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How To Hope Well

February 2026

Physician and medical ethicist Dr. Lydia Dugdale (Columbia University) argues hope isnโ€™t a careless wishโ€”itโ€™s a practiced habit oriented toward a future good thatโ€™s hard but possible. We talk about hope as a communal discipline, the dangers on both sidesโ€”despair and false hopeโ€”how doctors actually handle prognoses, why imagination relates to hope, and whether โ€œAI grief avatarsโ€ help or harm. Along the way: Aquinas, Augustine, and Howard E. Butt Jr. advising us to stay โ€œsteady in the saddle.โ€

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Transcript

00;00;00;00 โ€“ 00;01;41;17
Camille Hall-Ortega
One of my favorite things to do is to listen in on my kids as they play. They create magical worlds of make-believe, all while sitting in their playroom or running around in our backyard. I hear them say things like, pretend weโ€™re in outer space, or this time Iโ€™m going to be the dragon. And as I listen, the moments warm my mama heart for innumerable reasons.ย Theyโ€™re getting along. Theyโ€™re having fun. And theyโ€™re reminding me just how powerful the gift of imagination can be. I pray they carry that gift with them forever. Because imagination continues to be crucial throughout our lives. In fact, itโ€™s sometimes said that imagination is a key component of something else thatโ€™s very important. Hope. Because when we hope, we hope for the good, we can imagine.ย Todayย weโ€™reย talking allย about the concept of hope. What is hope? And why does our guest today note it as more than a careless wish? Butย rather somethingย that is fundamental to our health from age.ย From the H. E. Butt Foundation, this isย The Echoesย Podcast. On todayโ€™s episode, we welcome our guest, Dr.ย Lydia Dugdale. Lydia is a professor of medicine and the director of the center for Clinical Medical Ethics at Columbia University. She also studied at Yale Divinity School, a practicing medicalย doctor,ย Dugdale studies hope and end of life issues.ย Sheโ€™sย the author ofย The Lost Art ofย Dyingย and has a forthcoming book on the theme of hope.ย Sheโ€™sย also recently led a Laity Lodge retreat all about how to hope well.ย Weโ€™reย thrilled to have her here today.ย Iโ€™mย here with my co-host, Marcus Goodyear.

00;01;41;24 โ€“ 00;02;03;20
Camille Hall-Ortega
Welcome, Lydia.ย ย 

Dr. Lydia Dugdale
Thanks so much for having me.ย ย 

Marcus Goodyear
Weโ€™re glad youโ€™re here.

Camille Hall-Ortega
Lydia,ย thereโ€™sย so much here. I think most folks listening willย immediatelyย understand how relatable the concept of hope is, but also how complex this concept of hope is. And I think the place to start justย be. What is hope? Can you help us with a definitionย forย hope?

00;02;03;22 โ€“ 00;04;04;21
Dr. Lydia Dugdale
So hope is actually a rather complicated topic once you start to unpack it. And I spent about a year reading different philosophies of hope and theologies of hope to try to arrive at an explanation or a definition of hope that I thought did the most work for the broadest audience, in the best way possible. So let me start with that preamble. So that the definition of hope that I arrived at, draws heavily from Thomas Aquinas, but is not exclusively, Aquinasโ€™s account of hope.ย It sort of blends, as some other some other ideas. But hereโ€™s how I define it. Hope is the habit of orienting and reorienting and reorienting toward a future good. That is not exactly clear at the present moment. That is difficult to achieve, yet possible to achieve. So it has all of these elements. Itโ€™s future. Itโ€™s good.ย Itโ€™sย possible.ย Right?ย Weย donโ€™tย long for orient toward goods that are completely impossible.ย Right?ย Soย itย has toย be within the realm of possibility. Butย itโ€™sย also not somethingย thatโ€™sย just handed to you, right? Weย donโ€™tย orient towards future goods that are right in front of us. Right.ย So,ย thereโ€™sย a certain amount ofย struggle inย working toward hope. And I like this idea of hope as a habit. Or the ancients would use the word virtue. This suggests that thisย isnโ€™tย something just given to us.ย Actually, weโ€™reย talking about the kind of hope youย have toย work at.ย And,ย theย reallyย great thingย about this sort of idea of hope as a habit that one works at is that it gives us some agency in the process.ย 

00;04;04;23 โ€“ 00;04;29;25
Dr. Lydia Dugdale
Not onlyย weย ourselves, but also our communities.ย ย 

Marcus Goodyear
What does it look like to work at Hope?ย ย 

Dr. Lydia Dugdale
Yeah.ย Soย the ancients would say virtue is synonymous with a habit which is synonymous withย an excellence. These are thingsย that,ย one practicesย again and again and again. So, for example, Aristotle in the ancient world would say to have the virtue of courage.ย 

