After decades working as a medical oncologist and serving in church leadership, I have come to conclude the following: eliminating suffering lies beyond God’s effective power, because God operates within a universe that also has multiple other eternal entities, among them: eternal law, eternal matter, and eternal individuals (us) who have actual, meaningful, consequential, and eternal agency. Therefore, our Heavenly Parents are left, instead, to answer suffering with love and to invite us to learn to do the same.
But to illustrate how I have arrived at this conclusion, let me begin with two stories.
In 2020, the patient I will call Ms. Garcia underwent surgery to remove stomach cancer, but the surgery caused a horrendous series of side effects that eventually led to a prolonged admission to the ICU and the temporary failure of her kidneys. When she finally went home, Ms. Garcia was a shadow of her former self—weakened, emaciated, and far too debilitated to consider the chemotherapy we normally might have recommended. Instead, she worked to recover her strength while we ordered a new CT scan every six months to monitor for any evidence that the cancer had returned.
Eighteen months after the initial diagnosis, Ms. Garcia’s cancer returned. We treated her with traditional treatments: chemotherapy regimens and radiation, but nothing provided more than slight and temporary relief. Just as we were coming to the end of the therapies available to us, however, we became aware that the FDA was likely to soon approve a new and different medicine for this type of cancer. Rather than attempting to poison the cancer cells as traditional treatments do, immunotherapy would work by supercharging her immune system, harnessing her own white blood cells to attack the malignant ones. We obtained a charitable exemption to give her the drug even though it was not yet widely available and then waited with bated breath to see what would happen.
After three months on the drug, Ms. Garcia again entered the whirring tube of a CT scanner. The resulting images showed that her tumors had shrunk substantially. Three months later a second scan showed even further retreat. And three months after that, to our shared astonishment, a new scan showed no signs of cancer at all. What’s more, immunotherapy drugs often do not bring with them the side effects commonly associated with traditional chemotherapy. With this new medicine, Ms. Garcia was never nauseated, did not feel weak, and worked full time. Over the next years, scan after scan continued to show no evidence of disease. Finally, after more than three years on treatment, she decided to stop the drug entirely. That stoppage date now sits almost two years in the past, and Ms. Garcia’s scans still show no evidence of disease.
With that patient’s experience firmly in mind, let’s rewind the clock another five years. It is a Wednesday night in 2015, and I am the oncology fellow on call. Around 7:00 p.m., a twenty-year-old woman with acute leukemia has come to the emergency room with a fever. Both her disease and our treatment had weakened her immune system, so we took her fever very seriously. We immediately admitted her, administered fluids, and gave powerful antibiotics.
As the hours of the evening drew on, it quickly became evident that hers was not a standard case. Her blood pressure began dropping precipitously and her body hovered dangerously close to shock. Unusually, she had bleeding at her IV sites and in her gums, and she soon seemed to be bleeding everywhere. We checked all the normal laboratory tests and fixed what deficits we could find. Even after doing so she did not improve. Moreover, things simply didn’t add up; she seemed sicker than her tests indicated she should be.
I spent the evening in increasing desperation as I hovered back and forth between her room and the nurses’ station, assessing her status endlessly while I desperately called everyone I could think of for help. Finally, around 2:00 a.m., after a night spent with her condition steadily worsening and without a satisfactory explanation of exactly why, the patient’s heart seized, she went into cardiac arrest, and—despite the heroic efforts of multiple nurses, doctors, and pharmacists—she was pronounced dead about an hour later.
I juxtapose these two stories because, for me, as a doctor with faith, the comparison highlights the unbearable tension of believing in a God who cares about us and who can intervene in our lives. I recognize that many people, especially my fellow oncologists, might blanch at labeling Ms. Garcia’s story a “miracle.” The term “miracle” means magic, after all. To qualify as “miraculous,” doesn’t the process that brings about the happy outcome have to be inexplicable, even mystical? But the drug that helped Ms. Garcia was based on decades of scientific inquiry. Its mechanism of action can be described in biological, biochemical, and immunological detail, and its efficacy and safety have been demonstrated in rigorous clinical trials. What could possibly be less a “miracle” than that?
Nevertheless, such facile dismissiveness may miss the forest for the trees. If that same patient had been diagnosed with that same illness in that same setting just a couple of years before, it is almost certain she would no longer be alive. Her life has been extended by the infusion of a clear liquid she understands little if at all. On some fundamental level, does that really differ all that much from Jesus rubbing spittle into clay and using it to restore the blind man’s sight? After all, if a “miracle” is not really defined by our inability to explain or understand what is happening but, instead, simply by the remarkable nature of the good that has been rendered then, in fact, on some level, Ms. Garcia’s recovery really was miraculous.
But for the believing doctor, the willingness to call this a “miracle” is not the end, but the beginning, of difficult questions. Chief among these, of course, is simply this: why do the miracles we desperately long for come in such resplendence in some cases, but never appear—despite the most desperate pleading—in others? In the shadow of every miracle I choose to believe in is the specter of all the other situations where needed miracles never came.
