How to face medical diagnoses with hope | Mark Pochapin, MD | TEDxNYU Langone Health

When teaching medical students about gastroenterology, the speaker brings patients into the classroom, emphasizing that patients are the best teachers and that caring for them differs from answering exam questions. Patients share their experiences with illness, symptoms, and vulnerability, leading to a discussion of differential diagnoses. Crucially, the speaker asks patients what they want future doctors to know. Patients consistently express three desires: they want doctors to listen, truly care about their outcome, and most importantly, provide hope. The speaker distinguishes hope from a mere wish, explaining that a wish is fleeting, while hope is an active pursuit, the "fuel, the journey, the struggle, and the destination." In the context of illness, the medical profession must offer not just excellent medical care, but also genuine hope, not false hope, which can be dangerous as it breaks trust. Setting realistic goals is key to remaining grounded yet hopeful. The speaker recounts a personal experience when doctors told his mother, who was no longer responding to cancer treatment, "there's nothing more we can do for you." This left his mother feeling hopeless during her final nine months, which involved intravenous feeding, drainage, frequent hospital visits, and ultimately, hospice care. He believed he had given up hope until they met Dr. Michael Brusher, the hospice director. Dr. Brusher greeted his mother with kindness, promising to "restore" her. While a cure wasn't possible, Dr. Brusher and his team provided pain relief, enjoyable activities, music, and quality time with family, allowing her to embrace her cherished roles as a mother and grandmother. His mother died peacefully, with a musician playing her favorite song. The speaker emphasizes that while hoping to live forever is unrealistic, hoping for peace and comfort at the end of life offers dignity. The speaker then shares a story from 1997, at the height of the AIDS epidemic. He was asked to place a feeding tube in Tom, a patient with end-stage AIDS, to enable him to participate in a clinical trial for protease inhibitors. Tom was severely malnourished, and the speaker feared he wouldn't survive the procedure. However, with Tom's consent, the tube was placed, and he tolerated it. Three months later, the infectious disease colleague called, not to report Tom's death, but to request the tube's removal because Tom was "alive and well." Tom returned to the office transformed—energetic, having gained over 20 pounds. The feeding tube was removed, and Tom was seen again 15 years later for a routine colonoscopy, and then 10 years after that for another. Tom is present in the audience, illustrating that "miracles can and do occur." Breakthroughs in medicine can feel miraculous, with new drugs and clinical trials potentially leading to future cures. Finally, the speaker recounts the story of Renee, an 84-year-old woman seeking a second opinion for a pancreatic growth. Other doctors advised her to simply "get her things in order" due to her age. However, Renee, an active and engaged woman, refused to give up hope. She expressed a desire to live long enough to dance at her grandson's wedding, even though he wasn't yet engaged. The speaker explained the aggressive nature of pancreatic cancer and the possibility of focusing on comfort if treatment failed, a lesson learned from his mother's experience. Renee underwent surgery, chemotherapy, and radiation, doing "extraordinarily well." She became an advocate and spoke to medical students annually. Six years later, the speaker danced at Renee's grandson's wedding. Renee lived nine years after her diagnosis, dying at 93 from an unrelated cause. While not all patients with advanced pancreatic cancer will have Renee's outcome, many gain precious quality time through treatment. The speaker concludes by reiterating that hope is essential to medicine and life. Whether it's hope for a cure, a new treatment, to witness a significant life event, or even for peace and comfort at the end of life, "there's always something we can do for you and there's always hope."