Hope?

 Linked to optimism, hope is an attitude or outlook that good things will happen and one's wishes or aims will ultimately be fulfilled. 

Camille Preston (October, 2021)The Psychology of Hope,https://www.psychologytoday.com/ca/blog/mental-health-in-the-workplace/202110/the-psychology-hope 

Hope is Not A Strength of Mine

I have a challenging time understanding and fostering "hope."  I am not the most "hopeful" of people. Though I score high in transcendence traits, according to a list put together by Positive Psychology .com, hope tends to elude me.   I look up at the definitions and see that hope has a lot to do with being optimistic about the future.  That might be partially why I cannot wrap my mind around hope and I seem to have so little in my life.  I am not overly optimistic about my future. Nor do I try to be.  I tend to put effort into "not thinking about the future" by telling myself I am a present moment being...and I focus my attention on noticing what is in my life right here and now, finding satisfaction and happiness in whatever is unfolding before me. I am great, fantastic even   and getting better at accepting and allowing "what is" to be. .. but I am not so great at believing things will get easier for me any time soon.  I have been conditioned to believe from my own past experiences that, "things don't always work out the way one wants them to"  Heck...let's take that a step farther into honesty...I often operate from a core belief  that says "things in my life seldom work out smoothly or the way I want them to."   Pretty Pessimistic, huh? 

Hope is an emotion characterized by positive feelings about the immediate or long term future. Often hope is coupled with high motivation, optimism, and generally elevated mood.

Good Therapy https://www.goodtherapy.org/blog/psychpedia/what-is-hope

It seems that way but it really isn't. My core belief definitely needs some tweaking  but my lack of hope is not necessarily a sign that I am "pessimistic" in nature. Well...not completely.  Truth is, things in my version of Life have not worked out to date in the easy and grace filled way I wanted them to. I have had more than an average amount of extraordinary challenges that I judged as "unpleasant" and "difficult" and they did not get much better for "me"  over time. Hoping did not make "me" feel better.  Because of that , I found a new way of coping with them: acceptance.I have learned to allow and accept what is to be as it is and that brings something better than hope...it brings peace. 

I Used to be Hope Dependent.  This is Why I No longer Am: 

Let me give you an example of a long term  life experience that led me to stop relying on hope...to stop looking toward the future for things to get better. I will start by telling you that   I am a fairly bright woman with a good sense of medical intuition which goes  beyond my scope of practice as a nurse/nurse educator. So whether you believe this or not, I knew something was going on with my ticker way back in 1993 when I first began "presenting"in the health care system  with my symptoms. I had a strong sense , from the very beginning, that this was familial and had a lot to do with the issues going on in my father's family.  Tests were done, many referrals were made and I seen a few specialists in the early years. When the initial tests just showed an issue with heart rate,  the first opinion was a common one offered to women back then..."anxiety", and a bit of "histrionics".  Though they shamed me deeply and though I outwardly denied them, I could not completely discount these diagnosis' then.  I could not say, in all honesty to myself, that  they did not have some truth and validity to them.  My cardiac symptoms began, after all,   the same time  as my  Post Traumatic Stress started to make itself known to me.  There was anxiety and there was also a great deal of "fear".  I had this incredible sense of doom every time the chest pain started...thus my insisting something was going on...thus maybe what appeared as "histrionics" to others.  So part of me believed those shame-inducing suggestions even though I persisted with finding a physical cause. I also knew they were not the whole truth to my situation. 

For almost thirty years I went back and forth between believing "they" were right and I was just loopy, imagining such symptoms and knowing in my core that I was right and there was some physical cause to my experience. I  kept going between  shame and fear...shame when I presented and was sent away, fear that if I did not keep pushing for a diagnosis I, or someone else in my family, would suffer. I went back and forth, back and forth.  

