While packing up to leave work today, a colleague asked if I’d see just one more patient.  Acquiescing, I set out to meet with Manny, a 39-year-old man diagnosed almost three years ago with a rare spinal cord tumor. The neurosurgeon’s attempt to remove the mass had proven unsuccessful. What’s more, during the operation, a large blood vessel was accidentally severed, causing extensive hemorrhage.  Doctors eventually controlled the bleeding, but the patient awoke unable to move three of his four limbs.  
 
The paralysis had persisted. Now, to make matters worse, the tumor had spread to Manny’s brain, causing him severe headache.  My job would be to examine the patient and give my opinion about possible radiation treatment.
 
Upon arriving at the appropriate hospital ward, however, I was denied direct contact with Manny. He’d developed a highly contagious infection.  No examination, but we were allowed to speak through a protective partition.  Was I carrying out medical rounds, I wondered, or visiting a prisoner in his jail cell?! 
 
Manny explained that even his right arm—his lone functional limb--was growing weak because the prescribed steroids were depleting precious bone minerals. He couldn’t work and was "emotionally down," he said. 
 
My task, specifically, was to consider irradiating Manny''s brain. The potential benefit was headache relief. The potential downsides were possible damage to his cognitive skills and memory.  Only one question came to my mind. “Manny,” I asked, "What are your hopes?"
 
The question seemed to stun both the patient and an assisting intern.   Even to me, the query felt like a non sequitur.  The intern had so many pragmatic tests to order and procedures to perform, yet there I was, me and my chutzpah, throwing everyone off guard with my apparently irrelevant question. 
 
In my mind, however, the other activities were the intruders.  But where was my question coming from, I wondered? Mostly, I decided, it had arisen from my own desperation, my sense of not being sure what best to do.  The only thing I knew for certain was that, before I could counsel him effectively, I needed Manny to reveal his priorities.
 
He confided that he had no hope of radiation therapy curing his cancer or reversing his paralysis.  What mattered to him was his relationship with his two school age children. That’s what Manny was “living for,” he said. What he needed, he added, pointing to his forehead, was help with his headaches, so the throbbing wouldn’t compromise his duties as a father to his little boys. 
 
By defining his goals, Manny was guiding us both toward figuring out the best treatment plan.  I believe that we can successfully control Manny''s headaches, and most important, Manny believes he can remain hopeful.   
 
Among the most common impediments to hope tend to be stress, procrastination, and indecision.  As we go through our days, our mundane routines may not do much to propel us on a path towards hope.  What we need are triggers that move us in positive directions. A direct question can be a useful trigger to enable us, along with those who care about us, to identify the building blocks of our hope.  Manny’s answers to my question helped us to construct, together, not only a treatment plan but a blueprint for hope.
 
Discussions of hope may sound trite but—think about it--how often do we ask others about their hopes? Has a physician ever inquired about what makes you hopeful? Have you ever asked a friend to tell you his or her hopes?  “What do you hope for?” It''s not an easy question to pose.  It can be a startling question to receive. Yet it shouldn’t be. We might feel that the question violates personal space. In fact, however, asking about hope can affirm the other person’s dignity and confirm our own supportive interest.  So go ahead. If you truly care about someone, ask them, “What are your hopes?”  
 
Please post comments/questions on line or reach me via drhope@lifesdoor.org 
 
 

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