She was gorgeous, with long blond hair that was the envy of all her friends. Typically, such beauty is intimidating to other women; however, Julie’s external beauty was overshadowed by her inner attractiveness. She was a warm, generous soul. As a result, she enjoyed a rich life centered on her faith, family, and countless friends.
Julie became a mother in her thirties and somehow managed to balance a career and family life with unusual grace. In fact, she eventually found pleasure in mentoring young mothers as they struggled to juggle the responsibilities of work and home. By age 40 she had two beautiful school-aged daughters, and she stayed busy volunteering and managing all the roles of her life.
Julie began to feel excessively tired, she did not think it unusual. She attributed her weariness and occasional dizziness to her hectic schedule (and perhaps her age). But then one night getting up from the dinner table, Julie blacked out and fell, her head narrowly missing the countertop. Her husband Jeff jumped up to catch her without success.
“Julie! Julie!” he shouted, as the girls began to cry. Julie said later she could hear their voices as if at the end of a tunnel. She struggled for what seemed like minutes (it was actually only seconds) to lift her heavy eyelids. When they slowly fluttered open, her husband’s worried face was hovering over her, her teary-eyed, scared girls, were visible over his shoulders.
“I’m okay, I’m okay,” she mumbled. “I think I just stood up too fast. I must be tired or dehydrated, or both.” Seeing the fear in her family, she tried to sit up and comfort them with hugs. Jeff told her to lie down and started to call 9-1-1. Julie talked him out of it.
“No, don’t call an ambulance, I’m feeling better. Really. I just have been going too hard, and I stood up too quickly. I’ll take it easy tonight and call the doctor tomorrow. If she wants me to come in, I will, I promise.” Jeff agreed to this compromise, and the four of them then cuddled on the couch watching a movie together. Julie would later remember that night as “the night of innocence.” A night spent blissfully unaware of the path they were about to walk.
Julie’s go-to physician was her obstetrician/gynecologist, the doctor who had delivered both her daughters. She was able to get in the very next day. As she described her symptoms, she mentioned some abdominal discomfort she had been having off and on for perhaps three months. She had found minimal relief taking a lot of antacids. “It’s not a pain,” she explained, “More of a bloated feeling, a dull ache. It’s hard to describe.”
The doctor asked a few more questions, and Julie admitted to not having much of an appetite. The doctor recommended blood work, and they scheduled a follow up in two weeks.
Imagine Julie’s surprise when she got a call two days later that the doctor wanted to see her as soon as possible. Her lab results were concerning, the doctor said. Julie was profoundly anemic and had blood in her stool. She needed more blood work and a gastroenterology consultation.
The next three weeks were a blur (even more than usual) as Julie and Jeff shared the care of their daughters and went from one medical appointment to the next. Through all the additional tests and consults, uneasiness grew into full-blown anxiety. Most nights they found Fear piled up on the couch with them, an unwelcome visitor.
On a sweltering Southern day – the sort of day that Julie normally would have taken her girls to the beach – the couple found themselves sitting nervously in the office of a specialist. They were waiting for the results from a test earlier that morning. The doctor had asked that they both be there to discuss the results. Julie noticed as he entered the room that he seemed to be ruffling his papers quite a bit, looking down, avoiding eye contact. Finally, he cleared his throat nervously and said softly, “I’m sorry to have to tell you this, but your biopsy results are consistent with cancer.”
What Julie heard was, “Cancer! Cancer! Cancer!” Stunned, she looked to her husband, as if to say, “Why is he screaming at us?” She then realized that the screaming was in her own head. She had been hoping that word, the “C” word, would never become her word, her wife, mother, young busy life word. Shocked, she sat back in a daze, noticing for the first time the black second hand ticking its way around the clock just above the doctor’s head. She could see the doctor’s lips moving, but all her faculties of hearing and processing and questioning were temporarily disabled.
That night Julie and Jeff held hands in the dark, crying, praying and crying and praying some more, until they were all out of tears and all out of words. Her final thought before sleep? If only I had known…
* * * * *
Whether we are young or old, busy or slowing down, faith or no faith, hearing a doctor say a word like Julie’s “C” word takes our breath away and renders us unable to think. Even in our deeply grounded faith, the prospect of life change, dramatic life change to the possibility of dying and death, will shock us. The smoothly spinning top of life, begins its first wobble.
Thankfully, along the way we find, if we are at all observant, there will be unexpected moments that catch us by surprise and give us new hope. In the most unlikely places, we discover blessings: faith from another, needed strength, fresh courage, a measure of peace, a beautiful memory, an awareness of the aroma of the rain or the sensation of a tear gliding down one’s cheek. An invisible presence of the Lord, helps us spin upright once again.
* * * * *
Like his wife Julie, Jeff was too shocked by the words the doctor was speaking to clearly grasp all that was being said. This is not unusual in most instances of a new diagnosis. Upon hearing grim news, most patients (and their loved ones) are incapable of knowing hope. They cannot fathom a life with a time stamp on it. No one saw this coming. A life is now interrupted and is facing a sudden detour onto an unfamiliar, twisty path with an unknown destination.
