The Double-Edged Sword Of Hope

Photo: Albion Europe ApS

I’ve taken care of many patients with cancer throughout my career, but one in particular stands out in my mind, a forty-year-old journalist who came to me with a diagnosis of a grade IV glioblastoma—a malignant brain tumor with an almost uniformly fatal prognosis.  The reason I remember him so vividly isn’t just because he was nearly my age, or because, like me, he had a wife, a three-year-old toddler, and loved to write, but because of something he told me at our second visit.  “Hope,” he said, “is the one thing standing between me and peace.”

His thoughts continually vacillated tens and hundreds of times a day, he told me, between two extremes:  on the one hand, a belief—a hope—that he would somehow be cured, and on the other, a recognition that a cure was, if not impossible, unbelievably unlikely.  Fascinatingly, it was the idea he wouldn’t be cured that he found the most relieving and hoping for a cure that kept him awake at night, awash in anxiety.

We usually consider hope among the most wondrous of gifts; it keeps us going when we want to quit and makes possible victories that seem impossible.  A uniquely human emotion (only humans can envision the future well enough to feel anything about it at all), hope has a long and glorious history of bringing out the best in humankind.

The key to hope’s value, however, is that the thing about which we feel it must actually be possible.  Luckily, we judge far more things impossible than actually are, so in most cases hope serves us wonderfully well.  But in those cases in which the thing for which we hope is not destined to occur, hope does indeed stand between us and peace, blocking as it does in such circumstances our ability to feel the one thing that can bring it:  acceptance.

The problem with continuing to hope for the truly impossible is that it makes us continue to want it.  And wanting something we’re unlikely to get is awful:  tethered to uncertainty, our minds ruminate obsessively, invent far out schemes for getting it, and both rage and tremble at the thought of being denied it.  In such cases, hoping for the future we want does nothing but prevent us from letting go in our hearts of a future we can’t have.

Intellectually, my patient knew he wouldn’t be cured, but his desire to live prevented him from abandoning hope for it; and his inability to abandon hope not only drove him toward things he knew in his heart would prove useless (macrobiotic diets, vitamin supplements, fasting), but more importantly kept his focus on what he knew wouldn’t be his:  a normal lifespan.

He so very much wanted to stop pining for it, he told me months later.  He was a fighter, he said, and wanted to fight—but only a fight he had a real chance to win.

“You don’t know you can’t win,” I protested, my own desire for him to live momentarily clouding my vision, thinking, as I was, about his wife and daughter—especially his daughter—and my own wife and son.

“That’s exactly the problem,” he said.  “Intellectually I know this ends.  But that goddamn bitch hope won’t let me feel it.”

A few weeks after that, because of his tumor’s location in his brain and it’s inexorable growth, he lost the ability to write.  And though this was by far the most devastating blow his cancer had dealt him, it also turned out to be, paradoxically, its greatest gift.

“I’ve stopped hoping,” he told me at our last visit, though by then his speech was so garbled his wife had to translate the sentence for me to understand it.  I began crying, though whether from sadness or relief, I didn’t know.

He died a week later.  But, as his wife told me afterwards, without fear.  And at peace.

Next WeekEnd-Of-Life Discussions

16 comments to The Double-Edged Sword Of Hope

  • John

    Perfect timing…this is what I have been struggling with for the last year, as my partner and I face foreclosure after a series of unfortunate circumstances related to the recession. Five years ago we bought our place, built a business around a dream for a financially sustainable future, and now we are teetering on the edge of losing everything. On the one hand, I “hope” that we can find a solution that keeps us here—the long-term, fiscally responsible outcome, with potential personal satisfaction for both of us—but on the other, I want the freedom to move on, dream another dream, and let go of all the sadness and disappointment. Every day, “hope is the one thing standing between me and peace.”

    However bleak our situation, it is not lost on me that I am fortunate to not be facing imminent death, but I also know that death sometimes comes unannounced, and I don’t want my last day here on earth to be without peace…

    John: So sorry to hear it. It’s just so hard to know when to stop hoping and start accepting.

    Alex

  • John

    Thank you, Alex…your comment pushed me toward clarity by forcing me to answer the question: does acceptance make it inevitable or can we move into acceptance and “hope” for a better outcome, and still find peace? I believe that we choose our “peace” regardless of our circumstances; therefore I am at peace, and will be regardless of the outcome. Whew! I feel much better…

    John: Glad to hear it.

    Alex

  • wendy simmons

    Perfect timing, and just what I needed as I traverse the changes in my life. “The freedom to move on, dream another dream, and let go of all the sadness and disappointment”…well said too. This column is definitely a keeper. Thank you.

  • Mary K

    And this “one thing standing between me and peace” is the same thing that keeps people from moving on from doomed relationships. The hope that maybe the other person will change, suddenly understand, come back…Thanks for a wonderful story that perfectly illustrates the dark side of hope.

    Mary K: So true, what you say.

    Alex

  • thquah

    HOPE is all we must have to continue living but then back of our mind we tend to give up when we are facing cancer or an incurable illness.

    When my daughter was diagnosed with blood cancer/ leukemia, we have to belief and have great hope that she will be cured, we tried all types of treatment recommended by the hematologist unfortunately she did not make it after 2 years of intense treatment. She was just 19 years old but EVERYONE dies eventually.

    Although she was with us for not as long as we had wished, we should not be too sad, because of her smile, voice, laughter, thoughtfulness and compassion that touched many hearts.

