Worthy of a Miracle


As Angela Lakeberg defied the odds in a Philadelphia hospital last week after surgeons separated her from her Siamese twin, another Lakeberg story caught the media's eye. Her father wasn't exactly measuring up to the role of the humble parent who is worthy of a miracle.

Kenneth Lakeberg, it turns out, has a history of abusing drugs and a worrisome tendency to resort to violence. When he returned home for the funeral of his daughter Amy, who had shared a heart and liver with Angela, he and a relative argued about whether the casket should be open or closed at the funeral. The disagreement escalated into a fistfight, bringing police to the funeral home.

He admitted that he misused $1,300 in donations to the family for a three-day cocaine binge before the twins' dramatic surgery and acknowledged that he has violated probation imposed after he wounded a relative in a knife fight last year.

In a further burst of frankness, he mused openly about the possibility of turning his daughters' story into a movie deal and suggested he could play himself.

In a society enamored with heroic medicine yet perplexed and impatient with the dilemmas it raises, the travails of 26-year-old Kenneth Lakeberg may well be as revealing as the rarefied surgery that brought him into the limelight.

Americans like miracles -- who wouldn't? And the story of the Lakeberg twins seemed to provide one. Even though one twin died, their joint liver and malformed heart have so far been sufficient to keep her sister alive. The fact that Angela survived the surgery was a medical triumph, especially in the face of the 1 percent chance doctors had originally given the family.

But miracles are not always unmixed blessings, and Ken Lakeberg's troubles are proof. Friends and relatives suggest that the publicity and media attention was too much for the young father, whose adult years, at least, have not been characterized by stability.

The operation has produced an ethical debate of the kind this country will hear more often as it comes to terms with limited resources.

Critics point to the operation as an example of heroic medicine our society cannot afford. On the "MacNeil-Lehrer NewsHour," former Gov. Richard Lamm of Colorado put the case this way:

"We simply are not wealthy enough as a society to pay a million dollars for a one in a hundred chance," he said. "We may do it in this one, but we have all kinds of one in a hundred chances facing us every day in America. . . . We have to ask ourselves, how do we spend our money to buy the most health? Why is it that] in no statistic America is as healthy as they are in Europe or in England or in Canada or in Japan? Well, there's lots of reasons, but one of them is we do things like this, and don't give women prenatal care . . . ."

Mr. Lamm's complaints reflect a larger problem, the fact that this country has so far been unwilling to take a systematic look at the allocation of limited resources.

In the discussion with Mr. Lamm, Dr. Arthur Korhman, chairman of the committee on bioethics of the American Academy of Pediatrics, pointed out, "We do not have a rationalized society that allows us to capture in one place that which we save in another."

That is as true in other areas, from defense budgets to school spending, as it is in health care. But judgments about fairness and futility take on a sharper edge in the life-and-death questions physicians encounter every day.

In the absence of a rational allocation of health care resources -- a system in which heroics would not overshadow more mundane but more essential basic care -- most Americans are probably more reluctant than Mr. Lamm to deny the Lakebergs their chance for a miracle.

But, truth be told, they'd feel a lot better about it if the casting for this particular drama had been a little better.

In his eagerness to suggest he could star in his own movie, Ken Lakeberg seems to have overlooked the fact that there's a limit to the number of warts the public wants to see in its miracle fathers. But then, maybe Ken Lakeberg has as much to teach us as does his daughter Angela. After all, who of us really deserves a miracle?

Maybe there will come a time when we all have a more reasonable chance of getting what we deserve -- beginning with access to basic care.

In that context -- in a more rational system -- maybe miracles would not seem as random as a lottery. Until then, who's to say a 1 percent chance isn't enough, or that Ken Lakeberg doesn't deserve his 15 minutes of fame?

Sara Engram is editorial page director of The Evening Sun.

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