Heroes Not Zombies

I see two symbols of hope in this one image – a cloud with a silver lining, and the beginnings of a rainbow (or, if you prefer, the emergence of colour out of monochrome)

We human beings need hope. I’m not sure if it’s possible to live without it. That might sound dramatic but I expect you’ve heard tales of seriously ill people “turning their face to the wall”, and dying. Or, maybe the opposite, maybe you’ve heard those who recover from serious illness described as “fighters”, which doesn’t mean they have defeated an enemy, it means they have dug deep, found wells of hope and belief, and have healed.

Whenever I saw a patient with a serious disease I knew there were roughly three possible future paths – improvement, deterioration and something inbetween (a kind of continuation of the present). You can see that with common, acute infections, such as a cold or flu, and you can see it with this COVID-19 virus too. Some people make a complete recovery, some go downhill quickly and die, others recover well enough to leave hospital but continue to have disabling symptoms (people are calling them “long haulers”).

Perhaps one of the silver linings from this latter group is the growing recognition in Medicine that some viral infections can produce seriously disabling chronic states. Sadly, in my own work, I saw patients with diagnoses from “Post Viral Syndrome”, to “ME”, to “Chronic Fatigue Syndrome” who had been dismissed and/or not believed by other doctors. These patients were hit by a double whammy – illness and disbelief. That was always hard. I hope this pandemic might have changed the mindsets of some physicians who have dismissed such chronic states as “psychological”, “depression”, or “fraud”.

But to return to the issue of hope. What makes the difference? What influences which of these three paths lie ahead for you when you get sick? The improvement path, the decline path, or the chronic illness path? The truth is we don’t know. But I sure hope there are people invested in research projects to try to shed a light on this issue. The other truth is that nobody can accurately predict which of these paths lie ahead for any single patient.

Yes, of course, we can use statistics and probabilities, but when it comes to an individual, those generalities don’t determine the outcomes. I’d be explicit about that with patients, and I’d say, the truth is that for this individual, their path may well be the improvement path, so why not take on board that truth? Taking that on board is a kind of hope.

A little further down the road things might look very different. Someone who was getting better might decline. Someone who looked as if they had no chance might make a stunning, and unexpected recovery….and so on. But as the story proceeded, so did the three options. At every point, every day, those three paths lie ahead – improvement, decline or staying much the same. Is it ever helpful, then, to give up hope? If we hope, then don’t we try our best? Don’t we put in our greatest efforts? If we don’t hope, the danger is that we give up.

Because, here’s the other piece – the self-fulfilling prophecy. How often does it seem that what we anticipate, what we expect, comes to pass? Is it possible that hope can contribute to improvement and that despair and hopelessness can contribute to decline?

What do you think?

I think we human beings need hope. And I think hope contributes towards improvements. And even when things don’t improve, we can always change what we are hoping for. Changing what we hope for keeps us realistic, but being realistic doesn’t mean we have to give up all hope.

What’s your experience?