Why do some people facing difficult circumstances find and sustain hope, while others do not? And what can we learn from those individuals who hold on to hope? How is their example applicable to our own lives? In his illuminating and inspiring book, Harvard medical school professor and New Yorker staff writer Jerome Groopman strives to answer such questions. Spanning some 30 years of his clinical practice, Dr. Groopman explores the many ways in which hope contributes to healing. Complete with artfully crafted plot, character, dialogue, denoument and epiphany, the book begins from a point of abject ignorance - when the author was a medical student and did not recognize the role of hope in patients' lives - and goes on to chronicle Groopman's growing understanding - and utilization - of hope in the healing process.

CHAPTER 1

Unprepared

In July 1975, I entered my fourth and final year of medical school at Columbia University in New York City. I had completed all my required courses except surgery and was eager to engage in its drama.

Surgeons acted boldly and decisively. They achieved cures, opening an intestinal blockage, repairing a torn artery, draining a deep abscess, and made the patient whole again. Their art required extraordinary precision and self-control, a discipline of body and mind that was most evident in the operating room, because even minor mistakes--too much pressure on a scalpel, too little tension on a suture, too deep probing of a tissue--could spell disaster. In the hospital, surgeons were viewed as the emperors of the clinical staff, their every command obeyed. We students were their foot soldiers. I was intoxicated with the idea of being part of their world.

The surgical team I joined was headed by Dr. William Foster. Foster was a tall, imposing man with sharp features like cut timber. His rounds began at dawn, followed by two or three surgeries that lasted until late afternoon. As is typical in a teaching hospital, all of Dr. Foster's patients were assigned to medical students who learned the basics of diagnosis and treatment by following cases. Not long after I began the course, I was designated as the student to help care for Esther Weinberg, a young woman who had a mass in her left breast.

Esther Weinberg was twenty-nine years old, full-bodied, with almond-brown eyes. She was a member of the Orthodox Jewish community in Washington Heights, the neighborhood adjoining Columbia's medical school. When I entered her room, Esther was lying on the bed, reading from a small prayer book. Her head was covered by a blue kerchief in the typical sign of modesty among married Orthodox women, whose hair, as a manifestation of their beauty, is not to be seen by men other than their husbands.

"I'm Jerry Groopman, Dr. Foster's student," I said by way of introduction. I wore the uniform of the medical student, a short, starched white jacket with my name on a badge over the right breast pocket. The badge conspicuously lacked the initials "M.D." Esther quickly took my measure, her eyes lingering over my name badge.

I did not reach out to shake her hand. Men do not touch strictly Orthodox women, even in a casual way.

Esther's eyes returned to my name badge, then to my face. I guessed at what was crossing her mind: whether my not shaking her hand indicated that I was Jewish and knowledgeable of the Orthodox prohibition, or simply an impolite student. "Groopman" was Dutch in origin, not a giveaway. Dr. Foster had described Esther as anxious, and I felt that disclosing our shared heritage would put her at ease.

"Shalom aleichem," I said, the traditional greeting of "Peace be with you."

Instead of offering a welcoming smile, her face drew tight.

Following protocol, I began the clinical interview, which includes taking a family and social history. Esther Weinberg, nee Siegman, was born in Europe in 1946. Her family was from Leipzig, Germany, and of its more than one hundred members, only her parents had survived the Nazi camps. The Siegmans immigrated to America in the early 1950s. Esther married at the age of nineteen, had her first child--a girl--a year after the wedding, and then twin girls eighteen months later. Her father died of a stroke not long after. Over the last year, she had worked as the personal secretary for the owner of a cleaning service in midtown Manhattan; her job was strictly clerical, without exposure to toxic solvents that can be carcinogenic.

One of the primary risk...