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

David A. Waller, I. David Todres, Ned H. Cassem, Ande Anderten

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1121-1125
Number of pages5
JournalAmerican Journal of Diseases of Children
Issue number11
StatePublished - Nov 1979

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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