Hope and False Hope

In one of my clinicals, there was a patient that had been in the hospital for a while.  Most of the nurses on the floor had had them as a patient on one shift or another and I caught the report from the one nurse to the oncoming nurse regarding this patient.  There was a moment of grief for this individual, that they were going through a rough time and were still in for a difficult recovery.  I had already interacted with this individual earlier in the day, ignorant of the full complexity of this history.  

I took a moment to reflect back on my actual experience with the patient earlier that day, with this additional information from the seasoned nurses.  Did I say anything that was flippant about the patient's situation to the patient?  Did I give false hope anywhere it wasn't warranted?  Did I explain elements of their care that they already knew fully but were just too polite to say something?  

I worry about that hope one more than anything.  Hope is as necessary as it is dangerous.  Normally, I can supply this for myself when I need it, but there are times when I have to work up to it, to help process what I need to.  I've had people try to give me hope when I wasn't ready to accept it, using it to slap a smiley sticker over a gaping wound that I needed to process.  That first major stint at Mayos, when my surgery failed, I kept a lot of my emotions in check (*cough* more like buried *cough cough*) and remained upbeat on the surface, focusing on the work that needed to be done:  I remember my cracking point.  

Vancomycin is a powerful antibiotic.  Thing is, your kidneys can only take so much of it, not to mention the other stresses my poor kidneys were also working through.  They were shutting down.  As evidence, I had some SERIOUS positional edema with legs like tree trunks and a very obvious difference in which side of my body was angled lower last.  We were starting to float the idea of dialysis.  In the midst of this, we were starting to at least discuss when I might be going home.  Finally.  We had a day lined up, started sharing the news and making plans, and the poor kidney specialist came in to tell me my creatinine was too high and I couldn't leave.  

I shattered.  The tenuous control was ripped away, and I had a damn cathartic cry, much to the horror of said specialist (who, at this teaching hospital had only just been given my case early in their new rotation, no less).  

It wouldn't have hurt so damn much, though, if I hadn't finally considered something larger to hope for other than my default for that month of "maybe tomorrow will be better."  

[Bonus sidebar:  there was an incident after that still enrages me to this day, where one of the new doctors that rotated in came into my room with a mock pouty-face and said "I hear someone's having a bad day."  As a reminder I A) was 25 and B) had been in and out of the ICU for a month at this point.  In therapy, I have reimagined telling him to fuck right off--it helps a bit.]

So, where's the line between false hope and actual hope?  Where's the line between what's possible and what's likely?  Where's the line between helpful hope and hurtful hope?  And how can I ensure that my patient gets the kind that they need in that moment?

I don't know.  So in lieu of an answer, I want to offer less smiley face stickers and more listening.  There are enough other people around to help throw in some platitudes that I certainly don't have to add those into the mix.  I can offer my personal experience--particularly regarding a full, articulate experience of living with an ostomy--but I also don't want to cover pieces where the patient needs to find their own expression.  AT THE SAME TIME, I want my patients that do need hope to see it reflected in me, to voice those places where things may be rough in this moment but are not a permanent hindrance on their life.  

...yeah, this is going to take some specific intentionality again.