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February 22, 1971

The Worth of a Miracle

JAMA. 1971;215(8):1320. doi:10.1001/jama.1971.03180210064017

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Many major open-heart operations are costly in terms of money, effort, and manpower. Would it not be wiser to divert this vast expenditure to wider uses? This question rarely bothers the people who are directly involved with the patient, but it causes much concern to those who evaluate priority. How can the equation of needs, logistics, and cost to society be sensibly resolved?

One cost which is rarely thought of, but surely must enter this equation, is the cost to the patient in anxiety, fright, and pain. Its dimension is made manifest in a recent narrative by Rachel MacKenzie ("Risk," New Yorker, Nov 21, 1970, pp 56-101). In this unique semidocumentary, the author records her experiences before, during, and after left ventricular aneurysmectomy and coronary bypass surgery. Using the third person mode of narration to dampen the intensity of her own response, she recreates her painful odyssey. It begins with