- NEWSDAY.CO.TT - A la Une - 25/Aug 08:00

Holding on to hope

WHEN IT comes to medicine and illness – the human experience of disease – there are many things that we doctors do not understand. We depend on patients to show us what they are, how they look, what they sound like, and, most importantly, how they work – how well they work or how bad they work. Our medical textbooks do not have the answer. And dare I say not even artificial intelligence has the answer. Hope is one of them. It is intangible, invisible, untestable – out of the doctor’s, and ChatGPT’s, grasp. But, as patients show us repeatedly, it is there and always on our side. “Hope is itself a kind of medicine,” Lewis Thomas wrote in his memoir, The Youngest Science. He added: “I believe this, although I cannot prove it.” Lewis Thomas was no ordinary physician. He attended Harvard medical school and went on to be the dean of Yale University medical school and president of Memorial Sloan-Kettering Institute, a premier cancer treatment centre in the US. He witnessed and was at the centre of some of the most significant advancements in medical therapeutics in the mid-20th century. He saw the beginning of antibiotics and chemotherapy. He was at the frontline of the scientific revolution that transformed medicine into the modern science we know today. Yet, he was a believer – in hope. Many studies have since demonstrated the therapeutic value of hope and its positive effect on health and well-being – it is safe to say that it is a universal truth. But like so many other universal truths, it remains kind of inexplicable, elusive – a mystery. As doctors, though, we are privileged to experience it – we see it, hear it, feel it – in a kind of vicarious way through our patients. Ask any doctor, he/she will tell you how patients have defied them, defied their predictions, and defied all odds to live an extra month, an extra year, to beat a disease after being told, perhaps in a kind, empathetic way, that they had no chance of winning. “The doctor gave him two months – that was almost a year ago. He is still going.” How many times we’ve heard this! And by winning, I don’t necessarily mean cure and immortality. I mean an extra month to see a grandchild graduate, attend a child’s wedding, finish the book; an extra week to write the last column; an extra day for family abroad to reach at their loved one’s bedside. And in the case of someone with dementia, a smile. That’s a victory. “I can’t go on. I’ll go on,” Paul Kalanithi wrote, quoting Samuel Beckett in his memoir, When Breath Becomes Air, a book about dying, and hope. How can we doctors prescribe hope? If only we could write it on a prescription pad and say, “Take this everyday.” Alas, it is not so easy. In fact, I find it very difficult. We doctors are very weary of giving false hope, and misleading patients and their families. We know the high expectations – sometimes reasonable, other times not – that patients and their families have of us, and sometimes we do need to cut these expectations down. In cutting down these expectations, I wonder if sometimes we come across as giving up, losing hope. Shouldn’t we fight alongside the patient? I don’t think so. For the sake of objectivity – and perhaps our own emotional stability – I think it is better we don’t. We are doctors – not superheroes. But patients and their families come to us looking for hope. They show up at the hospital, in the doctor’s office, night and day, hopeful. Hope brings them to see us – otherwise, they would not come. The families waiting outside the intensive care unit hold on to nothing except hope. Indeed, hope is a kind of life support – what a tragedy it is if we inadvertently disconnect it. Dousing a patient’s hope is perhaps one of the worst things we can do as doctors. Perhaps killing a patient’s hope is like killing the patient. If hope is a medicine, hopelessness is a potent poison – Lewis Thomas talked about this, too, referencing a couple anecdotal reports to make his point. As doctors, if we can’t give hope, perhaps the least we can do is not kill it. “It is silly not to hope, he thought. Besides I believe it is a sin,” the old fisherman said in Ernest Hemingway’s story, The Old Man and the Sea. It’s the closest I can come to a prescription. Taureef Mohammed is a physician from TT working in Canada E-mail: taureef_im@hotmail.com The post Holding on to hope appeared first on Trinidad and Tobago Newsday.