Certain words seem to inspire strong instinctive emotional responses when expressed among patients, family members, doctors, nurses, and healthcare providers. One such word is "miracle."
I have witnessed well-meaning healthcare providers initiate a conversation with patients and family members about their goals and wishes (read Post 7: I Want the Best Care Possible for ME - Part 1 of 2) and awkwardly stop, not knowing how to proceed when someone in the room says, "I'm praying for a miracle."
I think many people, caring for patients or otherwise, are highly conscientious of inadvertently offending others; to avoid the potential to offend, they might refrain from conversations related to miracles, prayer, religion, and spirituality. However, as many palliative care specialists know (read Post 1: What Exactly Does a Palliative Care Specialist Do?), spiritual health, religious faith, and existential distress may be key drivers in how a patient or their family member make life altering medical decisions.
We may even avoid exploring what we define as a "miracle" with our own loved ones, either making assumptions of what a "miracle" means or perhaps not wanting to hear a loved one voice out loud a "miracle" that may not come to pass. However, a "miracle" could mean something different for ourself, our loved one, and our doctor.
A miracle to someone may be having the strength and energy to engage with family during a big Thanksgiving dinner, whereas a miracle their family member is referring to is that their loved one remain alert, calm, and comfortable for as long as possible even if that meant resting from the big Thanksgiving dinner to conserve energy. At the same time, many healthcare providers would likely assume praying for a "miracle" indicated a wish to focus on disease-eradicating medical treatments and prolonging life for as long as possible.
If a loved one talks about miracles, and you are not sure how to respond or you want to explore further what your loved one is trying to say, consider using the AMEN communication tool to guide the conversation and continue discussions on hopes and goals. The AMEN communication tool was developed by chaplains and healthcare providers at Johns Hopkins to guide healthcare providers with conversations about miracles:
1. Affirm your loved one’s prayers for a miracle. Ask what a miracle means to them.
"What would a miracle look like to you?” is a highly personal question, and a loved one may have more than one answer. Because each of us has a different, and sometimes more than one, idea of what “miracle” means, it is important to keep in mind that when a loved one says, "I am praying for a miracle," they could be hoping for any number of things.
Family members may ask a loved one with a serious diagnosis what they are hoping or praying for, and their loved one may reply, "I'm praying for the cancer to go away." This would be many people's fervent wish and initial response. This statement does not necessarily mean that a person is in "denial" or does not understand their health situation. It does not necessarily mean that a loved one would choose only medical treatments aimed at shrinking the cancer at the expense of quality of life or comfort.
Rather, this response could be the beginning of a meaningful conversation on next steps. Family members could consider asking, "What else are you praying for?" or "What else are you hoping for?" to get a sense of all the concerns that may be weighing on their loved one's mind. It is normal human nature to have conflicting desires. A student may work hard for and wish to have come first place in a competition, and still tell themself, "I'll be okay if I at least place." So when a loved one says, "I wish I were completely healed," they could also be telling themself, "I'll be okay if I can at least get up to use the commode when I need to use the bathroom."
Asking "what else?" could open a door to conversations about values, priorities, wishes, and goals of care that the patient, family, close friends, and healthcare providers could work together to attempt to achieve or fulfill (read Post 54: Why Should I Care about My 'Goals of Care?').
2. Meet your loved one where they are, and express that you, also, wish for a similar hopeful outcome.
This is the time to be accepting and supportive - or at least neutral - listening without judgement nor rushing in to reassure or correct at a time when a loved one is being vulnerable and open. Articulate that you hear - and that you are validating - what your loved one is saying.
"I also pray for your miracle."
"I wish that were so."
"It sounds like a beautiful miracle that you're praying for."
3. Educate your loved one on the medical aspects of their illness, especially if they have misconceptions or misunderstanding.
Sometimes healthcare providers give family members a more complete picture of the medical situation than the patient themself, especially if the patient is fatigued or suffering from uncomfortable symptoms. Sometimes a loved one must be told difficult-to-process news multiple times before they truly hear and acknowledge the reality of what is going on (read Post 13: Sometimes It's Denial, and Sometimes It's Just Really Bad Timing).
If a loved one says that God has the final say, consider exploring further what their understanding is of realistic possibilities.
"Yes, death is in God's hands. How do you wish to live until that moment?"
"How might we know when God thinks it's your time?"
"Would talking about 'what if's' undermine your faith right now?"
If a loved one is ready to hear, family members could describe medically what is happening. “Yes, God has the final say. Do you want to hear what the healthcare team believes is happening scientifically?”
The responses to these questions could result in meaningful conversations enabling a loved one to gain a better understanding of their health or medical situation and make plans moving forward (read Post 17: How to Discuss Serious, Difficult, Hard to Hear, Bad News in Six Steps).
4. Reassure your loved one that No matter what happens, you will support them and not abandon them.
Sometimes a loved one may attempt to use faith or religious beliefs as a means of avoiding discussing the reality of the situation or to avoid dealing with strong emotions. They might say something along the lines of, "I don't need to hear what you have to say. I don't need to make decisions or make plans. Everything will happen according to God's will." Or a loved one may indicate denial with the language they use, such as "I have strong faith, and I have my prayer circle. Everything will work out."
If this is the case, the best you may be able to do is gently and repeatedly over time ask your loved one about their thoughts, reminding them that you are available to support in any way and available to talk and listen whenever they feel ready (read Post 33: Seven Ways to Approach a Person in Denial).
Remember, we can be gentle AND encourage and nurture hope while addressing the reality of a difficult situation.
"Sometimes the miracle we get is not the one we want. Sometimes a miracle comes as an another day of alertness rather than a cure."
"There are some miracles that are out of our hands. There are some we can try our best to make happen."
I hope this post inspires all of us to sit down, inquire, and listen (instead of turning away or assuming without exploring) when a loved one talks about the miracle they hope to experience. Instead of feeling helpless, we may find that we indeed can play a part in making a miracle happen.
Casey mentioned to her doctors multiple times, "I'm praying for a miracle. I'm praying I'll be healed," to which her doctors and her family would nod solemnly before proceeding on with their agendas. One day, after one of these emphatic statements, Casey's sister asked, "What other miracles are you praying for?" Casey exclaimed, "I'm praying I get to see my 'babies' go to a good home before I'm gone!" Her sister carefully replied, "I also pray that you'll be healed, and only God knows if this will happen before death or after. What I do know is that I'm going to work on getting you your other miracle. I'm going to find your dogs adopted into the most loving families." Casey smiled, "Thank you, thank you. That would give me peace."