Hope Is Delicate Suffering

“Hope is delicate suffering.” — Amiri Baraka

This quote is taken completely out of context, but I think it can stand alone. These four words are amorphous. The words themselves are so beautiful. Each person will have their own unique train of thought after reading it. I wanted to briefly share with you my thoughts on what this quote sparked in me. Disclaimer: this piece is unedited and an outlet for me to process what I feel. I choose to share it with the world as a form of cathartic release and letting this energy flow into the universe.

My shoulders ache from an invisible weight pushing down on me. There is added responsibility that comes with seniority in the hospital, and I expected that going in. What I didn’t expect was learning how to navigate the concept of hope. As a human, I hope that all my patients achieve their treatment goals. This can vary from the patient being able to breathe on their own again after COVID to having their chest pain resolve after a cardiac stent placement to dying peacefully at home from metastatic cancer. As a physician, I translate this hope into a goal directed treatment plan and, most of the time, the plan works. Inevitably, there are times when Plan A fails and so we move to Plan B and so on and so forth. This is where the words ‘delicate suffering’ really hit home for me.

The question that keeps me up late at night is: “How much hope do I have left to give?” Asking this question is itself a form of suffering. My mind races whenever I contemplate it. At the end of the day, I’m human too. There are moments where I feel hopeless. It’s one thing to feel hopeless about a situation that revolves around you. It’s an entirely different thing to feel hopeless about a situation regarding someone else. This is where the word ‘delicate’ fits in. Am I allowed to feel hopeless when the patient and their loved ones are full of hope? I honestly don’t know. Do I let the patient and their loves know of my real thoughts or do I hide behind the façade of hope? As you can imagine, going down this line of philosophical questioning is a downward spiral and a sort of delicate suffering.

To me, being a good physician is based on two key characteristics: empathy and compassion. If a physician truly practices with these two traits, then I think everything else (including medical knowledge) falls into place. Whether or I not I feel hopeful about a patient should not affect how empathetic and compassionate I am. In different words, I sometimes find the need to compartmentalize when discussing the prognosis of a patient. The challenging part comes when the patient and/or the family ask, “Well, what do you think?” This phrase is essentially them asking me to give them hope. In these situations, I find that the empathetic and compassionate approach is to be honest. I fully explain my line of thinking. The level of detail may vary per patient, but I really try to make sure the patient/family understand where my head is at. The end goal of this approach is for the patient/family to come up with their own level of hope. It is soul crushing to see hope dwindling away from a patient’s eyes or a loved one’s sniffled voice as they come to their own realization. At the end of the day, hope is delicate suffering. Sooner or later, we all want the suffering to subside. For that to happen, some amount of hope is inescapably lost. This doesn’t mean that we need to lose all hope. The balance of hope and suffering must be made by each person on their own.

I have begun to equate the balance of hope vs. suffering as the beginning of peace. This change in mindset allows me to continue to have hope even through the darkest of nights. I hope all my patients and their loved ones will attain a sense of peace. For this hope, I will gladly take on the associated delicate suffering. There is something beautiful about this to me. I can already feel the weight gradually lifting off my shoulders…

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