Several years ago, John and I sat in an oncologist’s office after what was supposed to be a major turning point in his cancer treatment.
The plan had been surgery. The hope was that the surgeon would remove the tumor and we could continue moving toward a future where cancer was behind us.
Instead, the surgeon stopped the procedure. Once he got inside, he discovered the cancer had spread further than scans had shown. The tumor could not be removed.
A few days later, we met with John’s oncologist. Trying to understand what came next, we asked what seemed like a logical question: Would John continue chemotherapy to shrink the tumor and then return for surgery later?
The oncologist looked surprised.
She explained that there would be no future surgery. John would need chemotherapy for the rest of his life.
I remember feeling stunned.
Not sad. Not angry. Just stunned.
We left the appointment and sat with that information. I don’t remember asking any follow-up questions. We had been given an answer, but emotionally, we weren’t prepared to absorb what it meant.
Looking back, I’ve thought a lot about that moment and why conversations about serious illness and end-of-life decisions can be so difficult.
It’s easy to assume that these conversations happen too late because physicians are reluctant to have them. Sometimes that may be true. But I think the reality is often much more complicated.
The truth is that many of us struggle with these conversations.
Patients struggle.
Families struggle.
Friends struggle.
Healthcare professionals struggle.
No one wants to be the person who takes away hope.
I sometimes think of it as a “hope bubble.”
When someone is facing a serious illness, hope becomes precious. It may be hope for a cure, hope for more time, hope for a meaningful milestone, or simply hope for a good day tomorrow. Hope helps people keep going.
Because hope is so important, we often work hard to protect it.
Families avoid difficult topics because they don’t want their loved one to feel discouraged.
Patients avoid asking hard questions because they are afraid of the answers.
Physicians may worry that conversations about prognosis or future planning will be interpreted as giving up.
Everyone is trying to protect hope.
The problem is that sometimes protecting hope leaves no room for another important conversation.
What matters most if things don’t go as planned?
A year later, I experienced a similar moment.
John’s health had reached the point where I needed to take a leave of absence from work to help care for him. His oncologist had to complete paperwork for my employer. It seemed like a routine administrative task until I looked down at the form.
The physician had written that John would require care for the rest of his life.
There it was in black and white.
Even though we already knew his cancer was incurable, seeing those words was jarring. Once again, I don’t remember asking questions. I simply sat with the reality of what I was reading.
That experience taught me something important.
Sometimes the barrier isn’t that information isn’t available.
Sometimes the barrier is that we are human.
We hear difficult news in pieces. We process it over time. We absorb what we can and come back for more when we’re ready.
But there is also a cost to waiting until illness forces these conversations.
When a diagnosis arrives, emotions are high. Fear, uncertainty, and grief often enter the room alongside the patient and family. Conversations become deeply personal because they are no longer hypothetical.
Before illness, however, the conversation is different.
Before illness, we can talk about values.
What makes life meaningful?
What gives us purpose?
What abilities are most important to us?
How do we define quality of life?
Who would we trust to speak on our behalf if we couldn’t speak for ourselves?
These aren’t really conversations about death.
They’re conversations about living.
We plan vacations, graduations, weddings, and retirements. We talk about our careers, our goals, and our dreams for the future. Yet many of us avoid discussing one of life’s only guarantees.
Not because we don’t care.
Not because we are irresponsible.
But because these conversations feel uncomfortable.
The irony is that having them before they become necessary often makes them easier.
There is no crisis.
No diagnosis.
No urgent decision that must be made before the end of the day.
Just two people talking about what matters most.
Hope and planning are not opposites.
We can hope for the best while preparing for the unexpected.
We can pursue treatment while discussing our wishes.
We can believe in possibilities while acknowledging reality.
If there is someone you love, don’t wait for a diagnosis to start the conversation.
Ask them what matters most.
Then share your answer too.
You may discover that talking about the future doesn’t diminish hope at all.
It simply helps the people who love you understand what matters most if they ever need to speak on your behalf.
