August 14, 2010 3 Comments
Mens agitat molem.
Mind moves matter.
Virgil, Aeneid, 19 BCE
Atul Gawande wrote an article for Slate back in 1998, E.R. and the Triple Hex, about whether more accidents happen when a full moon and a lunar eclipse collide with Friday the 13th. Although there is no hard and fast evidence that Friday the 13th, the lunar eclipse, or a full moon is associated with increased hospital admissions or illness severity, there is still room enough for us to entertain that possibility. The one piece of evidence that the moon may have an effect on us is that for women, menstruation typically occurs on the 28-day lunar cycle. This month’s full moon – August 24 – safely surpassed the 13th, but the hospital was chaotic through the late hours of the night nonetheless – and I daresay the chaos subsided as daylight broke on the morning of the 14th. The diagnoses from yesterday’s admissions to the intensive care unit – peripartum cardiomyopathy, persistent hypotension after carotid stenting, myocardial infarction with minimally improved cardiac function after balloon angioplasty and stenting, acute renal failure requiring hemodialysis after cardiac catheterization – were striking in their unusual nature and their degree of severity. The emergency department was filled beyond the point of overflow – the census of critically ill patients downstairs was comparable to the holidays.
The degree of superstition in the hospital is quite remarkable, especially given the propensity of hospital staff – physicians, nurses, and PAs alike – to use logic and scientific evidence in their daily thought process. I have never uttered the words “quiet night” in the hospital without being told vehemently by someone in the near vicinity not to say such things out loud, for fear that it would “jinx” the night. For that reason, I am not as surprised as Gawande that researchers have tried to “prove” superstition exists with scientific data. As inquisitive, scientific people, we are looking for a concrete reason for our superstitions. We are looking to make our own anecdotal, intangible evidence both concrete and tangible. The easy explanation for superstition is that we are biased observers – on the night of a full moon or Friday the 13th, we look for – even expect – a high patient volume or increased severity of illness and attribute anything out of the ordinary to the date. We give people’s illnesses meaning within the context of time. In contrast, on other days we try not to think about it – we move through the day as usual and dismiss anything unusual to pure chance.
The concept of mind over matter does not only apply to Friday the 13th. Last night, a family gathered round the bedside of their father who suffered a stroke several weeks ago. Mr. K continues in a long, hard fight for recovery. His brain has undergone permanent damage from a stroke that has not completely resolved – a large clot still sits in one of his cranial arteries. He is lethargic and unresponsive at his worst, and he squeezes his hand in response to his family at best. He has not been able to speak or eat since the injury. He is now reaching the point where, from a medical perspective, we have done all we can to optimize his condition. As his family begins to take the next steps in his care and to answer the difficult questions of what quality of life might mean for him, they circle around the bed, sharing stories and memories through the years. In the room next door, a young woman who has just delivered a baby stays up all night with her husband – she has developed peripartum cardiomyopathy and is praying for her own recovery so that she can go home to care for her newborn. And in another room still, a middle-aged gentleman who suffered a massive heart attack fights for his life – with a balloon pump in his aorta to increase his cardiac output and with a breathing tube and ventilator machine to help treat his florid pulmonary edema, he will need to undergo much more than his initial cardiac stenting before he will be able to recover any meaningful, active life again.
Although quiet words about Friday the 13th circled among hospital staff last night, none of these patients or their families mentioned it to me. Perhaps they were too distracted to notice. Or perhaps it didn’t matter.
The idea of mind over matter is an important one in the hospital – and although I am certain of this, I am equally certain that it is nearly impossible to prove. But patients’ and families’ mental state of health has a direct impact on their physical health, and even – I would venture to say – on their outcome. The mind plays a critical role in illness, far beyond what we can elucidate or fully understand as scientists. This is something that needs to be explored in greater depth, and as we gain a better understanding of it, we should integrate it into medical care. This is the “art” of medicine – and we should be embracing it, especially for patients whom we have little else to offer.
And so, on Friday the 13th, a plenitude of anecdotal and intangible evidence win out in the end, even in the hospital. I have learned from experience never to utter the words “quiet night” except in my mind. But if I think it to myself, maybe even then it is a silent jinx…