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November 1979

Coping With Poor Prognosis in the Pediatric Intensive Care Unit: The Cassandra Prophecy

Author Affiliations

From the Joseph S. Barr Pediatric Intensive Care Unit, Children's Service (Dr Todres), and the Departments of Psychiatry (Drs Waller and Cassem) and Social Service (Ms Anderten), Massachusetts General Hospital, Boston; and the Departments of Pediatrics (Dr Todres) and Psychiatry (Drs Waller and Cassem), Harvard Medical School, Boston.

Am J Dis Child. 1979;133(11):1121-1125. doi:10.1001/archpedi.1979.02130110029002

• The intensive-care pediatrician who prophesies to parents that their child's illness is irreversible may encounter denial and hostility. The physician may compare his plight to that of Cassandra—the mythical Greek prophetess of doom, who was cursed to see into the future and not be believed. Four cases are reported in which parents rejected their child's hopeless prognosis, counterprophesied miraculous cures, resolved to obtain exorcism, criticized the care, or accused nurses of neglect. This produced a painful breakdown in the usually harmonious relationships between doctors, nurses, and parents. Parental denial as a coping mechanism is discussed. Guidelines are presented for the prevention and/or early recognition and management of the Cassandra Prophecy phenomenon. A miraculous recovery in one case is a potent reminder to physicians and nurses that they do not have the gift of divine prophecy and cannot see with certainty into the future.

(Am J Dis Child 133:1121-1125, 1979)