The freedom of patient speech is necessary if the doctor is to get clues about the medical enigma before him. If the patient is inhibited, or cut off prematurely, or constrained into one path of discussion, then the doctor may not be told something vital. Observers have noted that, on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.

To hope under the most extreme circumstances is an act of defiance that permits a person to live his life on his own terms. It is part of the human spirit to endure and give a miracle a chance to happen.

I had learned that every patient has the right to hope, despite long odds, and it was my role to help nurture that hope.

Many years before when I had serious back pain from a sports injury, the surgeons said they would explore my spine and "figure it out." Out of frustration I had impulsively opted for the procedure. They ended up fusing the vertebrae. It left me debilitated. In hindsight, I blamed myself more than the surgeons. I had pressed them for a solution when in fact none was apparent because the cause of the pain was obscure.

True hope is cleareyed. It sees all the difficulties that exist and all the potential for failure, but through that carves a realistic path to a better future.

Help, then, is the ballast that keeps us steady, that recognizes where along the path are the dangers and pitfalls that can throw us off; hope tempers fear so we can recognize dangers and then bypass or endure them.

Hope differs from optimism. Hope does not arise from being told to "think positively," or from hearing an overly rosy forecast. Hope, unlike optimism, is rooted in unalloyed reality.