As a critical care physician I am often asked to intervene in a patient’s clinical course when things go awry. Usually these patients have been dealing with chronic illness for a number of years and have an acute deterioration which lands them in the hospital. They may deteriorate further and go into severe breathing difficulty, a very low blood pressure, worsening lethargy leading to unconsciousness or severe metabolic derangements to name a few.
When this happens they end up in the intensive care unit and may end up of one or several forms of life support. When they first deteriorate the situation usually looks dire and I always get asked the same question, ‘Is there hope?’ This is never an easy question to answer.
Earlier in my career I used to answer this question objectively based on what I know about the patient’s history, physiology and current condition. In most cases, I usually did not have good news for the family. I would give them the same line which is that their loved one is critically ill and the prognosis is guarded but we’re doing everything we can. Over the years I have now realized that this is not all that families want to hear.
This lesson was burned into my mind many years ago when I looked after a patient, in the hospital, with metastatic lung cancer. He had been my patient for more than one year and had been avoiding addressing the mass that was growing in his lung until he agreed to a lung biopsy. When the diagnosis was made I determined that it has spread beyond the lung. I told him his prognosis was poor and he went steeply downhill. He did not tolerate chemotherapy, continued to have worsening shortness of breath and pain and eventually ended up in the hospital. He deteriorated further to the point where the only thing we could do was to keep him comfortable and he eventually died during that hospitalization.
I remember his daughter’s last words to me after he died, ‘You took his hope away.’ Those words haunt me till this day and have changed how I approach the question of hope. What I have learned from this patient and others is that words are one of the most powerful forces we have at our disposal. They can create or destroy, uplift or devastate, heal or deteriorate.
What I have also learned is that hope is personal and its definition varies from person to person. It is not my role to define what hope is for anybody but to help them find hope in the most seemingly hopeless situation. When it comes to illness, most physicians use hope in the context of finding a cure. However, I have found that, for the patient, hope has a broader definition which encompasses relief of pain and other symptoms, the ability to remain active despite the illness, being able to spend more time with family, partaking in the hobbies and interests that they enjoy despite their disease process and, for some, continuing to fulfill their greater life’s mission.
What I now realize that there is hope in any situation no matter how dire or desperate it may seem. So no matter what you may be facing, whether it’s the loss of a job, financial debt, the end of a relationship or a chronic disease, there is always hope. It can be found by finding the good in the challenging situation.
The fact is that we are never sent a challenge or any adversity that is not meant to teach us something or to show us something about ourselves which we have yet to learn. I know this from personal experience. So realize that whatever difficulty you may be facing that appears hopeless on the outside is simply the outer appearance of a deeper situation which holds the great treasure of deep personal growth and discovery which is the greatest adventure you can experience.
This is how you affirm hope in any situation no matter how dire it may seem. All it takes is to see the situation from a greater perspective and to allow yourself to experience it and the feelings that surface from it without resistance. This is the true meaning of hope and how it can be a powerful force to transform your life situation and your experience of life.
Never give up hope no matter what you may be facing. You may end up discovering what was previously unimaginable about yourself, the world and life in general.
Nauman Naeem MD