00;04;29;28 โ€“ 00;05;02;23
Dr. Lydia Dugdale
Youย have toย be thoroughly courageous inside and out.ย And what does this mean? This means that you practice courage. If you want to be courageous, you do courageous acts. Andย in the process of doingย courageous acts, oneโ€™s character is transformed into one who is courageous.ย ย 

Camille Hall-Ortega
Lydia, it sounds kind of like exercise, likeย weโ€™reย needing to create these habits and kind of a regimen of exercise that kind of strengthens our hope muscles.ย 

00;05;02;23 โ€“ 00;05;25;28
Camille Hall-Ortega
Is that way off or is thatย thatโ€™sย it?ย ย 

Dr. Lydia Dugdale
Thatโ€™sย it exactly.ย Yeah.ย ย 

Camille Hall-Ortega
Iโ€™dย love for you to talk a little bit more about how hope is a communal work. What does that mean?ย ย 

Dr. Lydia Dugdale
Yeah.ย Soย itโ€™sย interesting. I, I think as a Christian, Iย canโ€™tย help but think about hope as what one poet calls the middle sister between the two older sisters of faith and love.ย 

00;05;26;00 โ€“ 00;07;07;00
Dr. Lydia Dugdale
Okay. And so on. That accounting, what is the relationship between faith,ย hopeย and love? Hope is in the middle. Andย Iโ€™mย just going to answer your question, butย Iโ€™mย going to do so by way of faith. Thenย itโ€™sย great. Andย thatโ€™sย great.ย Soย in the Greek, the word for faith isย pistisย (ฯ€ฮฏฯƒฯ„ฮนฯ‚), whichย actually inย the ancient world was used synonymously with the evidence that would be presented in court.ย Soย you knew that you would win a court case because you hadย faith,ย you had theย pistis, the evidence that would support the claim you were making. Okay, so if hope is the middle term between faith and love, then faith is looking backward and saying,ย โ€œI know that a future good will come even though Iย canโ€™tย see it right now because I have evidence.ย I have proof in my life that even when all hopeย seemed to beย lost,ย actually goodย did come.โ€ย Andย soย faith is a way of looking backward to give us the foundation, the stability, to know that we can hopeย goingย forward. Okay, soย thatโ€™sย the relationship between faith and hope. Love. Thenย itโ€™sย aย two wayย street.ย Soย when we become people of hope, we can then be agents of hope or surrogates who hope on behalf of the hopeless around us, on behalf of the despairing and our communities.ย 

00;07;07;02 โ€“ 00;07;33;15
Dr. Lydia Dugdale
But when we ourselves are incapable of feeling hope, of practicing hope, of exercising hope, then those of us embedded in communities can draw on that.ย The hope that has been cultivated by our communities, by the people in our communities, to hope on our behalf.ย Does that make sense?ย ย 

Camille Hall-Ortega
Absolutely.ย Itโ€™sย beautiful, really, thatย thereโ€™sย this leaning on of each other in community, in this context of hope.ย 

00;07;33;15 โ€“ 00;07;55;21
Camille Hall-Ortega
Thatโ€™sย really gorgeous.ย Thank you.ย ย 

Marcus Goodyear
Iย donโ€™tย know if I should say this or not, butย Iโ€™m,ย Iโ€™mย in Kerrville andย weโ€™reย dealing with community trauma here. There were some floods this summer, and it was rough.ย So,ย I am thinking right now of some of the communitiesย Iโ€™mย in right now.ย Ifย I were to turn to those communities for hope, they might not haveย muchย resources for me.ย 

00;07;55;27 โ€“ 00;08;16;10
Marcus Goodyear
And I think thatย thatโ€™sย probably somethingย peopleย encounter, whetherย theyโ€™reย in a community that provides hope for them for a time, and then something in that community breaks or becomesย darkย andย it ceases to be a hopeful support for them.ย So how do weย how do weย remainย beacons of hope for our communities, whenย maybe ourย communitiesย donโ€™tย have that hope themselves?ย 

