Chapter One

Introduction
The Anatomy of Hope

Why do some people find hope despite facing severe illness, while others do not? And can hope actually change the course of a malady, helping patients to prevail?

I looked for the answers in the lives of several extraordinary patients I cared for over the past thirty years. They led me on a journey of discovery from a point where hope was absent to a place where it could not be lost. Along the way, I learned the difference between true hope and false hope, and describe times when I foolishly thought the latter was justified. There were also instances when patients asserted their right to hope and I wrongly believed they had no reason to do so. Because they held on to hope even when I could not, they survived. And one woman of deep faith showed me that even when there is no longer hope for the body, there is always hope for the soul. Each person helped me see another dimension of the anatomy of hope.

Hope is one of our central emotions, but we are often at a loss when asked to define it. Many of us confuse hope with optimism, a prevailing attitude that “things turn out for the best.” But 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. Although there is no uniform definition of hope, I found one that seemed to capture what my patients had taught me. Hope is the elevating feeling we experience when we see–in the mind’s eye–a path to a better future. Hope acknowledges the significant obstacles and deep pitfalls along that path. True hope has no room for delusi