Conflicting reports have come out regarding the current health and fate of Bobbi Kristina Brown. After nearly drowning in an Atlanta bathtub on January 31, she is in critical condition, surrounded by a family struggling to decide what next steps to take. Thus far, among other requests, they have asked friends and fans to pray for a miracle.
For some this approach may seem at odds with the fast-paced high-tech world of modern medicine. For me it makes all the sense in the world.
Brown’s story is tragic for many reasons well chronicled by the tabloids. She is the daughter of celebrity parents whose lives also were endlessly chronicled in the press, especially the death three years ago of her mother, Whitney Houston. Now Bobbi Kristina is a critically ill 21 year-old woman, lying in a hospital bed.
The confusion on how best to proceed serves as a reminder of how difficult it is to think realistically about death, even, and especially, in the 21st century. For a long time the dismal task of trying to guide the dying and their families through moments such as this fell to the priest. Priests have a unique set of skills for the role, having spent a life in thought about the spiritual world. In addition, for many people, they can offer the promise of heaven and an eternal life. Surely this concept of the non-death death has brought, and will continue to bring, meaningful solace to countless people.
In recent decades, as science has crept farther into daily life, the responsibility to advise the sick and their family increasingly has been assumed by the medical profession. Yes, the priest continues to have a role as counselor and support, but it is left the physician to be Charon and pronounce that the time to let go has arrived. To make the unfathomable task of agreeing that the best next step is death, the physician lays out evidence—a lab test, an X-ray—as if presenting to a court. The family then combs through the welter of information to find a way out, a small ray of hope.
It is, in the best of circumstances, an impossible situation. Even when the patient is elderly and frail and has said the good-byes and directed his or her wishes, no one, really, can believe what is happening. And when the patient is young and so recently vibrant, the discussion is even more heartbreaking and incomprehensible.
Many have decried the perceived heartlessness of a medical profession that seems too comfortable with numbers and dates and trends. Yet it is the premise itself that is flawed. Unlike the priest who brings a philosophic and spiritual perspective, doctors are trained in the hard-edged world of pathophysiology and statistical likelihoods. This works well for most situations but by definition must fail miserably when it collides with the hopes and dreams of a loving family about to watch someone die an unexpected and premature death.
And surely there are many situations where the doctor-as-robot charge is correct. Some people good at math and science are not people of introspection or emotional agility. The necessary discussions are not within their range of possibility any more than a discourse on natural logarithms is possible for many others. This is a basic problem with medical education.
To remedy the problem, medical schools have tried to change selection criteria to find more sympathetic, kind-hearted souls. In addition, they are trying to train doctors better for the task of handling end of life discussions. This certainly is a worthy strategy.
But nothing in the real world, no selection committee, no lecture series, no life experience, can prepare anyone for the nightmare of seeing a critically ill 21 year old who was in perfect health a month before. Discussions inevitably wobble between dispassionate presentations of facts, such as new lab results or a visit from a consultant, and the suffocating heartbreak that looms ahead. As a doctor, it can feel almost deliberately cruel to continually bring a discussion back to the reality at hand. It is much easier to reminisce and speculate, to trade stories, to chat.
However there are decisions to be made, decisions without precedent for the stunned family. And the decisions must be informed by facts as ruthless as the facts sometimes can be. So of course the discussion is bruising; treading on another’s hopes when a situation is hopeless remains the most painful thing any doctor must do: to watch the agony of the family forced into making impossible choices. Yet it is played out daily in hospital hallways and ICU lounges across the world.
And under the welter of so much, so cruel, so fast, a family understandably seeks and often finds hope in the notion of a miracle. This can be in the form of a case lifted from the Internet that seems similar to the predicament of the loved one, where all hope had seemed gone—but now the Internet patient is up and doing fine, mowing the lawn! Or it might be an overlooked vitamin regimen or a new wonder drug or an old-fashioned Biblical miracle precipitated by the prayers of hundreds.
Who is the doctor to question any useful strategy employed by the patient or family to get through the next few cement moments? So please do pray for miracles if it moves you and can afford you some relief. And don’t worry about the ridicule. As TS Eliot once memorably said, “In a world of fugitives, the person taking the opposite direction will appear to run away.”