When hope is lost

Sprawled across the lounge room sofa she sighs. A colourful headscarf draws attention away from her skin; pale and morbid. Were she otherwise attired it would dominate a face once considered youthful for her age. She’s feverish, tired and wasted.

My grandma is dying, and everyone in the room knows it.

It won’t happen tonight, but soon. Two months ago we were told that cancer had spread through her body, and that treatment was failing. Chemo has exhausted her immune system and frequent infections mean frequent visits to the hospital. Given the thermometer in my hand reads 39 degrees, tonight will be one of them.

Before the cancer was terminal, these trips to the hospital felt different. Now, futility hangs heavy in the air. Comforting her seems trite; apologising seems insincere.

Instead, we say nothing. Delaying the inevitable in an uncomfortable silence, we know that soon, she’ll have to go to hospital, and not long after, we’ll be doing it all again.

Health professionals have an obligation to maintain a dialogue with patients that is as open and honest as possible. Patients have a right to anticipate their journey with illness, and when our options have been exhausted, it is important to broach the subject of death.

Doctors particularly pride themselves on the pursuit of an unbiased truth. Offering false hope to patients is frowned upon, and with this in mind those pursuing medical practice are taught complex word games that help them remain impartial. It’s an art that any aspiring clinician must learn to master.

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Watching my grandma die, I’ve been far from impartial. Without hope, each treatment, round of antibiotics and night in the ward seem meaningless. For my grandma, and for those around her, hope is the tenet that makes life worth living. Without it, we sit quietly on the lounge room sofa, denying the painful reality to come.

It’s a catch 22 that’s difficult for me to reconcile. A part of me understands the importance of truth and acceptance in the navigation of a cancer diagnosis, and the difficult role doctors play in delivering this news. Another part of me, however naïve, knows that we thrive on a hope to improve: to expand, learn and grow. We wake up knowing the next day brings something the one before did not.

Loved ones of palliative patients live this reality each day. Studies have expanded the role of hope in cancer patients: from increasing their well-being, to reducing distress and psychological pain. It seems natural to let hope guide our interactions with dying friends, family and patients.

In light of all, I give in. On behalf of my family I research novel immunotherapy drugs: these treatments are exorbitant, but offer the slim chance of success in terminal patients. Quietly, we share a belief that nothing will delay her death. But hope is the ticket to distraction that we need.

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Future medical professional or not, each of us can expect to walk this fine line in the future. It’s easy to understand the importance of honesty and truth. Yet when we deny people the right to hope, we exert a unique privilege in the situation: a privilege to say and believe harsh truths with our well-being intact. From a position of impartiality, we have a privilege to accept reality and not suffer its consequences.

Perhaps there’s a happy medium. People often say the hardest part of being a doctor is being the bearer of bad news. To me, a greater challenge would be to deliver reality in a way that wills the patient to continue on.

There comes a time when we can no longer offer a hope to live. But we can offer a hope to find meaning, and a hope that more is to come. A hope that death will come, a hope that it will be peaceful, and a hope that family will be by their side.

For our loved ones, it’s the least we can offer.

The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.