You sat next to your patient, looking at her latest results. Half to yourself, you asked, “Is it time to despair?”

 

It has been a tough cancer to predict and a tough one to treat. Every time you thought that you were one jump ahead, it popped up in a completely different corner, grinning at you. Now, shockingly, despite the successful surgery, here it is: brutally gnawing on her spine.

Is it time to despair?

It depends on what you hope for.

We can “despair” of finding a parking spot in time for our meeting, or of getting the life partner we want. Small or large, that’s localized despair, wearing a lowercase “d”. When we realize a specific hope will not be realized, we replace that hope—maybe after a dark pause—with another one: there are other fish in the sea…

Despair, with a big “D,” means the loss of Hope with a big “H.” It’s not the realization that the particular outcome we sought is no longer on the table, but our descent into the icy spiritual crevasse of believing that we have run out of things to hope for.

As an oncologist, what you hope for is a cure, or at the very least a long remission. And there you sit, only a year or so after the first diagnosis, looking at the evidence that “cure” and even “long remission” are words whose time is running out.

So: is it time to despair?

If all you have to offer her is the chance to watch her children grow up, then it is time for you to despair. Because you no longer believe you can give her that.

But your despair is not hers. Do not assume your tunnel vision must be mirrored in her. She still has so much to hope for: treatment for the debilitating spinal injury, and vigilant reduction of the new and looming tumors. The precious seasons: how many? Summertime in her childhood family home. Her children’s next accomplishments, or the next laugh at their silliness. Time to plan ahead; time for family and friends to show their love; time for her to plant something that will live for years in her garden. Energy to write, and to pursue her vocation. The ongoing development of wisdom and insight. A clear enough understanding of her medical situation so that she can weigh her options, and decide wisely when to seize an opportunity. And, who knows when, a quiet end, free from horror.

Reshape your own hope into a new one: the hope that you can support those footsteps. Offer the generous heat of your commitment. Share with her your own knowledge, experience, compassion, and perspective. Tell her and her husband what they might expect, what you think her symptoms mean, whether there is a way to mitigate them. Listen to them. Respect their journey. Help them as they decide whether it’s time for a new therapy, or time for a trip to France, or time to call Hospice.

Is it time to despair?

Only if you all you ever had to offer her was a cure.

Do you value your own knowledge and spirit so little?