Sunday, October 21, 2007

Transforming Hope

Today I, with two other volunteer hospital chaplains, spoke to an incoming class of volunteers about our experiences: what we do, why we do it, what it's taught us about ourselves. Both of the other volunteers had very moving medical stories of their own. One went through the agony of almost losing a spouse to heart disease ten years ago -- of being convinced that this was the end of a beloved partner -- before a last-minute transplant turned everything around. The spouse is fine now, although no one expected that outcome during the crisis.

The other volunteer chaplain has donated a kidney to a relative, and routinely tells patients -- even those with terminal cancer -- "There's always hope. The doctors don't know everything."

I was very moved by their stories, but I found myself pondering the nature of hope. I think good pastoral care is a matter of discerning genuine hope from false hope. As a Christian, I believe in the ultimate hope of the resurrection, but I know that Good Friday has to come first. As chaplains, we're taught not to pray for seemingly impossible cures, to pray instead for acceptance of whatever the future brings.

Sometimes the seemingly impossible happens, but if it doesn't, other things are still possible. Acceptance, reconciliation, love. The successful completion of the "five last things," the last statements we need to make and hear in this life, whether to or from others, ourselves, or God:

Forgive me.
I forgive you.
Thank you.
I love you.

At the moment, I know three people in various stages of cancer. One is in hospice now, engaged in making final arrangements and saying goodbyes. Another has been stunned by, and is trying to come to terms with, a recent recurrence. And the third is in the "we hope the remission holds" stage.

I suspect that the three of them, if asked, would describe three different kinds of hope:

Hope for a peaceful end.
Hope for a sudden turnaround.
Hope for current conditions to continue.

I suspect, too, that these are the three main varieties of hope for all of us, in all circumstances. When things are going well, we hope they won't change. When things are going badly, we hope they will change. When it's clear, at last and despite all our efforts, that they can't get better, we hope that our exit from whatever we're leaving -- the life, the career, the marriage -- will be as calm, graceful, and painless as possible.

At each stage, we need help moving to the next, recognizing the appropriate thing to hope for. This is part of what chaplains do.

During this week's hospital shift, I visited with a patient who's had "a wonderful life," and who expressed gratitude for many blessings. The patient was ready to die, if that was what God required. The patient's spouse was not ready to end more than four decades of marriage. I listened to the patient's litany of thankfulness, and handed the weeping spouse tissues. I tried to affirm both of them.

Later, I stopped by their cubicle and learned that the patient's symptoms had been far less serious than the couple had supposed. They were going home. Both of them were beaming, and I could see the relief in the patient's face, no less than the spouse's.

I wonder if we ever really stop hoping for the miraculous turnaround. I can only pray that when this couple runs out of medical miracles, they will find faith, and acceptance, and comfort in their love for each other.


  1. Have you ever encountered Henri Nouwen's little book, "Our Greatest Gift"? Your post reminded me of that, about dying and caring and especially, dying well.

  2. You should read Ira Byock's books, particularly the Four Things That Matter Most. A must read for anyone dealing with patients near the end of life. Multiple ways to address transforming hope.

  3. Anonymous10:42 PM

    Dear Susan,

    Thank you for this moving meditation and thoughtful reflection, which happens to come at a particularly appropriate time for me as I have just said good-bye to one of my best friends myself.

    All those who read these lines, please take a moment to remember Russell, who died in hospice on the feast day of St. Francis, 4 October 2007. Russell was a third order Franciscan, a mystic who loved to meditate, a faithful Episcopalian, a long-time church treasurer, a sometime church choir member, a passionate bowler and an expert needle-worker. He dressed simply, he spoke clearly, he listened carefully, he laughed easily. Surely God delights in him as he delighted in God. I miss him.


  4. I just recently had recommended to me The Anatomy of Hope: How People Prevail in the Face of Illness by Jerome Groopman. Might also be worth checking out (in all your free time, right?)

  5. What a wonderful post and a wonderful lesson in how to balance hope with reality.

  6. "There's always hope. The doctors don't know everything."

    --- Yes, I very much agree. I'm a doctor and I don't pretend that I know when a terminally ill patient is going to die. However, I think telling the patient and his relatives about the status of an illness, especially cancer, is the hardest one of all. Yes, we can give an estimate of how long the illness would take but as a doctor, I think it's still my duty to let them know that it isn't an absolute, that there are still many changes that could happen. It's not about giving a false hope that a patient can get cured of something when the possibility of that happening is almost close to nil, but it's just an admission that we honestly do not know everything.

  7. This is important stuff. One of the things that I've learned over the years working with patients, is precisely this: when hope seems gone, perhaps we can determine something different to hope for.

    I learned this with a patient I followed for three years, from his diagnosis with multiple myeloma to his death of leukemia, after two failed attempts at bone marrow transplant. We were able to move from "hope for recovery" to "hope for the good death," without losing some sense that there was still something to hope for. For that patient, he got what he wanted: his last days at home, supported by wife and friends, watching the birds at the feeder. For him it was good.

    Paul writes, "But if we hope for what we do not see, we wait for it with patience." Sometimes I think he's optimistic; and if it wasn't for how he connects it with faith I might sometimes think he was cruel. For us offering the love of God, and certainly for us offering the love of God in Christ, hope is always important - not in hoping for the "impossible" ("We call 'em miracles for a reason," as my best beloved says), but in discovering what blessing remains that we might hope for.

  8. Thank you for your wonderful post. Can I link to it in my blog?

  9. TK -- link away! Thank you!


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