Numbers and Hope…Friends or Foe?
I find myself surrounded by numbers…I try to get away from it, and yet I land smack dab in the middle of numbers. I’m in the business of people and yet I recognize that this book is going to be crucial to my studies and surprisingly is one I am glad I purchased, and I plan to dip back in on a deeper level as it directly affects my NPO and the work I do. In hospice work and in healthcare numbers are everywhere, and it will affect all of us the older we get. Your weight, your height, your blood pressure and all the labs, your pain level…your white blood cell count. As you may guess, by the time someone comes to be in contact with me they have encountered so, so, so many numbers and mostly find with all those numbers they have lost HOPE! Are numbers and hope friends or foe?
I’m going to tell you my first encounter with death. A week before one of my best friends in college was going to graduate college with honors, she went into the hospital for a biopsy as they thought maybe she had mono and wanted to make sure her swollen lymph node was nothing. Well, it wasn’t nothing it was Hodgkin’s Lymphoma. Anecdotally, this is what they (medical community) say is the most “curable” cancer for a young person to get! That was a dose of hope we all appreciated! In fact, “the problem comes when you start using anecdotes in situations where things are more predictable-where the distribution of events isn’t straightforward” [1]. Hope comes from the generality of what the majority of patients experience through these anecdotes, that are most likely based on real numbers. The hope of cure came because 95% of patients who have this cancer are cured after one round of radiation. My friend, Tristen, did not respond to radiation, so she landed in the 5%. Okay, that happens, but guess what here comes real hope again, of the 5% who fail radiation, 99% of that 5% are cured through chemotherapy. We had hope with our friend for 3 years through chemo after chemo and stem cell transplants. I got the call right after Christmas 2003, that her last transplant didn’t work and there was nothing left to do. She moved on with hospice, and here I am supporting my 25-year-old friend as she married her boyfriend and died 3 months later. I have a lot of regret, and I’ve learned so much by working through those numbers that seemed “hopeless”, even now 20 years later, her faithfulness and hope continue to have a lasting impact on my and are part of my “Why” I work in hospice.
How many of us have faced the “odds”? Honestly, we all have, we just survived a pandemic, but did we? Or has our life changed, has our hope been recreated into something new because our reality has changed? Goodhart’s law seems to really explain how our mindset and definition of hope maybe changed based on the metrics, this law states “that when a measure becomes a target, it ceases to be a good metric” [2] I cannot think of anything that speaks to hope from a numbers perspective more than that, did we change or did our perspective on our hope change? I had a professor once talk about the difference between hope and hopes. Hope is a deep profound way of being especially when we have a savior who gifts us eternal life and forgiveness and grace. Hopes are the little things that we “hope” will happen, such as I hope I get a good grade on this blog. I hope I don’t get chosen in class to critique this blog, or I hope it doesn’t rain, or even as big as hoping this round of chemotherapy works! Isn’t it amazing how much hopes change, in Goodhart’s law, we change the “hopes” we have as we move through situations and things that are out of our control.
Hospice is all about numbers, and in the middle of that are families and patients who feel they have “lost the battle with the numbers” and are now often times hopeless, and going to die. We have real opportunity in medicine to make huge differences in people’s lives, especially when we can work at a macro level. We can have great sample sizes [3], statistical significance [4] and causality [5]and effect [6], and all the theories that black and white numbers give us…and yet we fall into the 1% of the 5% with whom this or that works, where can we find hope? I do think numbers give us hopes, but our “Hope comes from the Lord, the maker of heaven and earth” Psalms 121:2.
My friend Tristen was interviewed for a radio show during her cancer journey and it inspired a book by this radio show host. Here is the transcript of the end of this interview:
(host) Tristen, what would you say to people who are battling serious illnesses right now? What advice would you give?
(Tristen) They need Christ and prayer. The combination produces joy and hope. Hopefully, friends and family will raise their spirits. If they’re all alone, I suggest calling a local church and talking to a minister. The hope is there if they reach out for it.
(Host) What you’re telling us is there is hope in what might be considered hopeless?
(Tristen) Even if a situation ends in death, there’s still hope. I know that I’m going to spend eternity with Christ. There is nothing sad about it. It’s amazing! [7]
Wise words from someone too young to die and who had every reason to be bitter and angry about her situation. The “numbers” did not work out for her (though they did keep up spirits and hope for all of us) they also didn’t lie…nothing was 100%, except that she loved Jesus and her faith never faltered and has ripple effects even to this day. So… did I prove number and hope are friends or foe? I don’t know, I think it’s friends and foe. We need them, medicine needs them, but what do we do when the “odds” are not in our favor? What do you think?
[1] Chivers, Tom and Chiver, David. How to Read Numbers: A Guide to Stats in the News (and Knowing When to Trust Them). London, Weidenfeld & Nicolson, 2022 (16).
[2] Ibid, 158
[3] Ibid, 35
[4] Ibid, 21
[5] Ibid, 55
[6] Ibid, 43
[7] Dahmen, Jerry. I Love Life: The Real Survivors: 50 stories of Faith, Hope and Inspiration. Sioux Falls, SD. Pine Hill Press, 2005, 101.
About the Author
Jana Dluehosh
Jana serves as a Spiritual Care Supervisor for Signature Hospice in Portland, OR. She chairs the corporate Diversity, Equity, Inclusion and Belonging committee as well as presents and consults with chronically ill patients on addressing Quality of Life versus and alongside Medical treatment. She has trained as a World Religions and Enneagram Spiritual Director through an Anam Cara apprenticeship through the Sacred Art of Living center in Bend, OR. Jana utilizes a Celtic Spirituality approach toward life as a way to find common ground with diverse populations and faith traditions. She has mentored nursing students for several years at the University of Portland in a class called Theological Perspectives on Suffering and Death, and has taught in the Graduate Counseling program at Portland Seminary in the Trauma Certificate program on Grief.11 responses to “Numbers and Hope…Friends or Foe?”
