It’s dark. It’s cold. And it’s 5 p.m. here in Iowa. If that sounds rather bleak to you, I wouldn’t blame you. But to Stella, my 12-year-old canine companion, it’s a wonderland. She’s half-Shetland sheepdog and half-American Eskimo, so the colder and snowier it is, the more she feels at home. And although I do grumble putting on heavy layers of clothing and gloves in preparation for an icy walk, I have to say, overall, I’m pretty satisfied and happy. I get to spend quality time with my dog, to exercise my heart and lungs, to wave (and cheerily bark) hello to our friends from across the neighborhood and to meditate on the larger things in the world. And I know that with every passing day, I’ll get closer and closer to warmer and brighter days. So this month, let’s rheuminate on the tenacity of hope.
1. Finding Hope
How exactly does a rheumatologist find hope in this day and age in which we sometimes feel surrounded by despair? Certainly in our field, we face daily challenges of managing chronic, often debilitating, diseases. Our patients often arrive to us in pain, frustrated and looking for answers that we may not readily have. It’s our duty—and our privilege—to help guide them toward better days, even if better means small increments rather than quantum leaps. In these situations, I find hope by witnessing and participating in the small but significant victories.
The same can be said of larger societal trends. There is no doubt that the world we live in is fragile and imperfect, but it is so much more imbued with concepts of justice and equity than ever before. We are blessed to live in a time in which people all around the world see themselves as having a mission to create a better world for our descendants. There’s no doubt that our progress is often shaky, with one step backward for every two steps forward, but it is progress that comes from warm hearts and bright minds nevertheless.
As a rheumatologist, I recognize my role in that by upholding the health of those who may have fallen on harder times. By helping direct therapy and expanding access to treatment options, I am helping others find hope in their everyday lives.
In those ways, finding hope isn’t merely a fleeting thought during a stroll—it’s a necessary mindset that must be reinforced time and again. Like well-worn paths in snow, we must make sure that hope leaves footprints that enable others to find the way. After all, hope for the future is what drives us to continue investing our time and energy, to persevere through difficult cases and situations and to celebrate the seemingly small triumphs alongside our patients.
In every moment that we encourage a patient, adjust a treatment or review the latest studies, we are cultivating hope in the future.
2. The Tenacity of Hope
Once we find that tiny atom of hope, we have to build on it. In our society, there’s a connotation that hope is fragile thing and holding on to it is irrational. Yet if hope were indeed fragile, we wouldn’t survive long in the field of medicine. The practice of rheumatology, like life, demands a resilient form of hope—one that can withstand setbacks and adapt in the face of adversity.
Rheumatology patients, perhaps more than those in many other fields, are sources of inspiration in how they demonstrate the tenacity of hope each time they commit to treatment, reevaluate their goals or continue to show up for appointments even when they may not feel like it. Through these actions, our patients teach us about the kind of hope that can endure the rigors of hardship.
Hope, in this manifestation, is not fragile but a hardened form of resilience and resistance. If something so ephemeral can give patients the strength to get up and try again after a setback, to adjust to the evolving limitations of the human body and to relish moments of joy when possible, then we, as rheumatologists, can reciprocate by engaging in our own sense of hope. There is no doubt that we share in our patients’ disappointments, but we can also absorb their optimistic attitudes and positive dispositions. In turn, this tenacity of hope reminds us to keep moving forward with our patients, even when the path is unclear or the results aren’t exactly what we’d hoped for.
The other conception of hope that we often consider is that it is blind optimism, but I would contend that authentic hope is tempered by realism. As rheumatologists, we are painfully aware of the limitations of our treatments, the unpredictable nature of systemic autoimmune rheumatologic diseases and the challenges of chronic pain. Yet we continue to hope because we possess the power of perseverance. And sometimes, it’s that hope we carry for our patients that strengthens their own resilience, a gift we pass back and forth.
3. Fostering Hope
With all that said, can we grow our ability to hope? This might sound like a simple question, but nurturing hope is an ongoing process, one that requires dedicated practice and intention. As rheumatologists, fostering hope means seeking out and moving toward what gives us energy and joy. Sometimes, that’s a scholarly project that excites us, a mentor or mentee who grounds us or even a hobby totally outside of medicine that reconnects us with life beyond the clinic. Hope thrives when we are not solely consumed by the negative aspects of our professional lives, but are also invigorated by a sense of personal purpose and curiosity.
