CC Issue 42 / Social Work

The Physiology of Hope

The reality of working as a doctor is that I see people die. Often it is expected, sometimes it is not. It is always a possibility.

Recently I had a patient who was diagnosed with an advanced form of cancer. At 60 he was not young, yet he was twenty years off the time when a funeral is as frequent and expected a social gathering as a wedding for the late 20s.

Physiologically, he was expected to die from his disease. The cancer had spread and his blood tests were getting worse. No doctor likes the question ‘how long, doc?, with any answer destined for the bin of failed prophesy. But if a gun was put to my head I would have said a few months, perhaps a shade longer.

Yet as I went to see him each day and spoke to his family it was evident that the most powerful prognostic factor (medical speak for something influencing future outcome) was missing: he had no hope. He had given up. He stayed in bed instead of getting up. He would not eat or drink. He just lay there. He was literally hopeless.

And then one morning he died. Just like that.

Of course medically it was the cancer that killed him. That was what all the clinical evidence showed. That is what is on his death certificate.

Yet what I cannot explain medically is why it killed him then. Or, to put it another way, why one patient, facing a terminal diagnosis, belies the odds in the duration of their survival and another in their brevity.

I wonder if it was hopelessness that ended my patient’s life that day. I cannot prove that. No randomised controlled trial comparing hope and despair has been conducted. No doctor will stand up in front of a set of survival curves and describe the risk factor of hopelessness. Yet it is widely acknowledged among medical professionals as we chew the proverbial cud that this is what we see. Some people simply give up and die.

Of course ‘hope’ can mean anything and everything. This observation does not lead me to change my practice. I cannot ‘prescribe’ hope. I do not want to invent hope. Indeed, many would say all hope is invention in the light of terminal disease. But it still makes me ask the question of is there hope?

I’m confident there is.

‘Praise be to the God and Father of our Lord Jesus Christ. In His great mercy He has given us new birth into a living hope through the resurrection of Jesus Christ from the dead.’ 1 Peter 1:3

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