Four hopes (advice for a sick person)

When we fall ill, it can happen that, even if the illness is not extremely serious, many thoughts and worries cause us to suffer. It may also happen that the illness is severe, and a careless doctor, concerned about not being misunderstood or raising false hopes or potential lawsuits, delivers bad news in a cold and impersonal manner. Fortunately, many doctors have a special sensitivity and are attentive to psychology, but some are more technical. As a result, it can sometimes happen that we experience the trauma of a prognosis that is not only unfavorable but is further worsened by words that leave no room for hope, delivered without much compassion—or, paradoxically, with excessive pity, which can also be harmful.

To survive these emotional tsunamis, it is essential to know that every patient, regardless of the severity of their condition, can always hold onto the four hopes listed below (which become five for those with religious faith):

1) Hope of not dying soon (i.e., a prognosis is just a statistic). Medicine can never make exact predictions, even for very advanced diseases. Sometimes, patients deemed hopeless survive far longer than expected. In essence, a prognosis is nothing more than a statistical number, a probability, not an absolute truth. Understanding this allows us to cultivate hope for this world and this life. Doctors know well that some patients surprise with unexpected longevity. For those seeking something even more radical against medical certainties, there is a (scientific) website that collects cases of inexplicable and unexpected recoveries: https://noetic.org/blog/ions50-spontaneous-remission/. Among these cases, as you can see, there are even advanced and metastatic cancers.

2)Hope of not suffering (serious illnesses often don’t cause more suffering than minor ones). Some may be shocked and, based on their own painful (and unfortunately undeniable) experiences, think I’m delusional. However, at any level of severity, if a good palliative care service is promptly activated, one should not expect to endure prolonged torment, even at the end of life. The medications available today can adequately treat the worst symptoms of diseases, including psychological ones, with the exception of fatigue, which is not always manageable (though it’s rare for fatigue alone to cause anxiety; at most, it raises concerns about the future of the illness). Therefore, it’s not accurate to say that certain diseases inevitably cause immense pain: they do so only if adequate palliative care, managed by experts, is absent. 

A prominent pain management scholar, Patrick Wall, notes in his book “Pain (The Science of Suffering)” that sometimes severe bodily injuries (like being pierced by a bullet or losing a leg) generate less immediate pain than smaller, less concerning injuries (e.g., the excruciating, yet benign, trigeminal neuralgia if untreated). Extending this reflection, we can say there is no direct correlation between the severity of a disease and the intensity of the pain it causes. This means that while life can bring intense pain, it’s not guaranteed to occur with serious illnesses. Paradoxically, it’s often harder to adequately treat pain when the illness isn’t severe (for various reasons, including the fact that non-serious conditions may not involve close monitoring by pain specialists).

3) Hope that death is not the end (even from a rational perspective, death might not be the end of everything). Even for those who are not religious, it’s important to know that science still cannot say what happens to a person after death. Several respected scientists (e.g., Federico Faggin) do not rule out the possibility that our deepest consciousness might survive the death of the body. After all, many great scientific minds were religious (e.g., Isaac Newton, Galileo Galilei, Blaise Pascal, Gregor Mendel, Louis Pasteur, Max Planck, Michael Faraday, and contemporary figures like Francis Collins and Fabiola Gianotti; even Einstein, in a sense, was a believer). This faith implies that the mind does not end its journey with the body. 

Consequently (unless these great minds were schizophrenic!), this kind of “immortality” is compatible with and not contradicted by mainstream science (I’m not saying it’s proven, only that it’s not disproven). In essence, no one has ever proven that death is the end of everything, nor that the brain is exactly the same as the mind (the brain certainly dies, but the mind may not).

4)Hope that death is a beautiful experience (sometimes a “paradise” is encountered). The moments leading up to death can be extraordinarily beautiful and meaningful, as shown by accounts from people who have “returned” to tell us about it (e.g., the world-renowned neurosurgeon Eben Alexander, with whom I had the pleasure of a valuable epistolary exchange on the state of consciousness in the dying). There are well-known websites that collect these NDE (near-death experience) accounts. Skeptics point out that these events could result from biochemical changes in the brain, which is why I’ve chosen to refer to the “moments leading up to death” rather than death itself, to avoid complex and non-scientific discussions about the afterlife. Whether biochemical or not, these can be, in any case, beautiful experiences.

5) Hope of reaching the Absolute Mind (the purpose of life, according to major religions, transcends this world). This point, of course, applies only to those who are religious. For these patients, it’s important to remember that the body is only a temporary home, and all mystics of major religions have shown that the purpose of life is not to cling desperately to this body but to unite with the universal Mind of love, detaching from one’s small self (this Mind is called Buddha, God, Allah, Krishna, Shiva, depending on the culture). In this sense, an illness does not come to destroy what we hold most dear (especially love, understood as the foundational sentiment at the core of the mind) but rather to advance us on our journey.

The mind, with its thoughts and feelings, not the body, is often the source of the worst pain. Therefore, in case of illness, it’s essential to seek help and listen to friends, psychologists, spiritual counselors, or meditation teachers. Never assume that a given situation must inevitably lead to depression or despair. I will discuss how to manage the mind and address physical and psychological pain in a future article.

Davide Corvi

davidecorvi@gmail.com