The chest pain was very, very real but it was seldom  considered to be a real thing by others....even when I had ST changes that  supported it. My chest pain became something no one took seriously.  For a while, I stopped taking it seriously. Though it was very challenging,  I pushed myself to do the activities I so loved to do.  I was actually a fitness instructor at the time, leading aerobic classes. I also ran, skied, snow shooed, walked and did yoga.  On top of that I had four small children to run and look after. One day, eight years after it  began,  I went into ER...with chest pain episodes (that were accompanied by near fainting and palpitations) I started to experience while at the gym. At that point, I worried  I would be sent home without an answer but I still had some hope.  I was lucky enough to be seen by someone who took the time to do the necessary tests and the next thing I knew I was in CCU waiting to be shipped out by ambulance to the regional cardiac unit. I even got my last rites as I was waiting to be shipped out.  The internal med strongly suggested that it was definitely my heart and  if it was not a blockage... it was coronary vasospasm and assured me they would  test me there for that and treat me.  When I arrived there, I had a cath  done...there was no blockage... but the cardiologist who seen me  did not test me for spasm...he did not think it was necessary in a young fit female like myself.  Others  heard the mitral valve clicking and that became a big thing among the medical students but after an echo to determine a mitral valve prolapse I was sent home, not knowing what was causing the chest pain. It was 911 and my little issue seemed so insignificant compared to what was going on in the world.  

I still had the pain and this overwhelming fatigue. It was suggested that I either see a rheumatologist or a GI guy to determine some alternative cause for the pain and fatigue. I agreed to see a rheumatologist though I was still quite sure it was the heart.  Before examining me, the rheumatologist sat me down to talk to me about my test seeking and explained how it was costing the tax payers money to have young women like myself "insist" on having such expensive and dangerous  tests, like cardiac catheterizations,  done that they do not need. Most of the hope I had left in me drained out  in his office. Still, besides a ton of shame and guilt, I left that appointment with a tiny  smidgen of hope  left within me.  His "opinion" was left on my medical chart and followed me where ever I went after that. The pain and symptoms did not go away though I did whatever I could for years after that not to mention them to anyone.   Though I eventually got a diagnosis of "coronary vasospasm" from a cardiologist in 2013 , twenty years after the pain started,  to support what I and one other  had been suggesting for decades  that it might be...to this date it is often dismissed as having any relevance. 

Even the valve issue, as benign as these things can be, was denied over and over...even when ultrasounds showed that it was there, even though the click-murmur was so obvious.  I was even called a liar to my face by an internal med when I insisted I had this issue and questioned if it was getting worse. I did my best to "suck up the symptoms"  and pretend everything was fine. But when my sister died of a sudden cardiac death at 45, the fear returned.  I was even more convinced this was familial. I persisted again  looking for an answer, not just for myself but my family. I was called a liar, I was told to stop "test seeking", I was referred to as an "interesting patient" ...like I was  some big medical joke. The symptoms got worse. I was able to do less and less. I was scared...so once again I began to present to the "ER" with my very real complaints. Though there were many kind and thorough GP's in the ER who took the test results and my complaints seriously ...the internal meds always seemed to refer to my chart and explain to me how I had so many tests done in the past that were not showing "enough" evidence to warrant concern or treatment. How my life was impacted by them was always dismissed with a shrug of the shoulders. I even had an internal med slip a piece of paper, with a latin word on it, in my hand on one ER visit, as he kindly told me to look up the meaning of his diagnosis for me when I got home...which turned out to be "Fat Folder Syndrome".  So much shame...just for insisting that something was wrong with my heart and possibly the heart of others in my family.  Eventually, in 2010 I had a stress echo done by a cardiologist that proved on top of three other echocardiograms that others dismissed over the years,  to myself at least that I was not lying about the valve. 

