Hope, true hope, has proved as important as any medication I might prescribe or any procedure I might perform.

Hope can be imagined as a domino effect, a chain reaction, each increment making the next increase more feasible... There are moments of fear and doubt that can deflate it.

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

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.

False hope can lead to intemperate choices and flawed decision making. True hope takes into account the real threats that exist and seeks to navigate the best path around them.

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.