“Hope is the thing with feathers” 

I recently had the privilege of caring for a 73-year-old-woman with schizophrenia and low mood. She begrudgingly presented to the hospital after her family called emergency services. The family supported her ability to live independently by supplying groceries, providing transportation, facilitating payment of monthly bills, and assisting with medical appointments. Recently, however, her paranoia and depression escalated to the point where she would only communicate by shouting through her locked apartment door; this went on for weeks. By the time she arrived at the hospital she was unable to walk and was admitted directly to the intensive care unit for heart failure and a large pulmonary embolus.   

When we first met, she was irritable, demoralized, and refused to take any medications. Despite this, during that first meeting, my bracelets caught her eye, and this became a topic of shared interest and common ground—our mutual love of jewelry. The next time we met, she was quick to firmly state she didn’t care to talk with me. I pulled up a chair, acknowledged her feelings, worries, and concerns and then, rather than diving into a more direct method of assessment, asked her about the issue of “Vogue” magazine on her bedside table. We chatted about her love of fashion for a while, and before long, her nurse arrived with the scheduled medications. The patient reflexively refused with an emphatic “No.” When I reminded her of the purpose of the medications and her own previously stated goal of being healthy enough to leave the hospital, she acquiesced, with a bit of gentle grumbling.  

Remaining present and engaged through the intensity of her initial refusal and giving kind reminders of the medication’s purpose was key. She improved and was downgraded to the medical floor where I saw her daily for two weeks; each time either hand delivering her medications to her or assisting her nurse to do so. I called the family, who thanked me for this humanistic care, which they’d rarely experienced. 

So, what is the hope in healthcare? The hope is that patients receive the excellence in clinical care that they need; the hope is that they have a connection with their healthcare team so they can embrace the intensity of receiving difficult news; the hope is that kindness is provided so they have the time and space to be human; the hope is the relationship that the healthcare professionals build with the family allows them to grieve, cry, or laugh as needed.

The bird in Dickinson’s renowned poem, “’Hope’ is a thing with feathers,” symbolizes the hope within each person that perches in the soul; as healthcare professionals it is our privilege to share this with patients.  

Clinical pearls:  

1. Embrace patients’ irritability, sadness, fear, or joy, and meet it with compassion, kindness, and understanding. 

2. Work with patients’ families to establish trust.

3. Build a therapeutic relationship with patients by taking time to learn what’s important to them as an individual.

4. If a patient refuses care, explore why in a nonjudgmental way.

5. Pull up a chair; show that you’re taking time to actively listen.

“Hope” is the thing with feathers –

That perches in the soul –

And sings the tune without the words –

And never stops – at all –

—Emily Dickinson, 1891 

 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.