“Hope” is the thing with feathers –
That perches in the soul –
And sings the tune without the words –
And never stops – at all
– Emily Dickinson
I scurried to keep up with the team as we weaved through the crowded hallway toward the elevators. We had just finished seeing the last patient on our consult list in the surgical ICU. We passed other teams who were also finishing rounds and several visiting families as we headed through the double doors.
Just as I was about to step through, a woman rushed past me in the opposite direction, her eyes down to the floor. “Are you okay?” I asked. Looking up at me, she blinked hard as if she had forgotten where she was. A single drop rolled down her cheek. “Just waiting for someone,” she said quickly. Then, shaking her head, “Waiting for a miracle.”
A miracle. Each day in the hospital, countless patients and families hope for a miracle. For some, it’s hope for a cure. For others, it’s for relief, a brief respite from excruciating pain or suffering. For still others, it’s hope for an improved quality of life, to walk again one day, or to spend some more time with their grandchildren. Even when the word “hope” is not spoken, hope is perched in hospital rooms, operating rooms, and the quiet of patients’ homes. Its tune echoes in the “How much time do I have left?” and the “Will I make it to my daughter’s wedding?” Its melody is present in every beat of the monitor, whoosh of the ventilator, and whir of the blood pressure cuff as it cycles again. Night and day, a ceaseless rhythm.
When I first met Mr. R, he had already been in the hospital for three weeks. He had walked in for a relatively routine procedure, but complication after complication arose. When I opened his chart to review his case, I was overwhelmed by the sheer volume of notes: five surgeries in two weeks and what seemed like hundreds of consultant notes from general surgery, hematology, and cardiology, to name a few. Even before meeting him, the severity of his condition was clear from his chart. When I walked into Mr. R’s room for the first time, his eyes were closed. The room was crowded with medical equipment: a continuous renal replacement therapy (CRRT) machine, drips hanging from IV poles, and plastic buckets of wound dressing materials strewn on almost every available surface. I called out in a near shout over the roar of the CRRT and ventilator, “Mr. R, can you hear me? Mr. R, can you squeeze my fingers?” No response. When I gently touched his shoulder, he stirred, but it was clear that even slight movement caused an unimaginable amount of pain. As I listened to his heart, trying to use the least amount of pressure possible with my stethoscope, I could not help but wonder, Where was the hope?
A few days later, as I pre-rounded on Mr. R, I asked again, “Mr. R, can you squeeze my fingers?” Not expecting anything, I almost jumped when Mr. R’s fingers curled around my own. I squeezed back hard, as I felt hope flutter back into the room and settle in amongst the chorus of the beeps, whooshes, and whirs. Days passed, and I moved on to a new rotation, but part of my mind remained with Mr. R. I periodically checked his chart, and there was hope in the numbers. From afar, I joined his family in hoping for a miracle.
A few weeks ago, I opened Mr. R’s chart. I was excited to check in on him and see how his numbers had continued to trend. Instead, I was met with the message: “This patient is deceased.” My heart sank. In an instant, it felt like all hope had flown away.
In the days that followed, I cared for another patient, Mr. A, who was enduring immense pain, both physically and mentally. When Mr. A was admitted, he told me clearly that he wished to be DNR/DNI, and I assured him that we would respect his wishes.
I updated Mr. A’s daughter daily on the phone, and as Mr. A’s mental status declined, these conversations grew more emotional. Each day, I desperately searched for a shred of hope that I could share with Mr. A’s daughter. My previous patient, Mr. R, remained heavily on my mind. My heart broke as I struggled to explain to Mr. A’s daughter that he was at risk of losing his airway. Though we would do everything we could to prevent his condition from worsening, if he could no longer protect his airway, we would not intubate him given his code status. Through tears, his daughter said, “You know, it’s hard… It’s not what I want, but I know it’s what he would want.” For her, hope was not merely about extending her father’s life—it was about honoring his wishes and ensuring that he spent his remaining days in comfort, surrounded by the people he loved. Just like for Mr. R, hope had been humming at Mr. A’s bedside all along.
As a medical student, it has been a privilege to observe some of the most emotional and private conversations that patients have with their care teams. It has been exceptionally meaningful to watch providers artfully navigate these conversations, joining the patient in their hope while also ensuring that they are adequately informed to have a realistic understanding of what lies ahead. As with Mr. R and Mr. A, even when reality points to a difficult road, hope can still carry the hearts of those suffering. Even when it may not seem like it, we can still cultivate hope—it just depends on what we are hoping for. When the end of this life comes, maybe hope has not flown away, but rather has soared to new heights – a better place, where suffering has ended. So, we keep hoping, keep holding the patient’s hand, keep accompanying their families through the end. Hope is never truly lost—it’s up to us to hold it close.
Shanelle Mendes is an MS3 at the Perelman School of Medicine.