    As quoted by President Ikeda:

    Hardships make us strong
    Problem give birth to wisdom
    Sorrows cultivate compassion
    Those who have suffered the most will become the happiest.

    We love you always, Lyn Si dearest!
    * We believed that she will continue with her next mission with a healthy body and mind.

  • Lisa

    Acceptance need not = abandonment of hope, For me, when I stopped “hoping” for a relationship to be what I had hoped, and instead accepted it for what it was, real hope entered the picture. When I accepted what was, I was free to either accept what I had or to move on. I had good reason to hope for positive results in either scenario, accepted authentically.

    The hope for something better returned after accepting the actuality of “no hope” in the existing scenario.

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  • So profound—and so true.

    Hope brings courage and effort—

    Acceptance brings peace.

    Double-edged indeed.

    I have heard a different interpretation of the story of Pandora, who was given charge of a precious box never to be opened—when because of curiosity she opened it, indeed, out flew all the buzzing ills and evils that plague humankind. Dismayed, she slammed down the lid too late. Only one creature remained in the box—eventually she let it escape, and it was Hope.

    Generally the interpretation is that hope counters all our ills and evils. But the other interpretation is that the last was the worst of all—

    As you say, double-edged.

  • Wendy S. Harpham, MD

    I’m a physician and 20+-year cancer survivor who has been exploring issues of hope and acceptance.

    I agree that in some circumstances hope can be detrimental to living as fully as possible at the end of life.

    People can expect, accept and prepare for the unwanted likely outcome while, at the same time, hope for the unexpected—but possible—good outcome. This blending of hoping for the best while preparing for the worst is called hopeful acceptance.

    I’ve come to believe that each person has to find a balance of hope and acceptance that works well for him or her.

    I’ve personally known patients who were happiest in their last days by letting go of every last vestige of hope of recovery. I’ve also personally known patients who were happiest in their last days by keeping hope for recovery full throttle, and to their dying breath hoping for a rescue.

    By helping patients find the balance of hope and acceptance that helps them—whatever levels that might be—we help them live until they die.

    With hope, Wendy

  • miriam

    This is so beautiful. In this world where there is so much happy talk and superficial twittering, it is a relief to read something that is not afraid to get to the heart of pain and anguish.

  • Vic

    One of my favorite movie lines is from the John Cleese film Clockwise. Cleese is trying to get to a conference where he is to receive an award, but of course all sorts of things stop him. Finally, gripped by a frustration that only John Cleese can portray, he says, “It’s not the despair. I can take the despair. It’s the hope I can’t stand.” Ever since I heard that line, I’ve had a distrust of hope.

  • Pamela

    Hope was all we had when the doctor told us that there is no more treatment that could safe our 18-yr-old daughter, Lyn Si from Type B ALL.

    The night before she died, I sat by her bedside praying. The whole night though I was battling with myself with faith and hope that she will survive this deadly illness.

    Lyn Si too fought on full of hope, fearless till the end of her life. She left us the next morning leaving behind for us to remember her courage and strength in this battle.

  • chris

    Your essay made me wonder whether and how much a patient’s mental attitude affects the outcome of treatment. Does believing it’s possible to recover make it more likely? Does acceptance hasten death? I doubt it’s as simple as either question.

    Regardless, it’s interesting to me to consider how our view of the world brings us either peace or suffering. I think peace of mind and hope can co-exist.

    Thanks again,
    Chris

  • Sara

    Thanks Alex for the post and Lisa for your comment.

    Am currently in a doomed relationship (as everyone says) , separated and sometimes neurotic to the point that i keep going back to what i could’ve done to save it. I tried several times and every time i got hurt (sometimes physically; sometimes emotionally) and came running back home. Sometimes I hurt the other (or maybe that’s my neurosis). It’s chaotic in my head even after 2 years of separation.

    Every time I start a chanting campaign, it gets worse and today was just that…

    Am so glad that I could pinpoint that hope is what is really not letting me be at peace with acceptance of the whole situation.

    Thanks for the wisdom. I will get it from inside soon, I hope . 😉

  • Chris

    What you have presented, Alex, is a new definition of hope. And if one finds oneself in an end-game situation, one must redefine EVERYTHING, it seems to me.

    John, who said he could face either outcome peacefully, had the best strategy—dare I say, the most hoped-for strategy/mindset.

    But how to train oneself (ahead of the crisis) to embrace the acceptance? Maybe that is what a consistent, lifelong spiritual practice does . . . We train to let go and accept in many lesser ways, in anticipation of the huge letting go that we must do in the case of a terminal condition.

    If you have been poor and done without, this can also be part of the training, I think. If you have had losses that you learned to live with, this is part of the training. We are in the week of the anniversary of 9/11, and we will all recall those losses and have this example before our eyes.

    Finally, I am trying to support someone through his journey with an aggressive cancer right now. I am not there myself, so I don’t REALLY know what this is all about. But I imagine that if my friend can visualize himself well, back to work, back to the school he runs, back to his vigor, then there IS a reasonable hope. It is not longing, nor ruminating, nor raging that I am talking about. It is just picturing oneself back to one’s life and activities . . . picturing in a peaceful way.

  • Jeann

    I think what goes hand in hand with making the acceptance “stick” is forgiveness—to forgive yourself foremost for how you judge yourself to be lacking whatever is causing the adversity, and if it involves another, as in a relationship that has ended, forgiving the other. It is with forgiving that the choice to accept what is can be firmly planted in new soil with renewed hope. Thanks, Alex, and for others’ comments here.

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