In listening to our terminally ill patients we were always impressed that even the most accepting, the most realistic patients left the possibility open for some cure, for the discovery of a new drug or the “last-minute success in a research project,” as Mr. J. expressed it (his interview follows in this chapter). It is this glimpse of hope which maintains them through days, weeks, or months of suffering. It is the feeling that all this must have some meaning, will pay off eventually if they can only endure it for a little while longer. It is the hope that occasionally sneaks in, that all this is just like a nightmare and not true; that they will wake up one morning to be told that the doctors are ready to try out a new drug which seems promising, that they will use it on him and that he may be the chosen, special patient, just as the first heart transplant patient must have felt that he was chosen to play a very special role in life. It gives the terminally ill a sense of a special mission in life which helps them maintain their spirits, will enable them to endure more tests when everything becomes such a strain-in a sense it is a rationalization for their suffering at times; for others it remains a form of temporary but needed denial. No matter what we call it, we found that all our patients maintained a little bit of it and were nourished by it in especially

difficult times. They showed the greatest confidence in the doctors who allowed for such hope-realistic or not-and appreciated it when hope was offered in spite of bad news. This does not mean that doctors have to tell them a lie; it merely means that we share with them the hope that something unforeseen may happen, that they may have a remission, that they will live longer than is expected. If a patient stops expressing hope, it is usually a sign of imminent death. They may say, “Doctor, I think I have had it,” or “I guess this is it” or they may put it like the patient who always believed in a miracle, who one day greeted us with the words, “I think this is the miracle-I am ready now and not even afraid any more.” All these patients died within twenty-four hours. While we maintained hope with them, we did not reinforce hope when they finally gave it up, not with despair but in a stage of final acceptance.