In 2004, Barack Obama delivered the keynote address at the Democratic Convention. He entitled it “The Audacity of Hope.” At the time, as a wide-eyed, innocent medical student who had just finished her third-year clerkships, I wondered if the medical profession had not only lost this audacity but, furthermore, if we discouraged our patients from “the audacity of hope.”
Throughout my third year, I had been exposed to a wide range of diseases and conditions, some of which were curable and some were not. Each of my attending physicians had different ways of delivering bad news to the patient. One surgeon simply said, “I can’t perform miracles. I am sorry, but there is nothing else I can do for you.” Another doctor, an internist, was more tactful and said, “I really wish there was more we could do for you but this is the best we can offer. I am so sorry to have to tell you this.” Although gentler in tone, the overall message was still the same. Time’s up. You are screwed. There is nothing we can do.
Was this really the right message to deliver?
As I finished medical school, went on to internship, then residency, then onto my first job as a hospitalist, I found myself becoming progressively more hardened and cynical. My gentle explanations to family members were replaced by contrite and matter-of-fact statements. This culminated one day with my telling a 95-year-old patient’s daughter, “There is absolutely nothing we can do about your mother’s swallowing. She is too old. Her body is broken down. She will never recover from this. You should let go.” The daughter had promptly replied, “Have you no compassion? No hope? Letting us hope would go a long way.”
I thought about what she said. Had I forgotten that sometimes even hoping the tiniest bit could do wonders for a patient and family member’s psyche? I suppose I had thought of myself as a realist and that there was no room left to let people even dare to hope. But as a doctor, was this the right thing to say? I didn’t know the answer, but her response made me think that, perhaps, we should allow our patients “the audacity of hope.”
San Carlos, California