The second story I recounted above is just one of hundreds I have seen over the course of my career. This story stands out in my mind because the patient’s decline was so precipitous and because, despite my best efforts, I felt so helpless to stop what was happening. But whether the decline comes quickly or slowly, whether a patient’s course into disability or toward death is dramatic or subtle, and regardless of the details that define each specific tragic story, the common dark thread that binds them all together is this: in almost all cases, patients and their families wish desperately for some force to intervene. Those who are religious may appeal to God, while those who are not simply call out to the universe. The difficulty here transcends creed and religious affiliation. The rub comes in recognizing the apparently unjust architecture of a universe that grants long life and years of apparent happiness to Ms. Garcia while keeping those same blessings from so many others.
The reality of these twin poles leaves our hearts heavy and aching. For those of us who are religious, the seemingly insoluble paradox demands answers to the universe’s most vexing questions.
In some ways, the most straightforward answer would be to abandon any attempt to believe in God. If God is all-knowing, all-powerful, and all-loving, then what room can we find for the apparent capriciousness of granting a miracle over here while withholding one over there?
On the other extreme, we as believers may skirt too quickly over and past the genuine difficulty involved in addressing these questions. We often do unintended harm when we try to offer God a way out of the difficult realities evident in our lives by attempting to “explain” the suffering around us. Stricken with sight as narrow and short as ours always is, it would seem an act of herculean hubris to pretend to be able to ferret out God’s designs when, for example, a young parent has died, or a good person has been betrayed, or a natural disaster has left a community bereft. In these instances and myriad others like them, I hope we will not rush in to try to explicate why sorrow ought not to cut as deep as it does. I believe that the territory of suffering constitutes humanity’s most sacred ground, and it is a place we should enter only after removing from our feet the shoes of arrogance and presumption.
Still, in the face of suffering, I find great comfort in an unusual and perhaps even uncomfortable aspect of restored Christian theology: God is limited. I recognize and love a God who cannot do certain things. God cannot engage in cruelty. God cannot create matter from nothing. God cannot contravene human agency. And, as best I gather, God cannot prevent or immediately ameliorate all human suffering. This last sentence makes me uncomfortable; part of my brain accuses my heart of blasphemy in that sentence’s composition. Yet, I am convinced that however weak my faith may be in such a conclusion, I prefer that tentative believing to a certainty proclaiming God is behind every instance of tragedy and suffering.
What I do not understand about all the eternal laws and forces that limit God hopelessly dwarfs the tenuous conclusions I am reaching. But I find comfort in the prospect that prophets seemed to feel their way in the dark toward a similar set of conclusions. Lehi does not suggest to Jacob that God will eradicate suffering but rather that God will “consecrate it.” He explains to his son that “it must needs be, that there is an opposition in all things,” arguing that opposition is inextricably woven into the fabric of the universe. If it were not so, the universe “must needs have been created for a thing of naught; wherefore there would have been no purpose in the end of its creation. Wherefore, this thing must needs destroy the wisdom of God and his eternal purposes, and also the power, and the mercy, and the justice of God” (2 Nephi 2:11–12).
In effect, Lehi suggests that even God must act according to eternal law. Within the shadowy recesses of these words, I intuit a cosmos that features both the reality of miracles and the difficulty of when they do not happen. This is a moral universe where the same agency that allows us to choose nobility and selflessness also empowers imperfect agents to choose war, destruction, and genocide. This is a world that sometimes leaves Jesus visiting the Nephites and weeping with joy and other times leaves God mournfully watching humanity’s inhumanity and watering the earth with ceaseless tears.
In all of this I discover a form of hope and faith that is more somber and less ebullient than I would like. I suppose this is a faith that makes room for the reality of Lazarus while also holding space for the horror of John’s severed head. In a world too often defined by injustice and tragedy, to believe in miracles is also to be left forever to grapple with all the miracles that will never be.
At first, this may all seem an exercise in hopelessness—but I argue that it is not. Instead, while I recognize that this would certainly count as what Elder Maxwell once called a “wintry doctrine,” I also believe that this understanding of the universe ultimately offers us a deeper hope for precisely this reason: because it allows us to face up to the world as it is. In my experience, we often spend a great deal of spiritual and emotional energy trying, in effect, to convince ourselves that things “are not really that bad.” Of course, in some cases this is precisely true—sometimes, a dose of optimism is just what the doctor ordered. But in other moments, things actually are that bad. Sometimes, loved ones die before their time; sometimes, the cruel win; sometimes, the unjust triumph. If we feel obligated to prove that these are not really what they seem, we are left to tilt against the reality of what is before us. But when we understand that other eternal entities and forces limit what even God can do, then we are freed to face the full brunt of what is real and yet to still choose love and hope.
In other words, to recognize the gritty reality of a God who cannot abrogate agency and who lives according to eternal law does not rob us of hope—it is, instead, the only way to access real hope. It does not diminish but instead empowers faith. It does not preclude but instead allows for the full flourishing of love. To recognize the reality of a tragic universe where miracles desperately desired sometimes simply never come is to equip ourselves with the truth necessary to turn toward that fraying cosmos and say, together with God, I see the full force of this suffering, and I will choose to believe in goodness and to choose to love, nonetheless.
Tyler Johnson is a medical oncologist and associate editor at Wayfare.
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Art by Vincent Van Gogh
This is beautiful and deeply resonates with experiences I have had as a medical provider in the emergency department. Thank you for articulating both the complexities and the reassurances of trusting in God while seeing death and pain. I will be re-reading this often.
Love this. If we truly believe in eternal progression, then there will always be something that we are learning but are incapable of at that time. I don't know exactly how that factors into God's power and everything, but there's something freeing and enervating in that. Thank you!