Saturday, August 28, 2010

Family Medicine: Hope

Hope is sometimes elusive for us.  Many patients over the years have taught me about hope which for me requires continuous learning.  I find hope through prayer, worship, the Bible, music, art, love, etc. If I sense or hear that a patient is becoming hopeless about their condition, suffering, life, etc., I respond to their feelings saying words like, "At times it may feel hopeless", etc.

I have many times suggested that the patient buy a lottery ticket "to remember what hope feels like", if they already sometimes buy lottery tickets.  This usually refreshes their "hope file" (separate from issues of depression that are treated when indicated with appropriate therapy and/ or medication).  One patient won over ten thousand dollars when they bought the ticket, which they proudly announced to my office staff at the next visit, promptly leaving without paying the co-pay.  They might have perceived that I had hope, so I didn't need money.

Hope at the end of life is another important opportunity to help people find meaning.  Many are worried that they won't die well and share concerns about making mistakes or looking foolish to others.  People with cancer are usually more willing to discuss death than persons with severe heart or lung disease.  Often the person with a terminal illness will be more accepting of their situation than relatives.  The relatives have to go on living and the dying person expects peace.  Sometimes one or more relatives is not accepting of the eventual death of the patient and the patient becomes a comforter for the grieving.

I admitted one of my patients with severe lung disease who had a pulmonary specialist and was going to need intubation and ventilation if she was to survive this episode of hypoxemia (low oxygen levels).  She was discussing her options with that doctor and decided to forgo the ICU and asked for a priest for last rites.  She signed the Do Not Resuscitate form and spoke with one of her adult children who tried to talk her into a transfer to the ICU for the intubaton, but she refused.  She met with the priest, asked for one mg of morphine, and died peacefully.  She called the shots and seemed very hopeful to those around her when she was peacefully opting to "go to be with her husband" (who died a few months earlier), as she described her decision.  There are a lot of variations on end of life hope that I will mention from time to time in this blog.

We all seek hope, as we understand it, and don't deserve "false hope".  As a family physician, I try to hold up a "hope mirror" to keep clarifying the patient's sense of hope or hopelessness and to allow them to align with their own brand of hope.  I'm reflecting on a JAMA piece this week that related about false hope sometimes being all you can give.  I would rather seek further clarification about the patient's deeper spiritual values than to withhold the truth from a dying person.  I think there's always a way to connect to a shared truth among caring persons.


  1. I wrote a post similar to this one. It's difficult for patients to balance their own hope and fear, as well as the hopes and fears of the people around them.

  2. Speaking of 'false' hope, there's a fascinating series on NPR called the Human Edge. Aug 30th episode was 'Is believing in God evolutionarily advantageous?' looking more at how religion serves as Enforcer of good behavior and avoidance of cheating...the hope of eternal life or the 'unhope' of eternal damnation and suffering as influencing human behavior over the eons of time and across every society.

  3. Thanks, Wisedoc,
    The Creator did us a favor by designing in all sorts of scientific surprises. Belief in Him is one of our secret weapons and much better than a lottery ticket.