I know my blogging has been sporadic lately. I've been more than busy at work; I've been . . . immersed. Occupied. Mentally engaged. And I've been thinking a lot about hope.
The best and worst parts of medicine tend to be the same. I am up close and personal with people and their families when they are ill. Much of the time, I deal with chronic illnesses, with managing things that will play out over one, five, twenty years. In the hospital, I admit young patients whose illness is a brief detour in their normal life, or older patients who seem to spend more time in the hospital than outside of it. It gets routine; until it doesn't.
Last week was, for my patient and his wife, the absolute worst week of their entire lives. A healthy and vigorous man in the prime of (retired) life, and some minor symptoms, minor blood work abnormalities, and then every day the news was worse. Ultrasound, CT scan, MRI, biopsy, PET scan, and three emergency procedures scattered throughout, and a healthy man learned that he has months to live. The medical folks out there know that none of this is particularly unusual, per se. What was unusual was how they approached it. What was unusual was the hope.
Hope must be the only word for it, I realized days later when I couldn't stop thinking about this patient. From that first moment when I told him that we needed to run more tests because it might be cancer to that last day when we told him that the cancer was uncurable, he looked me straight in the eye and thanked me. He was kind to the doctors, the nurses, and the cleaning staff. He was gracious in the midst of excruciating pain. When he went home to get his affairs in order, he cried, hugged me, and thanked me for being upfront with him. And all throughout, he asked all the hard questions, weighed all the options, and held hands with his wife. None of the options were good ones, and yet he radiates hope.
Hope is not what we have when times are good and the going is easy; hope is what we have in the face of unsurmountable odds, when life is hard, and when none of the options seem ideal. Hope is based firmly in reality, in knowing just how bad things may be and yet still believing that there is a best.
On Inauguration Day in these challenging days, I keep thinking about my patient and his sustaining, irrepressible hope. In the midst of my rounds today, I walked past many TVs and heard snippets of the calm and steady voice of our new president as he addressed the nation. I rounded on an elderly woman who doesn't know where she is, or why, but when we asked her what today was she cheered "Yay Obama." Because Hope can permeate any hardship. My patients - and that one patient in particular - are teaching me that Hope has so many more faces than I ever thought possible.
-President Obama's Inaugural Address