 I also knew I had atrial fib and flutter...I had been experiencing palpitations  for years along with the sudden increase and decrease in heart rate.  I even seen the evidence myself on a couple of reports while I sat in front of the internal med who had earlier  called me a liar as he told me it was just "muscle twitching".  Then when I mentioned the fluctuations in my pulse, he  told me again that I was lying about that.  Even though I had a run in his office while he was taking my pulse.  He was willing to prescribe meds for me then, only because I was"so insistent and so worried about this benign condition". It got to the point that I felt I needed evidence to prove to myself and others why I was  having such a hard time coping with my symptoms so I began to collect it myself...I began to record pics of my pulse readings from a running monitor I wore and from my BP cuff.  And it proved to me that yeah...my pulse is really going out of whack at times..up over 200 for no reason  and it is dropping into the 30's . Still no one would validate this truth for me.  A year after my encounter with this internal med who told me all I had was "muscle twitching" and that I was lying about everything else, he was cardioverting my brother who went into  a run, like I have been having for years,  after a stress test.  He ws taken very seriously.  I, on the other hand, was still just  a liar. Another familial connection that no one would put together. 

Hope- a feeling of optimism and anticipation about a positive future. 

Positive Psychology.com/ Courtney Ackerman ( March 23, 2022) Positive Emotions: A List of 26 Examples & Definitions in Psychology.https://positivepsychology.com/positive-emotions-list-examples-definition-psychology/

Though the hope was trickling down to nothing,  I persisted, with great, great shame, to find an answer for myself and my family.   I  walked away again and again with more shame, no answer. And as if manifesting what was going on in my mind...every test they did perform never showed "enough" evidence even though it always showed "some". The fainting starts. When I continued to insist something is going on, with the evidence of my own monitoring with me, I was sent to  a renown specialist for an EPS.  This specialist  seemed so nice at first, so willing to support me. The belief was that the fainting was not cardiac but vasomotor.  I was willing to entertain that possibility. When I asked about the chest pain, I just got that shrug of the shoulders I was was becoming so familiar with whenever I brang it up.   Still, my hope was actually renewed. Then out of nowhere everything changed.  Someone else did the procedure and he obviously read my chart before he did it because he treated me like a piece of you know what.  It took a while but I had a run...I also had very severe chest pain during the procedure. Though the report clearly stated that I had a run of fib and flutter...I was told there was none.  That it as perfectly normal.  There it is on the report so clearly in black print in front of me but I am told there was no fib or flutter and as for the chest pain I had...totally denied and dismissed. (My  hope is that the nurse put it in her notes...just to prove I am not a liar). I think the hope might have been nothing more than a drop then but it was still there. A loop recorder was inserted, a few months later,  to monitor this atrial fib and flutter I apparently don't have. A Cardiologist sees me for preop assessment before the loop is inserted, he hears  the mitral valve prolapse  I apparently don't have, and tells me he will see me again when I am 60...that I will likely need a repair or replacement then...I go home and get a call a week later saying that something showed up on the MRI I also had done before the procedure... a patch of ventricular dyskinesia. Ironically, the day before I get this news my sister  who is a year older than me, 50 at the time, infarcted out of no where ...no blockage. Later gets dismissed.  I am having more and more bradycardia , rates in the 30's , becoming increasingly tired. I am told by this specialist that ordered the EPS and Loop that there is no evidence of bradycardia.  I pushed when I was brady to record it, so how can there be no evidence.  I have it as well in my self collected evidence?  I have evidence of bradycardia! I am told I am likely just depressed. I leave that appointment hopeless...

After a few too many ambulance trips to ER after nose-planting at work,a cardiologist sees me and diagnosis's me with coronary vasospasm. He confirms the mitral valve click/murmur and tells me, from his past experience working with the man who termed the condition,  I will likely need a valve replacement or repair by the time I am seventy.  They also  finally see the bradycardia and are  concerned. A pacemaker is suggested. Hope returns...maybe, just maybe the pacemaker will make the symptoms go away. I was just about to sign the consent form for a pacemaker, literally had the pen in my hand,  when the cardiologist  discovered what this other specialist had suggested...that it was vasomotor, that the bradycardia  was due to my BP and not the other way around and maybe I am just "anxious," "depressed", and "histrionic".  That was enough.  I didn't get the pacemaker ( which is a good thing obviously...if there is any indication that it might not be beneficial, I didn't want it )  and no one mentioned my bradycardia again. Two years later another sister ended up stented. Two years after that another brother, not the one with the atrial fib,  infarcted...no blockage.This is indeed a familial condition! 

