant-garde pill or procedure.

This was dramatically demonstrated to me many years ago by a patient named Vivian, who was suffering from progressive heart failure. The cumulative cardiac damage caused by several previous heart attacks had forced me to admit Vivian to the hospital three times in four months. Her heart had weakened to the point where it no longer responded to maximum doses of intravenous diuretics and other powerful medications. Edema fluid had accumulated in both her lungs and legs.

In the previous twenty-four hours, Vivian's kidneys had begun to shut down, making it impossible to treat the massive watery accumulations in her body. Her liver and other organ systems were also becoming affected. All therapeutic options had been exhausted. Vivian's chances for survival were close to zero.

After suffering for ten days in the Intensive Care Unit, Vivian had had enough. ?Look, Doctor,? she said, ?I am seventy-two years old. My husband has been dead for fifteen years, and my daughter hasn't spoken to me since the day he died. I'm in constant pain, and I have nothing to live for. Please let me go.?

Despite their estrangement, Vivian had listed her daughter Janet as the person to be notified in the event of her death. When I asked whether Janet knew how sick she had been, Vivian shook her head.

?My daughter doesn't know, and I'm sure she doesn't care.?

?If you wouldn't mind, I'd like to call her.?

?I don't see the point. What good would it do??
"It might not do any good, but I think your daughter should know what's going on with her mother.?

?Frankly, I think it's a waste of time.?

Two nights later, Janet came to the Unit accompanied by her ten-year-old son, whom Vivian had never met.

The following morning, a different woman greeted me in the Unit. Vivian looked at me, eyes glowing, and said, ?My daughter is getting married in three weeks. She wants me to walk down the aisle with her.? Tears welled up in Vivian's eyes, as she took my hand and whispered, ?I want to be there, Doctor.?

Within days, Vivian's kidneys began to open up. The same dose of intravenous medication that had been ineffective now caused a substantial decrease in Vivian's edema fluid. After a week, her lungs were clear. By the end of week two, we were able to switch from intravenous to oral medications, and move Vivian out of the ICU.

Three days before discharge, Vivian began gingerly hobbling down the hospital corridor with the aid of a walker, the same one she used to walk down the aisle alongside Janet at her wedding.

Vivian not only attended her daughter's wedding, she also lived to attend her grandson's bar mitzvah three years later.

Every doctor has seen patients with a life-threatening illness make a miraculous recovery after they were thought to be beyond hope. But because medical science is unable to explain these extraordinary occurrences, their importance is often ignored. Medicine is so enamored of the apparent infallibility of science that it has become blind to other possibilities. But remarkable recoveries like Vivian's are possible for all of us. As Emily Dickinson wrote: ?We never know how tall we can be until we are called on to rise.?