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The biochemistry of hope.

How often have you heard the following statement: ‘‘If I talk to my patient (or my mother, father, spouse, etc.) about hospice then they will give up hope.’’ Are we, hospice professionals, really so powerful that our mere presence or our words can ‘‘kill’’ a person’s hope? What is hope? Webster’s dictionary defines hope as a verb meaning a desire with an expectation of a belief in fulfillment. Hope is also defined as trust and reliance. What do patients, families, and health care providers hope for? In this issue of the Journal of Palliative Medicine, Dr. Wallace Chi Ho Chan reports on negative outcomes suffered by both patients and their families when the truth is withheld. He tells us that the awareness of prognosis may not harm Chinese patients as commonly thought and that not knowing can result in patient anxiety and communication difficulties. I suspect that these families may be thinking that withholding truth is ‘‘helping keep hope alive.’’ It seems that our society defines hope mainly in terms of living longer. I think this may be the most important hope experienced by physicians, families, and caregivers, but I wonder if it is as highly valued by our patients? I recently read a book written by Dr. Allan Hamilton, a professor of neurosurgery at the University of Arizona, entitled The Scalpel and the Soul: Encounters with Surgery, the Supernatural, and the Healing Power of Hope. In the chapter entitled ‘‘The Thread of Hope,’’ Dr. Hamilton tells the story of Donald, a 23-year-old man he treated with an extremely aggressive glioblastoma multiforme. He underwent multiple surgeries and radiation and chemotherapy treatments. At one point, Donald, an avid fly fisherman, and Dr. Hamilton had the following conversation: