RAMBLINGS: Hope Vs. Magical Thinking

About twenty years ago, or more, I was living in Marquette, Michigan, on the shores of Lake Superior. One day I had a message from the front desk of our Internal Medicine office. One or our patients wanted to get the report of her recent CT of her chest. She had lung cancer and was following with a local oncology clinic. Our practice was her primary care home. Why she was calling us for a report of a CT scan, which was ordered by her oncologist, was not clear, except that I think the oncologist was out of town, and if I remember right, it was a Friday. I wanted to do my best to help her.

Mrs. Clarke (obviously not her real name) was put on hold while I came to the phone. I looked at her scan and radiologist’s report and studied it very carefully, prior to picking up the phone. I wanted to make sure that I got the story straight.

I picked up the phone and punched the flashing button. “Hello Debora, how’re you doing?”

She answered in a very nervous voice, “How’s my scan?”

I always try my best to put things in the most comforting tone when I explain tests to patients, trying not to under-estimate any real concern. I also try to talk about abnormal tests face to face, but this situation didn’t allow that. I explained to her, “The radiologist has compared the tumors to the previous scan and, overall, there has been some reduction in the total size of them.”  I was getting ready to say, “It appears that the treatment is working, but you need to discuss it with the oncologist when you see him.” However, as soon as the words, about the reduction, came out of my mouth, Mrs. Clarke burst out in tearful delight. “Praise God, he promised He would heal me, praise Jesus!”

I was staggered by her sudden response and I was afraid that I had not been clear. “But Mrs. Clarke, the tumors are still there, but they are smaller and that’s a good sign.”

“No, God promised me that He would heal me, and he has.”

She may have been so transparent about her spiritual perspective because we attend the same church (and it was a relatively small city). However, I suspect that her enthusiasm was so overwhelming to her, that she didn’t even think about who she was talking to. After all, I did not know her that well through church.

I repeated to Mrs. Clarke, “I’m so glad there’s been an improvement, but the tumors are still there.”

“No, they are not!” she said, this time in an angrier tone. “Don’t doubt the mighty work of God!”

“You need to discuss this with Dr. Patel (oncologist) when you see him. When do you see him again?”

“I’m never seeing him again, God has healed me!”

That’s the last thing I remember about the conversation, however, soon a message came through our Church’s prayer chain that Debra Clarke had been miraculously healed from her lung cancer. I was speechless and felt like it was somehow my fault. What had I said wrong?

People in my church were so excited about this miracle, where her lung was full of cancer and suddenly, it was gone. The story got embellished (not sure by whom) that the oncologist was shocked at the results and he had never seen anything like that. Abiding by the rules (HIPAA) I could say nothing, except to corner Mrs. Clarke after the Church service one Sunday and beg her to go back to Dr. Patel. She was very angry at me and accused me of not believing God or having faith.

Sadly, Mrs. Clarke never saw her oncologist again and, as far as I know, never continued her chemotherapy or radiation. Within eight weeks she was dead. The church was shocked and her miracle, or lack thereof, was never mentioned again.

There is a gray area between hope and magical thinking. I take the term from Joan Didion’s book, The Year of Magical Thinking. She is a fantastic writer, however, this book, and the sequel, Blue Nights, wears on you (especially if your read them back-to-back) as a narcissistic journey into the world of the Hollywood Bourgeoisie. Yet, I feel guilty for even calling her narcissistic when she had suffered so much loss (a husband and a daughter the same year).

The point of her title about magical thinking is that it took her 365 days to accept the reality that her husband had suddenly died, falling over in their New York apartment. For some, reading her book is a cathartic for grief and I’m sure that’s why she wrote it.

Magically thinking, per her story, is where you live in a world your wishes create, not the world we have been given. There can be short respites of this kind of imagination, which are healthy, but it quickly becomes stagnant and suffocating if it continues. Reality does sometimes suck, but to deny that reality or to delay it, carries us further from resolutions or recovery.

I am a realist. I know that in the end, the statistics are always right, and I mean ALWAYS. I know this, not because I don’t believe in a God but because I do. The entire universe is written in mathematical code. The math of the universe is the scent of a God’s order. The fidelity of math is so true, that Plato thought it must exist in a higher reality, where there is always certainty. It is so reliable that a smart physicist can stand in front of a green board, in some upper story office in Princeton, and discover a new mystery about the universe, using only a humble piece of chalk … and his or her brain. No other instruments are required.

But, within the microcosm of our own world, I don’t believe the statistics are fatalistic. Maybe we are predestined by God or our genes for the final outcome, but I sense that there is place for hope of changing what could have been.

There are lots of statistics about my Multiple Myeloma and paths of possible outcomes. I’ve studied them well. You can breakdown what I have into sub-sub-sub types, each with their own predictive outcomes. But when it comes to my own world, the statistics has limited meaning. As I have said before, I had a .04% chance of developing this god-awful disease, and I did. I now have a more than 50% chance of finding a remission for years and a small hope of a cure within my lifetime. The statistics of my renal recovery is more grim, but there is still hope.

So how does one live within the reality of what is, but still have hope of beating the odds?

I have so many people praying for me and for them I am deeply grateful. I do believe that prayer can, in a mysterious way, change the odds in my favor. For many other people, they have given me “good thoughts.” I am deeply grateful for that as well, because I understand their intent while I’ve never understood what the hell that means.

I don’t think my attitude determines my outcome. I’ve never seen a medical study that said if a patient thinks positive, they will do better. I don’t want to think positive in a magical-thinking way. I do want to believe in prayer and doing what I can to shape my own destiny. I do this by studying my disease, the treatment protocols and making the best choices that I can.

Of course, I want to live. Of course, I want to be free from the terrible symptoms of renal failure that plague me daily. I want to be free from the neck pain may cancer has caused and the side effects of chemotherapy. I pray constantly that God would deliver me from this nightmare but that He would also spare me from the trap of the magical.






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