The Power of Hope in Palliative Care

As I stand next to my patient, self-doubt coils its way from my fluttering stomach, tightening around my throat. I hope she cannot see my trembling hand as I reach out to grip hers. My mouth feels dry, and the muscles in my face are thick and sticky. I struggle to form a smile, hoping she is unable to see through this fragile facade of confidence I am trying to project. 

My gaze fixates on the doctor. His slight smile and gentle touch provide a calming harmony to the baseline of my thumping chest. My heart is now the most resilient part of this failing machine. As I lie in bed, with tubes and cables clinging to me, I have known for some time that the wick of my life has been close to burning out. I was fearful at the start of my journey. I was fearful of suffering, fearful of burdening my loved ones, fearful of losing control and most of all, fearful of the dying process. How could I not? Yet, over the last few months, this fear gradually transformed into a sense of comfort and contentment. I wish to say so much, to convey my happiness, and scream my thanks. But I have become too weak. I want my doctor to understand the extent to which he has helped, to allow me to come to terms with the final chapter of my book. 

I hope I have done enough. A self-soothing phrase, a mantra I repeat to myself. My thoughts wander back to our first meeting. She sat in front of me, optimism and hope etched on her face, searching for solace in her last few months. It’s an incredible pressure to feel. Few jobs require you to be both the spark and extinguisher of this hope, to be simultaneously realistic and optimistic. Hope is more complex than just the promise of a cure or the wish of a miracle recovery. It can be the thread that holds together the delicate spiritual, emotional and psychological tapestry of a patient’s being. We are the gatekeepers for this emotion, the dam resisting the weight of patient expectations. This responsibility has, and continues to, create a sense of unease within me, a fear of disappointing her. 

I will forever be filled with appreciation for the Doctor. He guided me into forming a realistic perspective of hope by balancing my expectations against the reality of my situation. He helped train the disobedient and dangerous animal that hope can become. As a result, hope provided me with an infinite war chest, which I used against challenges throughout my journey. Self-doubt was the first obstacle I had to battle. As I was initially coming to terms with my diagnosis, I blamed myself. I blamed my body, my habits and my mind for the position that I was in. I lost confidence in my ability to make choices that would benefit me. I relied on Doctors and loved ones to make decisions because I lacked trust in myself. I had lost my autonomy. However, hope became the scaffolding that I used to rebuild my self-confidence. It granted me the permission to show compassion towards myself, as it instilled the belief that I am capable of growth and resilience. Hope’s optimistic nature helped me reframe my illness. Instead of seeing it as an insurmountable barrier where any action would be futile, I began to view it as a hurdle with multiple approaches that I could use to overcome it. This realisation of choice loosened the paralysing knot of inevitability. It created a sense of empowerment within. As I regained trust in myself, I started to become more involved in decisions regarding my care. This gave me the confidence to wrestle back control, regaining a sense of independence. I began to live my remaining life on my terms. 

As I stand to leave the room, I take one final glance at my patient. She will never understand the profound impact she has had on me. By witnessing how she has used hope as a powerful instrument, I have also realised that hope is not only a valuable concept for her but also a crucial tool in maintaining my motivation as a Doctor. The coping mechanisms that I have developed, to endure aspects of this profession, have often led to feelings of nihilism and emptiness. It has been challenging to prevent apathy from seeping into my scrubs. However, by observing the transformative power of hope in my patient’s journey, I have discovered an antidote to this toxicity. Noticing the shifts in her perspective and the strength that hope instilled within her, profoundly changed me. Hope has now become a shield that I wield against my previous melancholy and pessimism. It has allowed me to find comfort in the small victories and savour moments of connection. Hope has become my anchor, providing stability and strength amidst the turbulent waters of emotional burnout. She has reminded me of the profound impact I can make, and I will forever be thankful. 

As my doctor closes the door, I silently express my appreciation to him one last time. With my eyes now closing, and a smile spreading across my face, I reflect on the most important gift that hope has given me in my last few months. A sense of gratitude. Hope became the damp cloth that cleared away dirt from the lens through which I viewed the world. I found joy and solace in previously mundane moments in my life. A walk in my garden became filled with moments of gratitude. I now felt the warmth of the sunshine on my skin as I felt the tenderness of earth beneath my bare feet. I noticed the swaying trees dancing to the melodic songs of the choir birds. I appreciated the sweet perfumes of the flowers surrounding me. Hope provided me with these new perspectives. It allowed me to cease worrying about my destination because I became lost in the journey of cherishing each of my remaining days. 

Ashveer Ramlugan

F1, Leicestershire, Northamptonshire and Rutland (LNR) Foundation School