00;08;16;12 โ€“ 00;10;18;19
Dr. Lydia Dugdale
Yeah, thatโ€™s a great question. And I, I know I was, down at Laity Lodge just the week after, the flooding in Kerrville. And, to be there was such an honor at that time. But also so hard. And it really brought into relief the need to think clearly about hope. What Iโ€™ll say is that there is a real give and take in all human relationships where circumstances change, trauma presents itself.ย Mental illness strikes a physical illness strikes. You know,ย Iโ€™mย a physician.ย Thatโ€™s what I knowย really well.ย And the person who may have been the one who had best cultivated, a habit of hope may, in a season, not be that person who can hope, well or hope on behalf of others. Weย canโ€™tย just rely on one person to be.ย Oh,ย sheโ€™sย the one who hopes for our congregation, right? But one body, many gifts. But we also, I believe, all need to be workingย atย thisย process ofย cultivating the gifts that we might not naturallyย possess. Right. So again, going back to the ancient world, you know,ย thereโ€™sย some debate in the ancient world about whether the truly virtuous person needed toย possessย all virtues.ย And some thinkers thought you did, and so you might not be naturally disposed at all toward hope or toward courage or toward patience. But thatย doesnโ€™tย mean youย donโ€™tย workย atย them. We can look around and see what sorts of traits we are called upon to inhabit, to adopt, to cultivate. And if weย arenโ€™tย those kinds of people, then we do need to be working at that and not just rely on someone else who might be so inclined or soย disposed.ย 

00;10;18;21 โ€“ 00;10;56;20
Camille Hall-Ortega
Right? Lydia, you mentioned just a bit there about this concept of hope in a context that is, of course, quite salient for you, which is in the health context or in the context of medicine. Can you talk a bit more about how you see hope come into play in your practice of medicine?ย ย 

Dr. Lydia Dugdale
Yeah.ย Soย I you know, I have two earlier books, both on preparing patients for death and in the process of doing hundreds of book talks, especially on the latter book, a theme that came upย again and againย is, okay, so you keep saying weโ€™re all going to die.ย 

00;10;56;20 โ€“ 00;12;53;03
Dr. Lydia Dugdale
We knowย weโ€™reย all going to die, but then what is hope? Andย itโ€™sย interesting because Saint Augustine talks about hope as being the middle term, or the golden mean, or the average between two extremes. On the one hand, you have despair, which is etymologically so. The word itself means lack of hope.ย Thatโ€™sย what despair means. Soย yeah, another way to put this is a deficiency ofย hopeย gives you despair.ย But on the other extreme,ย thereโ€™sย theย excess of hope. And what is theย excessย ofย hope? While Augustine would say excess of hope is presumption. But I think a better way to characterize it is false hope. Andย soย I see this in the clinical setting all the time. I haveย patients who get the terrible diagnosis or who are told that, you know, their prognosis is terminal, butย thereโ€™sย nothing else that can be done.ย And those patients often are prone to hopelessness, to fall into despair. The deficiency of hope. But then there are other patients who reject that andย say, no, no, no, no, no, Iย donโ€™tย believe you. I know that there will be a cure. I know thatย Iโ€™mย going to leave the hospital alive. And that, I would say, is an excess of hope, aย presumptionย orย a falseย hope.ย And soย thatโ€™sย the way I see both. I would say probably. Well, it depends, I, itย dependsย I,ย I think moreย despair in the community andย maybeย itโ€™sย half and half in the hospital, you know, half despair and half false hope. I thinkย physicians,ย medical doctors themselves probably prefer false hope because itย keepsย us from having to be honest with patients and have thoseย really hardย conversations.ย 

00;12;53;03 โ€“ 00;13;33;26
Dr. Lydia Dugdale
Soย if we can sort of, fuel or feed their illusions of false hope, then we donโ€™t have to, do the really difficult work of helping them prepare and grieve and walk toward their certain end.ย ย 

Marcus Goodyear
Wow.ย Yeah. What a job you have.ย ย 

Camille Hall-Ortega
Yes, I can imagine. Iโ€™m just thinking back on my own experiences, and I can imagine you kind of see both sides of that, where some physicians might want people to be really hopeful and, and some, you know, maybe giving information that feels like it leads to people, you know, being more likely to be despairing.ย 

00;13;33;29 โ€“ 00;14;51;17
Camille Hall-Ortega
I remember my grandmother, sheย had,ย cancer claim later in life, and she went many, many years and, andย didnโ€™tย have reallyย any symptoms.ย Soย they detected it early and so but then as the years started to go by, itย was becomingย harder and harderย for her. Andย soย she would have stints in the hospital. And I remember oneย time in particular, sheย went into theย hospitalย and they ended up saying, okay,ย itโ€™sย time for you to go to rehab now.ย And I remember my mother was so upset one day and I said, what happened? And she said, this doctor cameย in andย andย basically said, like, count the days. This is, itโ€™sย itโ€™sย pretty much overย here.ย The goodbyeย is coming soon. And he she said he was soย negativeย and Iย didnโ€™tย understand where that was coming from.ย And I remember in thatย particular instance, my grandmother got out of the rehab and lived for several years after that.ย Andย soย my mom really feltย kind of vindicatedย in that. Like, you see, he had no business talking like that to me. But then I can also imagine his perspective,ย maybe thinkingย of how many times itย didnโ€™tย go that way.ย ย 

