The Power of Our Words.

With COVID-19 overburdening our hospital system, we, as neurologists, were asked to take care of COVID-19 patients and others in the neurointensive care unit. One of these patients was a transfer from the oncology ward who had developed adenovirus viremia as a complication of a recent stem cell transplant. His viral counts were in the millions, and he was tragically becoming sicker and frailer each day. His respiratory status was precarious, and he was at high risk for decompensation and possible intubation. I could sense his wife’s pain while she watched her once vibrant husband continue to fade before her eyes. This stem cell transplant was supposed to be his cure, his return to a high-functioning life, and their hope for the future. Despite all the precautions taken, he became infected in his immunocompromised state. During one of my conversations with his wife, I asked her to confirm his code status, explaining that his overall prognosis was unfortunately poor. This triggered an unintended response and she said, “I’m going to call you Cassandra!” She saw the confused look in my eyes and replied, “Cassandra was the prophetess of doom. You only have negative things to say.” That night, I finally gained the courage to look up who Cassandra was. To my surprise, she was the Trojan prophetess of truth, not doom. She was pursued by the Greek god Apollo and when she refused his advances, he cursed her with the ability to utter true prophecies but never to be believed. She had warned the Trojans about the Greeks hiding inside the Trojan horse, but as in so many other instances, she was disregarded. This allegory depicts the inherent difficulty of prognostication. Doctors are often asked to prognosticate on an array of serious morbid conditions, from post–cardiac arrests and COVID-19 pneumonia to stroke and cancer. To patients and their families, we probably do seem like prophets with invisible knowledge, conveying people’s fate ordained by the preternatural gods and goddesses. Quite often we must play the role of Cassandra, uttering prophecies that are too painful to be believed. And with modern medicine (and its technological capabilities) becoming ever more complex with the ability to treat conditions and even extend life, it can be challenging for patients and families to fully understand the intricacies of everything taking place. A few months later, I heard that his condition had deteriorated, and he was intubated and started on dialysis. No effort was spared to save him. His wife agreed that he would not want to go on living connected to machines, and the focus was placed on comfort at that time. In the Greek myth, no one ever believed Cassandra and, consequently, no one was able to benefit from the wisdom of her prophecies. At least in this patient’s case, his wife accepted at her own pace what was to come and she was able to spare him some degree of unnecessary suffering. Perhaps in the modern-day version, it just takes time for the prophecy to make its way to the brain, past all the hurt and anger being felt by the heart. Medical practitioners of all specialties may lack Cassandra’s divinely inspired prophetic powers, but our training, research, and deep consideration for our patients’ well-being inform our prognostication. We hope that in this way, we are able to serve as guideposts along their ultimate paths. No matter how difficult the trajectory, providing that kind of guidance and support is a blessing—not an Apollon curse.