To foster hope, we need to zoom in on and very deliberately celebrate progress—even when it’s small. The scientific advancements that brought us targeted biologics, precision medicine and innovative pain management techniques all started with almost imperceptibly small, incremental steps. In the same way, we can foster hope by acknowledging each improvement, each sign of progress in a patient’s health or each bit of knowledge gained. These acknowledgments add up, reminding us that our efforts, however gradual, are moving us forward.
Consistency is also critical to building that sense of hope. Admittedly, it’s easy to lose sight of hope in the face of demanding schedules, difficult cases and the slow progress inherent in chronic disease management. Like most people I have felt at rock bottom without any hope left at times. Yet with the help of friends, family, and colleagues, I have been able to cobble together the small reasons for hope in something that brought me back to a more hopeful and joyful place. Just as Stella and I venture out on our evening walks regardless of the weather, we must keep moving forward with hope as our guide, even on the darkest of days.
4. Sharing Hope
In addition to the deliberate practice of generating hope, it’s imperative that we share hope with others, especially those who are encountering difficulty in finding it. This is especially important to those working in healthcare, a setting in which we often become bearers of heavy emotional and physical burdens.
Reams of paper have been printed for decades talking about the burden of burnout. Sharing hope with our colleagues and patients can alleviate some of this weight. Empathic understanding of struggle, simple, nonjudgmental words of encouragement, a shared story of progress or even a moment of humor in a challenging day can bring light to someone else’s struggle.
It’s wonderful to know that we have the privilege of working with patients who show extraordinary resilience. By sharing their moments and stories (anonymously, respectfully and with their consent, of course), we remind each other that, although the work is hard, the payoff is profoundly meaningful. These stories become a form of communal hope—a reminder that each of us plays a part in the larger, ongoing story of healthcare. It’s certainly one of the aims of The Rheumatologist.
Importantly, sharing hope also means creating permission structures within our environment to show that it’s okay to express both the joys and frustrations of our work. By building a culture that recognizes the emotional ups and downs of medicine, we foster a sense of camaraderie. We’re not in this alone, and knowing that can provide just the boost of hope that we need to keep going.
5. When You Feel Hopeless …
Although we strive to remain hopeful, there are times when even the most resilient of us feel absolutely drained. This isn’t a failure but a reminder of our humanity. In moments of despair or burnout, reaching out for help is not a sign of weakness, but of profound strength and wisdom. Normalizing this experience in healthcare and beyond is crucial; it allows us to acknowledge our vulnerability without fear of judgment.
In our line of work, we often see patients struggling with feelings of hopelessness due to chronic pain or progressive disease. We should encourage them to seek appropriate sources of support, to be honest about their feelings and to let others help them with their burdens. The same advice applies to us. Finding a trusted colleague, counselor or even a mentor to share our struggles with can be a powerful first step toward restoring our own hope.
Even when things in our modern world beyond the clinic seem daunting, there are always rays of hope that persist. The bravery and courage of everyday human beings are on display if we choose to see them. The resilience of organizations doing good in the world, even underground and in extremely challenging situations, is inspiring. Taking cues from them and intelligently applying their lessons can help replete our sense of hope.
As specialists in immunology, it seems appropriate to say that no one is immune to moments of doubt or darkness. By recognizing when we need support and having the courage to seek it, we pave the way back to hope. This tenacity—to keep searching for the light even when it feels out of reach—is what ultimately allows us to rediscover our purpose and to continue serving our patients with compassion and resilience.
Conclusion: A Walk in the Cold
As I unlock the front door and enter the warm house, my glasses fog up with the heat and my dear pup barks with delight upon seeing the rest of the family. The outside is still dark and still cold, yet persevering and journeying through it provides me the great clarity about the meaning of hope.
Hope is a journey that we walk daily, sometimes through chilly, dark stretches. But the rhythm of the steps in that walk, the companionship and the knowledge that spring will eventually arrive keep us moving forward.
In rheumatology, as in life, hope is seldom loud or flashy. Sometimes, it’s just a steady step forward in the company of those who share our path.
Dedicated to Lexi, who brought our family years of hope, love and joy.
Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X (formerly Twitter) @BharatKumarMD.
