This weekend I started reading a book that was recommended to me by a wonderful friend titled “Being Mortal.” I am in no way promoting this book but I keep thinking about a couple things I read from the book this weekend. Modern medicine has saved countless lives over the years. Because of modern medicine, diseases have been eradicated and people live longer now than any other time in history. Modern medicine has produced wonders and miracles. With all of these wonders and miracles modern medicine has brought challenges that many individuals and societies would love to avoid talking about….dying and that it will happen to all of us.
In medicine most clinicians consider themselves fixers and we feel like failures if we cannot fix our patients and cure their ailments. Several years ago I took care of a patient whose abdominal aorta aneurysm ruptured. An abdominal aorta aneurysm is an enlargement of the main vessel that delivers blood to the body and is located in the abdominal cavity. It’s a tube like vessel that looks like a small hose in the abdomen stretching to the heart. When this vessel ruptures it is considered a medical emergency and the patient has an 80 % chance of dying. To this day I still think of this patient and wish that I could have “fixed” him even though I knew then and know now that there was nothing more medically I could have done.
Because most of us in medicine are “fixers” there are a lot clinicians who struggle when a disease or ailment cannot be fixed and turns into something chronic or even worse terminal. This struggle between the psyche to fix the ailment often turns into medical decisions being made that don’t help the patient and can cause more harm then good.
When my dad was diagnosed with leukemia he was told he could receive blood transfusions to help extend his life and keep him more comfortable. In simple terms, leukemia kills blood cells causing severe anemia. The blood transfusions offered to my dad were to replace the cells that were being killed off from the cancer. At first my dad was having blood transfusions every couple of weeks. With each transfusion he would complete, when first diagnosed, he would feel energized but as the disease progressed the blood transfusions stopped working. There were to many cancers cells in his blood. My dad would drag himself to the transfusion room at the hospital, sit for hours to complete the transfusion, and then go home not feeling re-energized as he did in the past and very discouraged. I tried to talk to my dad about the transfusions and that they were no longer working but the hematologist (cancer doctor) was still encouraging my dad to continue with the blood transfusions. I did not want my dad to die but the long days at the transfusion center were killing my dad faster than the leukemia. I remember standing outside after a cold New York blizzard talking to his hematologist. I could see my breath in the air as I spoke because of the frigid temperatures. I informed the hematologist that I thought it was time for my father to stop the transfusions. Surprised, the hematologist proceeded to tell me that he was not going to be the one to tell my father to stop because he didn’t want to take away any of his hope. “Hope!!” The false hope the hematologist was giving my father was actually torturing my father. As his disease progressed and the leukemia took over his body each blood transfusion depleted his hope.
Sometimes in medicine the treatment recommended to the patient is not for the benefit of the patient. The treatment is for the benefit of the clinician. As a result the patient suffers more, is given false hope, and the treatment does not improve the life of the patient. Sometimes these treatments can actually shorten the patient’s life.
I am in no way diminishing the power of hope. Hope can bring peace, enlightenment, and a sense of feeling empowered. A wise man once said that “Hope can replace sorrow.” This is very true. I have been in many circumstances where I felt discouraged and then felt a glimmer of hope. This sense of "hope" helped heal my soul and provided the pathway to make changes in my life.
“If hope can be reframed as a dynamic process, then a patient has the potential to see hope and possibility even in the face of dying. Recent studies have demonstrated that the biology of belief and maintenance of hope have positive results for the patient by improving physical, emotional, and spiritual symptom management. Hope may also have positive effects for the clinician (AAHPM, 2015).” The goal for anyone who is encouraging someone to be hopeful is to provide what is called authentic hope.
As a parent, clinician, friend, and wife my desire and goal is to always encourage authentic hope. When we give our patients, friends, and loved ones authentic hope we give them a gift. A gift that can help them to muster up courage and to enjoy life to its fullest. Authentic hope can be used in all circumstances and situations in our lives. When we feast on authentic hope we can become a society that embraces our challenges with courage. Authentic hope helps all of us to conquer our fears and enjoy every moment to the fullest.