Where there is life, there is hope … or is there?

By Joyce Alexander, RNP (Retired)

One of the things I was raised to believe was, “where there is life, there is hope.” It was one of the precepts I was taught to believe to always keep “hope” alive.

In the last few decades, there have been many advances in the medical profession’s ability to save people that not long ago have surely would have died. My grandfather was one of the early members of my family who was “saved” from a sure death from pneumonia by the first “sulfa drugs,” antibiotics. It was a miracle, as he was already thought by the doctors to be “sure to die,” but he returned from the very brink of death and survived.

With cardiopulmonary resuscitation (CPR) and advanced CPR and defibrillation equipment, people have been saved from death by choking and the occasional heart attack, from being unable to breathe for themselves for a time, etc. The media, however, have led the general public to think that there is “always” hope of someone, even when they are comatose, reviving, waking up and hanging on to life.

The truth, however, is that even with these many advancements, there is still only limited hope of someone who is in a deep coma waking up and walking out of the hospital and living a full life. The truth is that there is not always a realistic hope.

Trying to resuscitate

Having been a member of my local volunteer fire department for many years, I was one of the first responders to many car wrecks, strokes, heart attacks and traumatic injuries of all kinds. Even if the person was non-responsive and I could look at them and know for a certainty that there was no “realistic hope,” I would do CPR on the person, unless there was a do not resuscitate order. In working in hospitals, I followed the same protocol, “doing my best” to keep the person alive.

In working in intensive care units, I have seen futile resuscitation attempts made on very old and very sick people that there was absolutely no chance in Hades that they would ever wake up, much less live any kind of quality life. I have seen children kept on respirators for decades because their parents could not give up the hope that their child would one day wake up and go home with them.

In our personal lives as well as in medical care, there are people who cling to unrealistic hope to the point that they sacrifice so much to hang on to that hope. In psychology, we call that unrealistic hope “denial.” But I have also coined the term “malignant hope” to, I think, better describe the results of continual, long-term denial.

Denying cancer

A patient came to me once with a large infected abscess on her breast. It was obviously infected, so I gave her some antibiotics to treat the infection, but I asked her, “Have you had a mammogram?” She said to me, “No, I don’t get mammograms because if I have breast cancer, I don’t want to know about it.” My consulting physician then spoke to the woman and insisted that she get a mammogram immediately, which she reluctantly did, and yes, she had advanced breast cancer. The lesion that had become infected had not arisen “over night.” It had been there and easily visible for some time. I am sure that this woman had seen the many public service announcements on television about women needing to be screened for breast cancer by regular examinations and by mammograms and self examinations to feel for “lumps.” Yet, she was afraid to find out the truth.

This woman had known for months that there was “something wrong” with her breast, that there was a lump there, but she clung to “malignant hope” in her denial, because the thought of having cancer was so painful to her that she could not accept that there might be something there she should do something about. She continued to endure the anxiety and pain from the lump, but she could not do anything about it as long as she maintained the “malignant hope” of denial. Denial keeps us from taking action.

In this woman’s case, she did not (the last I knew) die from her cancer, but she had a much harder treatment regimen than she would have had if she had done something about the lump when she first noticed it. Her denial, her “malignant hope” that she might not have cancer, was counter productive to her healing. To her very survival.

Malignant hope for change

When we are dealing with psychopaths in our lives, we want to have “hope” that the person we love will somehow turn out to be a better person than we are seeing evidence of. We want to hold on to that hope, rather than admitting that there might be no hope that they will reform, repent, or become whole. We cling to the denial, the malignant hope, that if we just wait, or if we just treat them better, or do more to show them that we love them, that what we dread and fear will not come to pass.

Just as people who are “brain dead” can sometimes be “maintained” on “life support” (I prefer to call it “death support”) for extended periods of time, we maintain our relationship with the personality disordered at great cost to ourselves and our lives in the malignant hope that will never be realized.

There comes a time in medicine when we must admit that we cannot prolong life, only prolong the dying process, and there comes a time in our personal lives when we must accept that we cannot improve or prolong a relationship with someone who is disordered.

Cutting the disordered, the malignant personality, out of our lives is likely to be a painful process, just as surgery to cut out a malignant tumor is sometimes painful and disfiguring, but it is essential to our health and sometimes our very survival. If we remain in our state of denial and malignant hope, our resources will be used in a vain attempts for cures that can never benefit either us or the personality disordered person we love.