A recent article in PlainViews asked the question, “How can we as healthcare chaplains help our patients look further down the road with hope?”  This is a significant question, especially in the hospice setting, as so many see terminality as the cessation of hope.  There are still occasions where family members ask us not to mention the disease to the patient, or not to mention hospice at all, as doing so will cause the patient to “lose hope” and die in a pit of despair and sadness.  Sometimes this does happen, but from my experience it is very rare.

It is true that a terminal diagnosis often causes or represents a loss of hope for the patient and the family.  The future that was planned for seems lost.  There can be last grasps at miracles, medical or otherwise, in order to make things as they were before the diagnosis.  It’s not surprising that the loss of hope comes with so much grief.  The question remains of how we can help patients and families look forward “down the road” when the road seems to have run out over a cliff.

In these circumstances, the chaplain can help by reframing what hope is and what is hoped for.  One must first recognize those losses, including lost hope, and find meaning in them.  When the meaning of what was hoped for is understood, it may be possible to find other resources to maintain that meaning, or find new meaning out of the shards of what was lost.  For example, a family has just been told that their aging mother, who always wanted to reach her 101st birthday, probably won’t make it to her 95th.  While recognizing the loss of that goal and the hope associated with it, the chaplain may work to find out what that birthday meant to her and find ways to celebrate than meaning in the here-and-now.

New paths of hope can be forged as well which had never been considered before: the hope that one can die at home, mend a broken fence with a family member, to choose not to endure undesired treatments, to live as one wants rather than as expected.

The loss of hope is not permanent.  The chaplain, through use of active listening and reflection and meaning-making, can assist by offering paths and opportunities which perhaps had not been considered, and by honoring the paths that are taken.

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