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What a story, nothing is truly certain but “death”, but there is even hope with that. Thank you for sharing that story, I know that had to be a difficult season, but it seems like you both found peace in it. Our tradition reinforces this hope beyond death and there is some quality research and significant numbers that support this notion as well. Ironically, we both dealt with this topic when thinking about numbers this week!
Yes we did. It was a challenging time, mostly afterwards as I emotionally disconnected at the time, even when a bridesmaid in her wedding. It was beautiful and meaningful and yet I still thought we had time! Numbers have such a significant place for all of us! For me, I encounter people where the numbers did not work in their favor, and yet we are still a business and how many we are serving at a time needs to be more then where we are! It’s as much about money and balance as it is about being present to sacred moments. Churches can be about the same thing..more members=more tithes=more opportunity to offer ministry that is life changing! It’s hard to weigh the mystical next to the rational.
Thinking about the answer to your title question: I guess it depends on which side of the outcome you land… if there’s a 1 in 1,000,000,000 chance to win the lottery and you win, I suppose you would feel like that little slice of hope and big statistical obstacle became friends; on the other hand having a 95% chance of survival and not making it would be quite a blow.
Maybe that’s why even accurate numbers can lie, even when they are telling the truth. They can’t ever tell the whole truth but just part of it. So when we put our whole trust in the part of the truth they can tell, we’re missing the truth that transcends the numbers that has to do with what the Spirt might be doing.
Sorry for the etherial comment, I’m not even fully sure what I’m saying, yet, but I’m wrestling (in a good way) with your post and what it means for me and the people I serve. Thanks.
Tim, I think you are going were I was going behind all of it! Hope can’t be defined by numbers as it is part of the mystical. However, what we all do depends on numbers and money. I have found that hopes redefine themselves as they go, If you take my friends story, our hopes for her changed as we went. Truly healthy people are able to adapt and redefine hope perhaps? In the end, the Hope of eternal life really is a key part maintaining hope, where it goes sideways is when people don’t understand God’s grace or forgiveness…the not been good enough is a major part of my work with Christians who are dying.
anyway, I think you were digging deeper to what I was trying to say. Thank you for sorting through my writing like that!
Jana,
Thank you for sharing from your own personal grief story. You have truly walked in the shoes of those you serve.
Through the years, we have sat at many bedsides where the numbers served as foe and death was imminent. And yet, over and over again we witnessed the beauty of eternal hope that transcends death. This hope carried me as my own parents faced death as well in the last few years. As my father noticed me struggling with the fact that his days were coming to an end, he looked over and simply said, “This world is not my home. I’m not afraid to die.” Romans 14:7–8 states ”For none of us lives to himself, and none of us dies to himself. For if we live, we live to the Lord, and if we die, we die to the Lord. So then, whether we live or whether we die, we are the Lord’s.” What an amazing hope we have in Christ.
thank you Esther, this is probably the first significant loss I experienced. I had lost my grandmother, but there is something impactful as a 27 year old do watch someone younger than you die. She is part of my influence in the work I do. The longer I work with Hospice patients the more I realize her outlook and deep hope was unique. I sometimes get really shocked by the hopelessness my patients feel, and I mostly work with older adults. I think we all tend to live this life like we have forever and that death shocks us when it knocks on our door. Thank you for showing up to those who are nearing the end. Presence and hope are the greatest gift near the end.
Thank you for sharing your story and introducing us to Tristan. I have said this to you before, but I want to say again that the work that you do is truly God’s Work. I have experienced hospice three times (My Daddy, My Father-in-Law and, My Mama) and I know that I would not have made it without the support, care and consideration of the three wonderful Hospice Teams.
After reading your post and reflecting on those three experiences, I can see how closely tied your work is to numbers. I’ve thought of it as one of the most crucial forms of soul care, yet it is also about numbers. I don’t have a transformative answer to your question. When I odds were not in my Mama favor…I cried a lot, found joy in the memories, was grateful for the moments and prayed. I am thankful for your presence in the lives of the families facing the transition of their Loved One.
She truly was a bright star. I’m so glad you had a great experience with your Hospice team. One of the articles I’m using for my research is called “How Hospice became a for-profit hustle”. Isn’t that sad? Hospice is the highest reimbursed line of service by Medicare and there are some really bad eggs who are ruining it for the rest of us..and yet I know within every healthcare system, we need to pay our workers, and now days a lot more then before, but there are really good people whose hearts are in the right place.
Ms. Jana, first, I want to say I am sorry for what you have gone through with your friend and my prayers. Second, I would like to thank you for the message of hope. It is certainly true, our true hope rests in the Maker of the heaven and earth.
Hi Noel,
thank you and yes, Hope is everything. It seems to me, that it is nature or nurture? Some of us find comfort in hope and can easily adapt to what it means, while others struggle to feel hope the second they don’t get what they hope for, such as praying for healing. What do you think? Is hope something we naturally have or don’t have or is it something we can develop? Curious on your thoughts.
Thank you for providing a deeper picture of Hospice service in your context, Jana!
I’m curious, how does the health service in your context view a patient (yes, one person) who is socially not a socially important person who struggles with health/healing and struggles for life and death?