Hope requires looking to the future. A future-oriented outlook typically involves goal setting. It''s not always easy, though, to set goals that are attainable.

On the oncology wards where I work, almost all patients aspire to achieve cure.  I''m all for that, especially since one of medicine’s best-kept secrets is that, today, most cancer patients are still alive five years from diagnosis, and most who reach the five-year-survival milestone will, in fact, be cured. 


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But there remains a substantial minority of patients with incurable disease. For those people, it doesn’t work to equate “hope” with “cure.”  For them, hope comes with setting other achievable goals.  In the scientific literature of hope, that process is called "re-goaling."


Setting goals for the future may be a scary proposition from several vantage points.  We run the risk of failure, or we may set the bar so low that we restrict our sense of accomplishment.  We all realize that we cannot predict the probability of such goals coming to fruition and that there is a limit to our ability to exercise control and make those goals happen.  Sometimes this can become an outright source of despair (one of the natural enemies of hope) but in most cases it simply shunts us down a path of passivity. And when we''re passive, thoughts about the future are--at best--relegated to "wishes" rather than hopes.


So, we might choose to employ an overused word in our modern lexicon by resolving to be "pro-active."  Great idea, but also fraught with downsides.  When we act on our goals, we invite unpredictability as well as chance into our world, even if our planning is sound and meticulous.  There is, by definition, a real probability that we will not reach even our achievable goals. That we will fail.  This is why President Obama is correct to have suggested that hope requires courage if not audacity. 
 
Several years ago, I administered radiotherapy to a patient diagnosed with a pancreatic malignancy, a type of tumor that still gives cancer a bad name.  According to statistics, my patient had only six months to live, a fact of which he was very much aware. In getting to know the man, I discovered that, for the previous six-and-a-half years of his life, he had been engaged in something called "the daily Talmud project" (in Hebrew, the Daf Yomi). Participants study one page of the massive Babylonian Talmud each day for seven-and-a-half years to complete the demanding text. 


Clearly now, statistics were causing my patient to lack hope of ever reaching the finish line. But then, bing!, we had the idea of arranging for a tutor to provide a second helping of Talmud study each day.  The strategy worked so that, several weeks before his death, fully cognizant, our Talmud student exalted in the attainment of his new goal which had nothing to do with his underlying cancer.


This YouTube video shows another re-goaling situation, albeit a bit more extreme case.  In the clip, Dr. Donald Low, the famous Canadian physician who led his country''s battle against SARS, has just been diagnosed with a rare, incurable brain tumor.  As I reviewed the video in preparation for writing an article about the controversy of physician-assisted-suicide, I noticed that, about halfway through, a discussion of hope arises. Dr. Low’s goal is to die without pain—in his words, "…to be able to face death without the fear of death itself." 


In life, as in final concerns, when initial goals become unrealistic, re-goaling can guide us to revisit seemingly insurmountable odds, to deepen our self-understanding, and to  devise creative strategies that align our aspirations with our most vital values.  Consider whether re-goaling might enhance hopefulness amid your future-oriented plans.  
 
Please post comments/questions on line or reach me via drhope@lifesdoor.org



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