Hope
By Jeff Kane MD
November 2002
My friend George bubbled with incongruent enthusiasm while relating what struck me as alarming news. "My oncologist offered me chemotherapy but said it only has a twenty percent chance of working."
"Twenty percent?" I answered. "That'd be a hard decision for me. What did you tell him?"
"Oh, it was easy," he grinned. "I told him I'll sure feel sorry for those other four dudes who ain't gonna make it."
Now, this was hope. Or was it?
During his next visit, his doctor informed George he was in denial. "Let's be realistic," he said. "This disease of yours is progressive. It'll become more and more disabling. No one survives it."
One of the things I've learned in twenty-six years of counselling folks with cancer is that the phrase, "Let's be realistic," means, "See things my way." In the mind of George's doctor, hope resided solely in the prospect of cure: no cure, no hope.
Most other patients would have deflated under such dismal coaching, but George happens to be a freelance writer, which means he’s nothing if not resilient.
"So my doctor's short on hope," he told me. "Big deal. Many of them are. I'll shop around for hope elsewhere."
George started at a logical beginning, examining exactly what constituted hope for him. "I made a list," he told me. "I wrote the phrase, 'I hope...' and completed it again and again. 'I hope I finish all my current projects. I hope I don't become a vegetable. I hope my family's around me when I eventually go. I hope I get adequate treatment for pain.' I finally had to stop after twenty times because I realized I could've gone on indefinitely."
For George—and really, for all of us—hope is a broader subject than we believe it is. Too many of us on either end of the stethoscope limit ourselves by equating hope with cure. The prospect of cure is only one hope; if that's your only one, you may as well throw in the towel, for ultimately we'll all succumb to something. This isn't to say people don't enjoy occasional cancer cures, just that a healthy hope portfolio accepts all possibilities. In my experience, people settle happily for surprisingly small quanta of hope--regular visits from friends, a favorite meal, a phone call.
Like humor, love, and support, hope is as therapeutic as antibodies. When I'll really worry about you is if your hope evaporates. We've known for a half-century that all else equal, sick people plummet when hopeless. Still, I've heard any number of my colleagues wax pessimistically, "I don't want to offer false hope," and wind up offering a false hopelessness, an anti-medicine destructive to both the patient's immune system and the doctor's morale.
If you want to offer meaningful hope to anyone, first learn your own hopes. Try George's exercise: write, "I hope..." and then complete it twenty times. Sick or not, we all harbor hopes, and to the extent they remain formless within us they will likely go unfulfilled.
Second, know that hopes are exquisitely unique to individuals. Ask sick people what hope means to them, and then listen carefully. As they articulate and finally comprehend their hopes, they'll perforce steer toward them.
George finished his chemo months ago and still feels well. His doctor, having linked George's response to his unflagging optimism, is gradually learning that he has a powerful medicine in his little black bag that begs to be used more often.
"You know what he told me on my last visit?" George recently asked me. "He said, 'Let's be realistic. You've beaten the odds, and there's no reason you shouldn't continue to do so."
Jeff Kane MD is Director of Psychosocial Education at Sierra Nevada Cancer Center in Grass Valley. His latest book, The Healing Companion (HarperSanFrancisco, 2001), is about to be reissued in paperback as How to Heal: A Guide for Caregivers (Helios, 2003).
