God and Man in the Neurovascular ICU

David Crippen, MD, FCCM

Disclosures

Editorial

I have had recent occasion to preside over the brain death protocol of an otherwise healthy young woman who suffered a massive brain hemorrhage from an arteriovenous malformation right in front of our eyes. This was an exceptionally disturbing scenario that prompted an emergency ventilation session for the staff. In so many words, the question was repeated: "If there is a God, why does He or She allow bad things to happen to good people?" I have grappled with that question frequently, and eventually came up with the following thoughts.

Recently, I ran into a cardiologist friend I hadn't seen in a while. As we passed the time of day, he asked me what I was doing these days and I related my new position as a staff intensivist in the neurovascular intensive care unit (ICU). On hearing this news, he rolled his eyes and gave me a knowing look. "Oh . . . the GORK* ward, eh?" The old joke: "The textbook of neurology is a thousand pages: 999 pages of diagnosis and 1 page of treatment." Unlike some illnesses, neurologic injury has been associated with easily recognizable residual disability. Neurologic disasters strike suddenly and indiscriminately, affecting young and old.[1] This is the popular perception. There is seemingly no justice, if that's the right word.

The reality is that we in the neurovascular ICU have an excellent record in returning patients stricken with neurologic diseases to functionality.[2] But, much like legal negligence cases, high-profile cases define the genre, not the mainstream. And high-profile disasters can be intensely depressing, especially when they occur in otherwise young, vital patients. When young people suffer catastrophic brain injuries, the entire gamut of observers, from family to physicians to nursing and ancillary workers, comes together to ponder potential reasons why. Not infrequently, we finally ask why God allows bad things to happen to good people. As a neurointensivist, I have pondered this question.

As a society, we believe in God, at least when it seems like the thing to do at the time. There are some intellectually convincing logical "proofs" of the existence of God. But as a practical matter, most folks simply prefer to believe in the existence of God because it answers most of our questions about existence. Physicists no longer debate the existence of God because the laws of nature are simply unalterable and can be proven so anytime. The existence of the creator of these laws is moot. Natural religions have never chosen to explain the existence of God in physical terms but in terms of his (or her) actions. On Broadway in the 60s, playwright Bruce J. Friedman once allegorically likened God to a Puerto Rican steam bath attendant who emerged daily to effect spates of good and bad luck for unsuspecting passersby.[3] Whether passersby found a fat wallet on the sidewalk or suffered a safe falling on them depended entirely on the mood of God.

If God is an omniscient, omnipotent being who already knows the future and formulated the rules for its outcome, the only question left is: does God meddle in the affairs of humans, and if so, does he respond to requests? Does man stand still while time flows around him, or does man move around in a static field of time? If God has a plan for the universe, did he simply create the universe with the plan built in, in which case all outcomes are inevitable and inalterable? Or did he create the universe with the possibility of changing the laws of physics by divine intervention? If that's the case, it is technically possible for God to answer prayer. But what criteria would God use to determine whether to answer prayer? Does God consider prayer length, passion of delivery, timing, the number of people involved, alternatives? Does God shoot dice? Act emotionally on whims? Cold logic? That there seems to be no consistency to the results of prayer strongly suggests against it as a conduit to God's ministrations.[4,5,6]

The long and short of it: God probably exists (or existed) because that is the best explanation we have. But it seems highly unlikely that God meddles in the current affairs of man for a lot of compelling reasons. If God alters physics on request, there should be some fairly firm evidence in His wake. If he were inclined to do so, he would then presumably be able to "change" observable and reproducible laws of physics in mid-stride. This has never been reliably observed in nature (except in the National Enquirer). If the laws of physics are inflexible, then the effects of those laws are equally immutable. God cannot Himself alter them even if He wanted to. And that means we're pretty much on our own. And bad things happening to good people essentially follow the laws of random probability.

If God is really an all-good and all-powerful being, why doesn't He do something to promote justice? Why does God allow bad things to happen to good people? Is suffering just a cruel cosmic joke? The probable answer is that God did not create evil; He allows it to occur as part of the original game plan. In order to stop evil, it would be necessary to squelch free choice and the works of man altering nature. What point would there be in creating a world where all events are predestined? When He originally created the world, He created people with the freedom to choose and act, necessarily allowing choices that may generate evil. God cannot and will not control those choices, else we would be robots in a self-fulfilling prophesy.

I suspect also that God tolerates the trials of life to develop our abilities and allow us the chance to work wonders when we can. The wonders of man. God never promised life would be problem-free. We are made to make the best of our world: a world full of liabilities, random, circumstantial suffering, being in the wrong place at the wrong time. In such a world, there is no point in looking for reason. Asking why always generates the same answer -- because it is. It's for us to do what we can to aid and comfort a painful world. Without us, the world is relegated to pure chance. Our role is to make choices that palliate suffering as best we can in a world we cannot understand as best we can use the tools at our disposal. A world created so individuals can make a difference, even when it hurts. The alternative is far worse.

*God only really knows.

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