Medicine Religion Surgery

Resolved for 2008: Let’s not use the word “miracle” when we really mean “unexpected survival”

“It’s a miracle!”

How many times have you heard that one, usually invoked when someone survives serious injuries that would kill most people? Personally, the use of the word grates on me and did even when I was a lot more religious than I am now. Yesterday, it grated on me when I saw this story:

NEW YORK — Alcides Moreno should be dead.

But Moreno, a 37-year-old window washer from Linden, not only survived a 47-story fall from a Manhattan skyscraper, but will likely walk again and make a near 100 percent recovery, doctors said yesterday.

“If we can talk about medical miracles, this certainly qualifies,” said Herbert Pardes, president and chief executive officer of New York-Presbyterian Hospital, during a news conference.

No, it does not. Improbable? Yes? Amazingly improbable? Sure. But a “miracle”? I don’t think so. It’s not even unprecedented. There are records of people surviving falls from airplanes after their parachutes failed to open.

Moreno certainly did have some devastating injuries, as the article describes:

Philip Barie, chief of critical care, Department of Surgery, at New York-Presbyterian/Weill Cornell, was so incredulous about Moreno’s survival that he had to ask emergency room physicians twice about how far Moreno had fallen.

“I asked the resident, ‘How many stories did he fall again?'” the doctor said.

“Above 10 stories, most of the time we never see the patients because they’re brought to the morgue at Bellevue.”

With Moreno drifting in and out of consciousness, two medical issues quickly became priorities for the trauma team — massive bleeding and a buildup of pressure in his abdomen, Barie said

Moreno was bleeding profusely because several of the fractures he suffered were compound, meaning the bones had broken through skin. The most severe injury Moreno suffered was a broken left shinbone and a shattered right ankle, Barie said.

It’s true. Survival is rare for falls greater than 10 stories. In urban environments, falls of three stories or more are associated with high mortality, particularly in adults. However, the height of the fall is not the sole risk factor for mortality. Moreno himself suffered multiple fractures, internal injuries, and massive bleeding. Indeed, the fact that his main fractures were lower extremities fractures suggests that he landed feet first, which is one factor that can increase the chance of surviving a high fall. That Moreno didn’t suffer a major head injury also suggests this possibility. Another factor mentioned in the article is that he may have been holding on to the scaffolding as he fell. If the scaffolding was still attached to the rest of the structure, this could well have slowed his fall or even broken it, a possibility suggested by reports that paramedics found him lying on top of the remains of the collapsed scaffolding while his brother’s body was apparently found lying partially underneath the wreckage. Moreover, in the same report it was stated that Moreno might have followed training that window washers are taught to maximize the possibility of survival if their scaffolding ever gives way:

Window washers are taught that if a scaffold gives way, they should lie down flat on the platform, on their stomach because, Mr. Bustamante said, it gives them the best chance of survival should the scaffold catch on something on the way down. Maybe that is what Alcides Moreno did, he said.

“If you go over, that’s it,” he said. “You’re dead.”

He believed that that was what happened to Edgar Moreno — that he was either thrown from the platform, or jumped from it out of fear. “That’s your first instinct, because you’re scared — to jump,” Mr. Bustamante said.

Also, let’s not forget the skillful intervention of the paramedics and trauma team, as well as the excellent care that they provided. Even so, despite all the more mundane reasons that can be invoked for Moreno’s survival, that doesn’t stop God from getting the lion’s share of the credit:

Moreno attributes her husband’s recovery to his faith as well as his physical fitness.

“My husband is very religious and very healthy,” she said. “He keeps telling me it wasn’t his time.

“He speaks, he watches TV, he asks for his glasses,” Rosario Moreno said. “Thank God for the miracle.”

Does this mean that Edgar Moreno was allowed to die because his faith wasn’t strong enough? Inquiring minds want to know. Sadly, even the doctors are falling into the “miracle” trap:

Meanwhile, doctors who are treating Moreno continue to marvel at his survival.

“After 30 years, I thought I’d seen it all,” Barie said. “I don’t know, you guys pick the adjective — if you believe in miracles, this was spectacular.”

Here are the two reasons that attributing unlikely survival from trauma or disease to a “miracle.” First, if we’re going to give God the credit for the unlikely survival of someone like Moreno, shouldn’t He get the blame for the scaffolding having given way in the first place? Shouldn’t He also get the blame for the death of Edgar Moreno, who was not as fortunate as his brother? It’s a question that can’t be escaped if one is going to attribute Alcide Moreno’s survival to divine intervention: Why didn’t God save both both brothers? The second reason using the term “miracle” in this context annoys me is that it discounts the skill, dedication, and hard work of the rescue workers and paramedics, as well as the team of doctors, nurses, respiratory therapists, physical therapists, and everyone else involved in saving Moreno’s life.

That’s why I’m hoping to get my readers to resolve in 2008 to try very hard not to fall into the trap of attributing to miracles what is merely highly improbable. “Miracle” implies something that can’t happen without divine intervention, and I’ve yet to see such a case. We can rejoice that Alcide Moreno was so amazingly fortunate to survive his fall, but please don’t attribute it to a “miracle.”

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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