“The tragedy of life is not death but what we let die inside of us while we live.” Norman Cousins.
As a middle aged doctor, some say I am a bit young to have learned this the hard way….I have experienced the devastating loss of some of my closest friends, family members, colleagues, and beloved patients. I have endured the loss of my own child. I have felt the crushing blow of physicians who have made me feel hopeless with their words or actions. I have faced physicians–who with their blank stares, cold shoulders, and disconnected jargon–made me believe that nothing could ever get better. I have met doctors who were so enshackled by statistics, codes, dosages, and computers that they never noticed the tears rolling down my cheeks. Why did so many medical providers fail to inspire hope in me or my loved ones? I have mourned and ached more than I should have. I have come to realize how much better my experience could have been had I been given hope. And so I have discovered how to embrace and share the uplifting momentum of hope in every role of my life—as a physician, family member, and friend. As physicians, many of us are so engrossed in becoming brilliant diagnosticians or masterful surgeons that we forget–all too often–to take a breath and think about what hope really means to all of us.
With every patient encounter—regardless of a patient’s prognosis– I have discovered that there is nothing more important to the patient-doctor relationship than hope.
Giving patients hope is offering them the possibility of something better than their current situation. That does not have to be the possibility of a longer life or a cure. It may be the possibility of a greater quality of life….a life without pain….being part of a clinical trial that may provide a cure….having a meeting with the world’s top experts to discover more treatment options….or the possibility that a patient could be surrounded by everyone she has ever loved in the next week.
Sometimes we forget about the purest essence of “hope” and we mistakenly confuse it with religion, a favorable prognosis, or expectation.
Hope does not have to come from established “religion.” When you inspire patients with the possibility of something better, it transcends any particular religion. To inspire hope, you must have a fervent belief that something better is possible. While the essence of religion can and should inspire hope, there does not have to be faith in a specific deity or prophet to be able to embrace or impart hope.
Hope has nothing to do with prognosis. You can inspire hope in patients at the end of their lives. Palliative care is an often underutilized approach to caring for patients at the end of their lives that can–contrary to common belief–engender hope. Thoughtful and compassionate palliative care opens up the possibility for more comfort, quality, tranquility, and peace.
Hope is not the same thing as “expectation.” Patients can “expect” to live three months, but still hope to live longer. Expectations are based directly on a known history of cause and effect. You can guide patients to “expect” to be in pain, to be drowsy, or to be unable to go to the bathroom without assistance. However, they can still hope for something better. They can still believe that there may be a new effective treatment for their condition, or that their pain tomorrow may not be as bad as their pain today. Disillusionment occurs when we allow unmet expectations to extinguish hope.
“Infusions of hope” should be standard of care medicine for all patients. When you interrupt hope’s steady flow, your relationship with your patients becomes strained. When you disconnect the line of hope completely, you will instantly sever your special bond with your patients. Why would any of us want a healthcare provider who chooses not to believe in the possibility of something better–for you, your friends, your family, or the world?
Of course, the possibilities that we offer patients as physicians must be based on sound judgment and experience. They must stem from our will to understand our patients’ needs and to work feverishly and fight relentlessly for our patients. We must never fabricate hope. No good can come from caregivers who invent possibilities that are based on false premises or empty promises.
When death is inevitable, can any of us ever find hope in death?
Death may bring peace or the possibility of a better life for our loved ones who will no longer have to witness our battles with sickness, our uncertainty, or our pain. We may find hope that what we have left the world may inspire a new generation. We may find hope that our children, friends, or students will do great things for the world….We may find hope that there may be a meaningful afterlife….We may find hope in the serenity that comes from ending our own intractable pain. We may find hope that through our death, we may save precious lives by sharing our organs. We may find hope in the possibility of becoming a pure, limitless self that transcends our physical boundaries. We may find hope in the possibility of reuniting with our loved ones who have died before us.
No religion can tell us exactly what will happen to us after we die. No scientific studies have confirmed what death will offer us. While no one knows what to expect after we die……there must be room for hope.
Even as we enter the gates of death, we may still hold on to hope.
“At the moment of death…I hope to be surprised.” Ivan Illich
We have failed miserably as healthcare providers if we allow our patients—irrespective of their religion, prognosis, or expectations–to feel “hopeless.” Although our current scientific knowledge and skills are finite, hope offers infinite possibilities and solutions. We must search for it, find it, embrace it, and allow it to invigorate our sacred bond with patients.
Anonymous. Submitted to DoctorCPR.com–America’s #1 Site for Medical Jobs and Practice Resources