HEALTH CARE and HOPE

According to J.R.R. Tolkien, author of The Hobbit and The Lord of the Rings, there are two kinds of hope. These two kinds of hope are expressed by two different words in an Elvish language Tolkien invented. The words are amdir and estel. Both words can be translated by the English word ‘hope’ but they have different meanings. Tolkien defines amdir as “an expectation of good, which, though uncertain, has some foundation in what is known.” Amdir is akin to optimism, expecting good things based on evidence or experience. When, in a time of drought, a man calls the appearance of dark clouds “a hopeful sign,” he is expressing amdir, an expectation of good based on what he has observed. Estel is more like trust. As one of Tolkien’s characters expresses it, estel “is not defeated by the ways of the world, for it does not come from experience, but from our nature and first being ... [as] the Children of the One.”  Estel is hope in God. For some of Tolkien’s characters, it is an explicit hope in the divine creator. For others, it is an implicit trust that good will ultimately prevail. Unlike amdir, estel is not based on experience of the world. It is based on who God is and who we are as God’s children. Thus, even when amdir is lost, when all worldly experience points toward evil, estel need not be defeated. For it is based on something deeper that worldly experience: our identity as God’s children.

Tolkien’s distinction between amdir and estel can help us understand what it means for us to have hope, especially when we or our loved ones suffer illness or injury. One of our goals as health care providers and ministers to the sick and dying is to bring hope. We want to encourage our patients and lift the spirits of those who suffer. Tolkien’s distinction between amdir and estel can help us to recognize the different ways we can do that.

One way we can inspire hope in the sick and suffering is by showing them that good things are possible. Doctors do this when they emphasize the positive outcomes that can result from treatments or procedures. They also inspire hope by their own competency. Having a reputation for excellence and high rates of success gives patients confidence. Other caretakers inspire hope by encouraging the sick person to focus on the positive or providing examples of successful outcomes.

I count myself blessed to be able to encourage people in this way. I am a survivor of brain cancer and sometimes, in the course of my ministry, find it helpful to share my story with patients I visit. Very often, they find in my story a new reason to hope. Seeing that I have made a successful recovery, they are encouraged in the belief that they can too.

The sick can also find hope in the healing works that God has wrought in ways that defy our understanding. The Lord Jesus accomplished countless miracles of healing. By doing this, he inspired great hope and more people came to him to be healed. Many more healing miracles have been performed by the power of the Holy Spirit that is constantly at work in his Church. The sick rightly see these works of healing as a reason to hope. Through their prayers and the prayers of their loved ones, and through the intercession of the Blessed Virgin Mary and the saints, God can and often does accomplish mighty works of healing.

This kind of hope is what Tolkien’s elves would call amdir. It is the expectation of good results based on human experience. This kind of hope is very important for the effective care of the sick. It is important for the emotional well-being of patients and their loved ones. It is also important for bringing about good outcomes. When a patient has hope, the patient will be more likely to positively cooperate in her own care.

Amdir is good and important and we do well to cultivate this hope in ourselves and seek to inspire it in others. But this kind of hope can be false. A person has false hope when he is deceived, mistaken, or in denial about the possibility of his recovery or healing. A person has false hope when she presumptuously expects a miracle. Amdir can also be lost. When death becomes immanent or when treatment options are exhausted, it may no longer seem sensible to hope for recovery.

Estel cannot be false and cannot be lost. This hope is both similar to and different from amdir. In both senses, to hope is to anticipate good things to come. The differences are about what those good things are and on what basis they they are to be anticipated.

The basis for estel is the faithfulness of God. Hoping in God means trusting that God will faithfully fulfill His promises. We expect good things from God because God is good and God has been good to us in the past. We therefore trust that God will also be good to us in the future. In particular, we trust that God will be good to us in the ways that He has promised. God’s promises are given to us most especially in Sacred Scripture. In Scripture, God has promised to answer our prayers, to give the Holy Spirit to anyone who asks, to give eternal life to those who believe in his only begotten Son and to make all things work for the good for those who love Him. We hope to receive all those things because God has promised them and we can trust God to be faithful to His promises.

The good things for which we hope, in the estel sense of the word, are the good things God has promised us. These are the best things of all. But they do not include many of the good things we rightly desire in this life. God does not promise us good health and long life, success and prosperity, freedom from suffering and deprivation. These things are indeed good and we can hope for them and even hope to obtain such things from God. But this hope is amdir. It is hope based on our experience of the world for the good things that seem possible. God has blessed people with health and prosperity and deliverance. Based on that knowledge, we can hope that God might bless us and our loved ones in those ways. But God has not promised those blessings and some people do not receive them. Estel is about what God has promised.

In caring for the sick and the dying, how can we encourage patients and their loved ones to hope in this way? One answer is that we can pray for them. This is something that everyone can do. We can pray for the sick and the dying and we can pray particularly that they will be strengthened in hope. Serious illness can lead to despair. The sick and the dying face the challenging task of persevering in hope despite the possibility, perhaps even the certainty, of a future with bad medical outcomes. It is not easy to see beyond that future to the future that God has promised. We need to help such people with our prayers.

Another way we can encourage the sick to hope in God is by building them up with assurances of faith. When Jesus encountered Martha after her brother had died, He assured her of the truth that “I am the resurrection and the life.” Family members and visitors to the sick and the dying can encourage their loved ones to hope by reminding them of God’s promises and the assurance that God will be faithful to his promises. Chaplains and ministers to the sick are especially called to give this kind of encouragement.

Many heath care providers cannot offer this kind of encouragement in an explicit way. Professional standards may prevent clinicians from overtly witnessing to their Christian faith in God’s promises and God’s trustworthiness. Nevertheless, they can inspire this kind of hope through the way that they care for the sick. When a clinician demonstrates her respect for the dignity of the people in her care, she is a witness to hope. When a clinician says by her actions, “This person, no matter how ill and debilitated, no matter the prognosis or quality of life, is a being of inestimable dignity,” she is sending a message of hope. She is inviting the patient and the patient’s loved ones to look beyond the apparent hopelessness of their situation and recognize the source of their dignity in God.

Whenever we recognize the dignity of a human person, we implicitly acknowledge that that person is a child of God. And understanding ourselves as children of God is the ground of our greatest hope. We belong to God, who can be trusted to take care of his children. To believe that is to have a hope that cannot be proven false or taken away.