Medical miracles get a lot of publicity but most of us have never seen one. Would you recognize a medical “miracle”? I expect we would all agree that an unexpected recovery from what was believed to be an incurable and fatal disease would qualify. But miracles are more than just good outcomes: they are rare events, otherwise they wouldn’t be called miracles; and unpredictable; and defy medical explanation. Miraculous cures contradict the best medical opinion and leave us amazed and perplexed. Jacalyn Duffin, who holds the Hannah Chair in History of Medicine at Queen’s University, has made a study of medical miracles, especially those which have been accepted by the Catholic Church for canonization of Saints (Medical Miracles, 2008). Her interest was piqued when she was asked early in her career to review a 5+ year old set of slides, blood and bone marrow slides from a young woman with acute myeloblastic leukemia. She assumed the patient was long dead but was surprised to learn that she was in remission and doing well, and the request for an opinion was from the Vatican. “They wanted to know if I had a scientific explanation for why this patient was still alive.” Her evidence was crucial in the canonization of Saint Marie-Marguerite d’Youville (1701-1771), founder of the Grey Nuns of Montreal and the first native-born Canadian to be canonized as a Saint. Still, Dr. Duffin’s opinion of medical miracles is very pragmatic: “these events were miracles for the people involved. The miracle, the thing of wonder, lay in the contemporary inability to explain the recovery.” They are cures that defy scientific explanation.
The medical history that follows is a true story; It is Ian Dickson’s story and I will let him tell it in his own words.
MANITOBA MELANOMA MIRACLE
In late October, 2005 my wife Donna and I were in Florida for a holiday. While applying suntan lotion to my back, Donna noticed a mole that was discolored and jagged in shape, and we agreed that I would have it examined upon our return to Winnipeg. Our family doctor removed the mole and it was sent to Toronto for pathology. In December I was heading home one afternoon, singing along with the radio as Xmas was only a few weeks away and retirement was good to me. I stopped at the doctor’s office to have him replace the bandage on my back. He asked me to sit down and told me the lab results were back and were not good, and I had melanoma. I would need to see a dermatologist and oncologist as soon as possible. I went home in shock and told Donna the bad news.
We contacted a close family friend who was head of surgery at Health Sciences Center in Winnipeg and asked for advice regarding my next steps. He outlined the four stages of malignant melanoma, the treatment and prognosis for each stage and asked that the lab results be sent to him for review. He called the next evening and advised that “we had a lot of work to do” as the melanoma was larger than 4 mm – an indicator of a likely poor prognosis. Through him, I was seen by both a surgeon and an oncologist very quickly, and my first surgery was done on January 23, 2006. I was able to avoid skin grafting in the area, but the sentinel nodes under my right arm were black – a sign the surgeon said was clearly cancer, and the first time she had seen such a color. A second surgery took place a few months later to remove the lymph nodes from that arm, six of which were involved with cancer.
Treatment of malignant melanoma involved interferon – a booster of my natural immune system. The side effects were that of a very bad flu, as interferon is the body’s immune reaction. One month of IV treatment was followed by a proposed year of self-injections 3 times per week. I was advised not to make any big decisions during that year, and that the effects of interferon may be reduced after finishing the IV treatment. I was also told that I may be giving up a good year for a bad one, given the seriousness of my diagnosis.
The flu like effects did not subside after 4 months, and I spent most of the time sleeping and unable to enjoy much of anything. My oncologist had told me that I was in charge of my treatment, and if I decided to stop at any time it would be respected by the staff at Cancer Care.
In August of that year, Donna and I had a “come to Jesus” meeting and agreed that the additional year that I might get was not worth continuing the interferon, as quality of life was more important than quantity. As promised, the doctors respected my decision to stop treatment, and I was told that based on statistics of melanoma, I would probably have about one year to live. This led to my identifying short term goals such as playing the bagpipes again at the Grey Cup in November in Winnipeg; and to join one of our sons for Xmas – and what a good Xmas it was!
My life returned to normal as I gained weight, returned to my workouts at Reh-Fit, and again enjoyed various activities with friends and family. I was seen every 3 months at Cancer Care for checkups, then every 6 months until 2015 when both doctors and I agreed that I could finally stop these visits. The only residual effect of the interferon treatment is that I still have occasional difficulty articulating words and phrases. And my experience has made me appreciate the wonderful family, friends and medical system that help one through such difficult times. I am especially grateful to my son who gave me a diary at Xmas, 2005 with the notation “Dad, I thought you might want to write down your journey experiences as you move through this challenge of your life”. I wrote in the diary until 2011, helping me with the memories of this experience.