Julie and Jeff chose to seek a second opinion at a respected cancer center. They were more prepared for that visit. The couple sat across from a doctor who confirmed Julie’s diagnosis but then offered more hope in terms of specific treatment options. Julie quickly came to trust and like this new doctor. Though still fearful, she and Jeff found comfort in leaving with “a plan.” While her diagnosis certainly interrupted their life, having a plan allowed Julie to continue to be who she was: wife, mother and friend. More importantly, she found a new and better word to replace the “C” word that had previously terrified her, the word hope.
* * * * *
Hopelessness kills, if not physically, then emotionally and spiritually. This is why I consider it vital for clinicians, family members and friends to speak hope into those who are struggling with debilitating and terminal illnesses. Patients need to know where to look for hope.
Hope can come in many forms: hope through faith, hope that they will receive the best care possible, hope for a cure (or at least a few extra months or years), hope for a decent quality of life, hope for less pain, hope that loved ones and friends will stay close by to the end, hope that one’s suffering might be minimal, hope that one’s life and legacy will make a lasting difference.
Ultimately, as patients understand that their number of days is few, some are also able to find genuine hope in what comes next. They confidently expect a life beyond death, a life free of suffering, a world where, to paraphrase author J. R. R. Tolkien, everything sad is going to come untrue.
For the dying, hope can also extend to those left behind: hope for their futures, hope for comfort from their grief, hope that their lives will turn out, not just okay, but happy. I have noticed that some of my “end-of-life” patients who were previously convinced that this life is all there is began to rethink their views. Some began to hope that they had been wrong. Others steeled themselves in hope of the nothingness they believed in – “from dust to dust.”
One author has stated, “The reality is that in the interval between the start of hope and when the outcome occurs, you don’t know what’s going to happen. The ego-mind dislikes not knowing. Feeling hope is a way of avoiding the discomfort of uncertainty.”
In other words, hope in this case would be described as a mere compensatory mechanism of avoiding uncertainty. There may be a molecule of truth in that statement; however, hope does not always help people avoid the discomfort of uncertainty. Hope and uncertainty often co-exist.
No, hope has a bigger purpose, a greater calling. Hope is a source of strength that enables one to continue on by focusing the mind on a future minute, hour, day, life, or eternity that is different from the current momentary circumstance. I appreciate the writings of Dr. Jerome Groopman, a hematologist/oncologist and author, on this subject. In describing his quest for how to care best for those with severe illnesses, he wrote, “Hope gives us the courage to confront our circumstances and the capacity to surmount them.” 
The power of such hope is clearly seen in a poem written in 1944 by Michael Flack, a child held in the Nazi concentration camp of Terezin. 
“On A Sunny Evening”
On a purple, sun-shot evening
Under wide-flowering chestnut trees
Upon the threshold full of dust
Yesterday, today, the days are all like these.
Trees flower forth in beauty,
Lovely too their very wood all gnarled and old
That I am half afraid to peer
Into their crowns of green and gold.
The sun has made a veil of gold
So lovely that my body aches.
Above, the heavens shriek with blue
Convinced I’ve smiled by some mistake.
The world’s abloom and seems to smile.
I want to fly but where, how high?
If in barbed wire, things can bloom
Why couldn’t I? I will not die!
The trees, the sun and the sky became little scraps of hope that were grasped by the same tiny hands that were bloodied by barbed wire. Historians tell us that of the 15,000 children held iBarracks L318 and L417 only 150 to 1,100 lived the truth of the poem’s last line. 
Hope. Hope. Hope. Could this be the good word of a good death? Come to think of it, could hope be the primary ingredient in a good life? I am convinced that those who are near death and those remaining in life all need hope. We all need to know where to look and where to find it. I found my hope in Jesus Christ. You can too.
Hope. Is. Good.
* * * * *
Two years passed and Julie added many new words and phrases to her medical glossary. They were terms like chemotherapy, immune suppression, radiation therapy, palliative therapy, alternative therapy, nutritional therapy, metastasis, failure of therapy, comfort therapy and hospice. Stop. Stop. Stop.
One particular day near the end, she stared out the window, awed by the clouds in the sky and listening to the beautiful notes of “Clair de Lune.” It was at this moment that her final word became evident. Hope.
Julie’s journey, which began with her saying, “If only I had known,” drew to a close with her knowing the most important things. She knew the love of Her Savior and the reunion to come, the wonder of a loving family and friends, the marvel of music, the magnificence of a cloudy sky that had never been before and would never be again, the story of a life that she hoped would continue through her daughters. Despite her sadness, she saw it all clearly. Life with hope is beautiful, and…
Beauty. Is. Good.
I was on my way back home from taking my son to camp when Jeff called me. Julie had passed away that morning. I imagined the scene. Julie was there surrounded by family in her home, going home.
Julie taught me a lot during her short life. She was a true friend. I loved her deeply and miss her fiercely. I find comfort in knowing her path.This is the path in which we can travel. It is the path of life and dying and death while walking with hope.
 Tolkien, JRR., Return of the King (New York: Houghton Mifflin Harcourt, 1967).
 Frazier, Jan., The Freedom of Being at Ease with What Is (San Francisco: Weiser Books, 2012), 201.
 Groopman, J. MD, The Anatomy of Hope (New York: Random House, 2003), 14.