Hopes most fragile state

Hope’s Most Fragile State

When is it wrong to provide hope?

I deal with hope everyday as do most of us on this planet. In addition to my own personal hopes I also deal with the hopes of others. I am in a way in the business of hope. It is part of my job to give hope and sadly some days it also my responsibility to take away hope. Daily and even sometimes hourly I find that I must somehow quantify and measure the elusive state of being; hope. I must ask myself; how much should I have for a person? How much should I allow another person to have? It is like trying to calculate an exact amount of air to into a measuring cup. Working within the cutting edge of medicine with what is literally the fastest advancing and arguably the most promising field of science in medical history I find I am the one often turn to in desperation. The clinical applications of Umbilical Cord derived Stem Cells is my specialty. Saying it is serious in nature would be of course a gross understatement. For many it translates into the quality of life in essence to live longer or to die. It is my daily task to answer questions about the worth of life, the functionality of life and the length of one’s life.

The desperate come to me daily with at least some small fraction of hope and for others endless amounts. The mere nature of my work allows hope even for those who may have been told to never have hope. They see my face on their television screens, many hear of my name on the internet seeking out information and literally looking for hope. Many find linked to my name a spark of hope kindles inside their pained hearts. I deal with many souls for whom I represent the last small fragment of hope. For some I can take this hope, cradle it softly and with a whisper encourage it to grow in slow measured amounts all the while safely shielding it in gently cupped hands. For others I can do nothing. It is for them that I must slowly open my hands allowing their hope to fall away. It sadly slides over and through my opening fingers, like a fine dust blown by the wind it disappears back into the blackness of desperation and loss. For me it is a strange mixture of science and faith. It is the business of medicine that bring with it a secondary challenge; the measuring of hope.

Be it however intangible hope itself is the right of each and every individual. To have it, to not or to what extent is an individual’s choice and one we all have the right to make. Hope as a verb indicates an action of wanting or expecting. As a noun it translates a confident desire, an intangible feeling that something is likely to happen. Hope is in essence a wish and or faith that something will happen or be possible. To have hope is our right as individuals. We also have the inherent right as an individual human being to make a choice as to in what we hope. One rather lesser known definition of hope is also trust or more accurately a feeling of trust. It is this trust that can bring us into the debate of who has the right to ask for a persons trust and to what degree is providing this elusive hope appropriate.

In medicine we often find it is this fine point that is the subject of much internal debate for caregivers and patients alike. When can we provide hope and is it humane to ever say there is no hope. We have all heard of medical marvels termed as miracles. Knowing such cases do exist one could argue that there is always hope to be found. Yet as human beings often do with something immeasurable by touch we attempt to qualify it by providing a mathematical scale. Hope is measured everyday in hospitals all over the world. We as practitioners of medicine subjectively measure and translate it for patients and their loved ones on an almost hourly basis. Lacking a better way we reach for numbers quantified in odds and percentages. Reaching back to any supportive data we can recall from lesson’s years before we quote the odds of successful outcomes but even this is still nothing more than an objective statement. We hide the hide the fact that it is really nothing more than an opinion by providing numbers and drawing on our education and personal experiences but still it is nothing more and nothing less than one person’s opinion. It is only that some of those attempting to quantify hope build their views on better foundations than others. Yet still is it right to make such statements? Could these statements mislead?

We know all to well that medical professionals are often wrong when they make statements about the percentage of hope one may have. They are human and thus despite their best intentions they can still be wrong and often are. We know and trust them and thus we accept what they say as true. We justify this in our minds using the knowledge that they have no reason to mislead us as they would gain nothing by doing so.

Now its time to flip the coin and begin the real debate; what of the private sector of medicine and the hope they might offer. Now the trust for which hope is based has just been turned upside down because those providing the hope now have something substantial to gain. This now brings with it the issue of the possible manipulation of a persons hope. I think we all can acknowledge that anyone manipulating a person's hope would be acting in an immoral and unethical manner. I personally think it is far too often the case that the private sector medical professionals prey upon those most in need. Some days it seems as no matter where one looks in the sky all that can be seen are the circling dark forms of vultures. With such a mass number and wide wing spans they seem to block the clarity of our sight. These birds of prey circle over those in pain and patiently wait as they calculate the time it will take for the emotional desperation to set in.

I also do not consider myself to be one of those birds although I do acknowledge that not everyone would agree. I have in fact refused to accept patients for treatment because I felt they did not have a realistic picture of what the outcome might be. It does happen that a person’s hope is simply not realistic and ethically it is my responsibility to check that. I actually have a question in one of the forms clients fill out asking "what is your hope in regards to this treatment". It is asked to ensure that thier hopes are indeed realistic. If the answer they give appears in anyway inconsistent with what is indeed realistic then I have not fully done my job and must then go back to them, working with them until I have confidence that they have realistic expectations.

Hope is a fragile thing and should always be handled with the utmost respect and consideration. The saddest days for me are those when I know I am a person's last chance for hope but still I must say no to treating them because I am aware of the reality that they will not benefit from the treatment I have to offer. It is a painful moment to remove an individual’s last ray of hope. It is not a responsibility I take lightly but rather one that weigh’s heavily in my heart. I still however will decline to treat a person if I do not feel there is a realistic possibility that they will benefit from the treatment. For me this is an emotional bit of business but none the less it is part of my job. I make every attempt to deal with this component with the greatest level of human sensitivity.
I in fact often ponder the concept and reality of hope as it is indeed such a huge portion of not only my job but also of my life. I would “hope” that my life experiences have enabled me to be aware of and respond to this issue with compassion and understanding.