What can we learn from this story? Is this a medical miracle? If so, do we have any clues as to the cause? Most important, is there a lesson here for others in similar straits?
Survival with malignant melanoma depends on the stage of the tumor. The worst is Stage IV which has spread to tissues distant from the primary site; in medical terms it has metastasized. The prognosis for Stage IV disease is, and was then, very grim. The latest authority, the Final Version of 2009 AJCC Melanoma Staging and Classification states, “the overall prognosis of all patients with stage IV melanoma remains poor”. The ten-year survival rate is so low they don’t give a number. Ian was given a generous prognosis of about one year.
Does Ian’s story qualify as a miracle? There are several flavors of medical miracle. One is the dramatic human interest story that the media love: unexpected survival from a tsunami or airplane crash. These events are rare but they do not violate natural or physical law and do not interest us here. The cure as described by Ian is properly called a “spontaneous remission,” very unusual for cancer of this type. Standard medical wisdom assumes that there is a natural cause for the remission, and even if that cause is not currently known it may someday be revealed by research. However, there is another explanation held by many, a theological explanation. If a miracle cure has been preceded by petitional prayer and is also scientifically inexplicable it may be accepted as a “sign” of divine intervention and be labelled a “miraculous cure”, a requirement for canonization of Saints. Of course “spontaneous remission” and “miraculous cure“ describe the same event and differ only in assignment of cause.
If we consider natural causes in Ian’s case, we should look to the immune system for a medical explanation. Cancer treatment now includes immunotherapy to redirect the native immune system to recognize malignant cells as foreign and to attack them. Genomics research is yielding more information about genetic factors that affect susceptibility and resistance. In this case, it may have been his own native immune system, released from the chemotherapy, which destroyed the cancer cells. Probably a number of factors acting in unison, rather than a single factor, were responsible. This is a plausible biological theory, but still a tentative and inconclusive explanation of the event. We all have an immune system; why did Ian’s react so much more effectively than others? The miracle is in the features which make this case unique. We can congratulate him on a happy outcome, but only with the rather banal, “You were the lucky one, old son!” But what is luck but random selection? Random selection is capricious and this is an unsatisfactory explanation for an experience of such personal consequence.
Ian and Donna recognized their helplessness in the hands of capricious chance. This reached a crisis point with their “come to Jesus” meeting, expressing a need for some certainty and autonomy, for some control over life events. For Ian, continuing medical treatment offered only the certainty of feeling terrible and the uncertainty of living longer. The outcome was still governed by the randomness principle. The decision to stop treatment can be seen as his attempt to retake control of his life and his willingness to accept the consequences, but on his terms. But “come to Jesus” also suggests a plea for hope, for at least temporary respite from suffering. Hope is an intangible asset, but essential to mental health in a crisis. Hope is the affective expression of optimism that the outcome can be influenced beneficially, and is usually accompanied by a plea for intercession. If medical treatment offers no hope where does one look for intercession?
Our less skeptical and more spiritual ancestors did not find this a perplexing problem; to them miracles were evidence of divine intervention which were invoked by intercessory prayer. Miracles demonstrated that nature is subservient to a higher authority, a reminder that randomness did not rule unchallenged. Moreover, the gift was free for the asking; it need only be accepted in faith.
How do we react today to the prospect of incurable disease? Normally we seek the best medical care and hope that chance will favor us, but we may also pray for divine intervention. It should be noted that these are in equal measure expressions of faith, not certainty. Ian chose an independent path that reflected his need for autonomy and hope for relief from suffering. Some might describe his fortunate outcome as simply a “spontaneous remission,” others may choose to call it a “miraculous cure”. The former is a descriptive explanation that emphasizes the diagnostic uncertainty regarding cause and accepts that in the end we are, like all creatures, the victims of chance. But the sense of awe and wonderment elicited by these marvelous events is not satisfied by statistical logic. Our emotional response is to search for personal significance and spiritual meaning, and a “miraculous”, not a statistical, explanation. But these approaches are not mutually exclusive; we do not need to choose between one or the other? The end result does not distinguish one from the other? That is my view, but I’m afraid that you, the reader, must decide for yourself. If you place your faith in modern science and accept the element of chance you are with the majority; but if you have faith in miraculous intervention you may pray with corresponding confidence. Dr. Duffin’s conclusion still holds: “the event is a miracle for those involved.” Perhaps best to hedge your bets and go with both.
- Duffin, J., Medical miracles : doctors, saints, and healing in the mode rn world. 2009, Oxford ; New York: Oxford University Press. xv, 285 p.
- Balch, C.M., et al., Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol, 2009. 27(36): p. 6199-206.