A 70-year-old female patient underwent a cardiac procedure to repair her mitral valve, and at the same time, she also underwent a coronary artery bypass grafting. She had an uneventful course for the first four postoperative days. On the sixth postoperative day, she started complaining of abdominal pain, with a drop in blood pressure. Her clinical condition deteriorated enough to transfer her to the intensive care unit and have her placed on a ventilator as well as vasopressor medications to artificially maintain her blood pressure.
We were consulted at this stage to rule out any intra-abdominal pathology that might need abdominal surgery, with ischemic bowel being on the top of the list of diagnoses. After we examined the patient and looked over her investigations, it became very clear that she had a very high likelihood of having ischemic bowel and the only definitive way to rule that out would be to perform an exploratory laparotomy.
Meeting the Family
This step would entail another major procedure with its risks in someone who is already so critically ill. We then started to seek out the family to discuss the potential procedure, with all its risks and benefits, as we always do in patients who are not capable of making their own decisions. It turns out that her next of kin was her equally old husband and their best friend (in her 50s), as they did not have kids of their own.
When I met them for the first time, the husband looked frail and needed a cane to walk. He was frail enough that we needed to support him by hand and a chair, as he could not stand for prolonged periods. Although he was frail in physique, his mental abilities were strong, intact, and sharp. After we went over the likely diagnoses and potential risks and benefits in detail, the husband wanted us to proceed with surgery.
To the Operating Room
We took the patient to the operating room. Due to her extremely critical condition, every attempt was made to be judicious in every move. In the operating room, we did find ischemic bowel, which would entail removing her entire colon. As we were proceeding with this proposed procedure, the patient went into cardiac arrest and required cardiopulmonary resuscitation.
She did come through this, and at this stage, we had discussions with the anesthesia and primary cardiac surgery teams to decide on whether to proceed or abort. Everyone agreed that although she had a cardiac arrest, as long as her ischemic bowel was in place, she had no chance of getting better. We went ahead and completed our proposed procedure of removing her colon. The patient tolerated the rest of the procedure well and remained stable throughout afterward. She was transferred back to the intensive care unit in stable but critical condition.
Bringing God Into the Conversation
After completing the procedure, I went out to talk to the husband and their friend. I took them through the series of events that transpired in the operating room. As is the case in most of these types of scenarios, the husband had the resolute dignity to accept the series of events despite the enormity of the situation and his frailty. I went over the likely possibilities for recovery in her situation and assured them that we would be watching her very closely.
As we were wrapping up the conversation, the husband stated that he prayed to God to help me and my hands to do the right job in the operating room. He noted that, “as long as he prayed, God will help me to do the right thing in the operating room.” With that, we held hands and finished our talk.
How many times do we have patients and their families invoke God in the physician-patient relationship? In my experience, plenty. I have had numerous situations where patients are clear in their intent to have God as a part of the conversation relating to their treatment. Some patients want me to pray with them and their family members in the presence of their religious person of authority or other similar representative of various faiths. Others have asked me if they could carry a religious symbol with them to the operating room and have it present throughout the case. In these situations, we have obliged by placing such symbols somewhere close to the patient without compromising medical care. In one form or the other, several patients wanted their faith in God to be their constant companion through the difficult times they were facing.
Where Science Meets Faith
How do we physicians react or respond to these situations? Is it something that we should be teaching our young medical students and residents? If so, how do we incorporate that into their training, considering the different opinions about the mere existence of God and not to forget the numerous types of faiths practiced? Or is it something that we ignore and dismiss the requests of the patients and their families?
This is the crossroads where science and faith come face-to-face. As a profession, we rely on science and evidence to do nearly everything. Most new drugs can only be used after going through rigorous trials from phase I to III or IV. Similarly, most operations need to stand the test of prospective or retrospective research to validate their benefits, without which they would not join the therapeutic armamentarium. Evidence of benefit is the rooting principle behind most of what we do in Medicine. As a profession that demands evidence for everything we do, it could easily be said to “show me the evidence” that involving God and prayer will help the treatment of our patients.
This is the classic situation where this saying applies well: “Absence of evidence does not equate to evidence of absence.” We may not have any concrete or even slight evidence to show that praying and prayers help in the immediate treatment of a patient. At the same time, we also do not have any evidence to show that it does not help. Or, more important, we do not have a shred of evidence to show that invoking God hurts a patient. Since Primum non nocere (do no harm) is our core principle, praying passes the most important test of Medicine; it does no harm.
A Closer Look at Benefit
Now comes the point of addressing whether praying has any benefits. It is appreciated by many that a sound mind can contribute to sound healing (ie, mind over body). If the mind is not right, then the body will not be right as well. So if saying a prayer or keeping a talisman close by keeps the mind of a patient sound, then why not let him or her do it. The last thing we want is a patient not in the right frame of mind to negate the benefits of the treatment we provide.
For all the drugs we prescribe and operations we perform with their purported benefits but also their attendant risks of mortality and morbidity, we still continue to prescribe them. I am not aware of any evidence of harm to patients that arose from these simple words: “shall we pray.” When a patient or a family member wants to rely on religion, faith, or any other beliefs to get through an illness, let not the rigid boundaries of science and evidence prevent us from abiding by their simple request. If saying a prayer helps an elderly husband tide through the burden of his wife’s extreme illness, our innate humanity, even as a person if not a physician, should not prevent him from doing so. As long as it does not cause any harm or interfere with the proposed treatment, acquiescing to such requests may not only make them more comfortable but also demonstrate that we care.
So the next time a patient or a family member says: “Doctor, we prayed for you,” accept all the help you can get. Besides, you never know when you may need it. ■
Disclosure: Dr. Are reported no potential conflicts of interest.
Dr. Are is Jerald L & Carolynn J Varner Professor of Surgical Oncology & Global Health; Vice Chair of Education; and Program Director, General Surgery Residency, University of Nebraska Medical Center, Omaha.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