The whole time I was becoming more and more debilitated by my symptoms. Without adequate specialist validation for them ..there was no support. ..even when  the symptoms seemed to control my life.   I had to reduce my hours at work, just so I could stay upright for my children and my students. Doing the stairs became a work out.  I had to carry my nitro with me wherever I went. I continued to faint and it was so embarrassing.  Though I had meds to control my fast rates and to help prevent the spasming, I still got a lot of pain. I went off work in hope I could get LTD just long enough until I got an adequate diagnosis and treatment so I could get myself back on track.  It didn't come.  I went without an income for over a year...cashing in everything I had saved or invested for the children and I.  I went back to work farther reducing my hours.  I loved my job and I needed some form of income...so we did what we could on my part time salary until it got bad enough again to make me have to go off.  Again, I go another year without a cent of income coming in...hopelessly waiting for things to change, for someone to say or do something to validate why I needed help. My GP  helped but it was no use. Another year, absolutely no income.  There is nothing left to cash in.  I went into even more debt.  So tired of fighting,  I completely give up...I go back to specialists and tell them I am "fine"...I don't need them anymore and I stop going to doctors about anything cardiac related.  I stop looking for support, validation and help... I get to the  point where I  make a very difficult decision to  retire early even when  it meant sub existing financially. I put my health first.  I take it upon myself to do what I can to make each moment better.

...Hope is the motivation to persevere toward a goal or end state even if we're skeptical that a positive end state is likely. 

Everett Worthington from https://healthypsych.com/psychology-of-hope/

The point is...I stopped hoping that someday someone would see this familial condition I see so clearly...and help me "fix" it instead of just treating some of the superficial  symptoms of it.  Anyway,the reality is I do have a cardiac issue that limits me , I am now living below the poverty line...if it wasn't for D.'s contributions to the household, I wouldn't have this roof over my head. That's the reality of my today  I don't have hope...that this will all get better tomorrow...that my life will get better. I have some serious skeptical doubt. I am not optimistic about my health and financial  future...but I am not pessimistic either. I am still persevering towards wellness...just not an externally determined state. 

Without hope I learned to do an amazing thing.  I learned to  accept what is. I learned to look for the conditions I need to be satisfied and at peace  in my present moment instead of waiting for them to arrive in some distant future,  the future that never comes. I stopped resisting what my body was doing...what the system was doing and allowed this to be a part of my Life.  I embrace the positive things this has given me...and there are so many positives besides the learning and growing I have done becasue of it. 

Hmm! So I do persevere in many avenues of my life...just not in the external health seeking one. I mean, I will go for  help when it is absolutely needed and if it is something I cannot manage on my own.  I will try everything else first.  I will tell my doctor about this pain when I speak to him next.  I will go in to ER  if absolutely necessary (if Nitro doesn't work after three shots) . I do want to stay alive as long as Life will let me. But do I have hope or trust that others  and the external situation  will change ? Absolutely not! Do I have hope and trust that if I access the system I will be helped and healed? Absolutely not.  That I will encounter more conscious and evolved people, than I have in the past,  who will  not attempt to shame me to protect their own egos? Absolutely not.  I do have trust and faith, however, that my changed internal situation will give me a lot more than a different experience ever could have. It has given me a much more stable and peaceful mind that is less likely to react. So though my situation may never change, my mind has. I can endure the hardship and tomorrow of course will be just as wonderful as today.

All is well. 

If we believe that tomorrow will be better we can endure a hardship today. 

Thich Nhat Hanh