Dr. Lydia Dugdale
Yes. Well,ย Iโ€™mย thankful for your family that your grandmother had some more years.ย Yeah. But,ย yeah, itโ€™s,ย itโ€™sย so tricky.ย 

00;14;51;19 โ€“ 00;15;16;25
Dr. Lydia Dugdale
We know from the data that doctors are horrible prognosticators. And at the same time, I do think,ย well,ย I do think good doctors want to try to help their patients prepare. Yeah,ย I think bad doctorsย often run away fromย the difficultย conversations. Or they might be technically competent. But, you know,ย I think good doctorsย are walking step in step with their patients.ย 

00;15;17;02 โ€“ 00;15;44;25
Dr. Lydia Dugdale
And then you haveย itโ€™sย often the young doctors who want to be brutally honest because they thinkย thatโ€™sย whatย theyโ€™reย supposed to do.ย Butย havenโ€™tย quite learned that maybeย finerย art of relaying this information gracefully.ย ย 

Camille Hall-Ortega
Finesse.ย ย 

Dr. Lydia Dugdale
Yeah.ย Thatโ€™sย right. Butย yeah,ย itโ€™sย aย itโ€™sย a veryย itโ€™sย very tricky. And because, well, becauseย weโ€™reย poor prognosticators and because the unexpected does happen, I mean, miracles do happen.ย 

00;15;45;00 โ€“ 00;17;27;17
Marcus Goodyear
So,ย Camille was talking about her, her grandmother, I, myย father-in-lawย died during Covid.ย Not ofย Covid, but it wasย very fast. The prognostication wasย accurate, unfortunately. But it was stillย sort of beautifulย because he knew what was going to happen and somehow was hopeful.ย So,ย I learned from him a tremendous amount during that process, andย weโ€™reย a couple of years away.ย But I am starting to see people grieve differently than I had an opportunity to. You have mentioned this.ย Itโ€™sย a little far out, but this ideaย thatย people are using AI to grieve differently. Can you talk a little bit about that and what you think of that as what advantages does itย bring.ย And are there someย downsides.

Dr. Lydia Dugdale
Soย you know AI is, is changing a lot of things.ย Yeah. But one, one tool that has become available is to, for example, take any audio or video that a loved one has ever made and feed it into an AI that can then generate an avatar of your loved one, where you can have conversations with your loved one.ย As if he or she was really there on the computer, right? Having a conversation with you.ย ย 

Marcus Goodyear
Butย itโ€™sย like a video avatar.ย 

Dr. Lydia Dugdale
Yeah,ย itโ€™sย like a video avatar. We already have these sortsย ofย weโ€™re using this sort of technology inย many different ways. But, you know, this is yet another way thatย itโ€™sย beingย useย it in a sense, itย doesnโ€™tย memorialize your loved one,ย inย inย memorializesย a loved one.ย 

00;17;27;17 โ€“ 00;19;13;00
Dr. Lydia Dugdale
Right. Because this is now someone whoย isnโ€™tย dead. Here you are. Youโ€™re having I mean, theyโ€™re dead, but youโ€™re here having a conversation just as weโ€™re having a conversation now, looking at them through the screen, theyโ€™re saying everything that they would say, as if you were actually talking to them when they were alive, using the same voice, making the same mannerisms, etc., etc..ย And so, you know, look, Iย donโ€™tย know data on this, but my sense is thatย maybe thisย helps people grieve.ย Well, Iย donโ€™tย think we know yet. Really, Iย donโ€™tย think I thinkย itโ€™sย too early to say.ย Weย doย know thatย itโ€™sย very normal for up to about a year after someone dies to hallucinate thatย youโ€™reย hearing them, to dream about them, to think, oh, wait, mom, you just oh, no,ย momโ€™sย not here.ย Right?ย Thatโ€™sย sort of aย phenomenon where you.ย Yeah, andย itโ€™sย as thoughย theyโ€™reย theyโ€™reย theyโ€™reย such a part of your consciousness that you feel likeย youโ€™reย always about to, to reach out to them, orย theyโ€™reย always saying something to you.ย Thatโ€™sย normal. That is a normal part of the grieving process. Andย usuallyย what patients describe to me is that that experience of if we want to call it hallucinations, Iย donโ€™tย thinkย thatโ€™sย actually quiteย the right word, but that what feelsย almost likeย a hallucination. Hallucination? I thought I heard my loved ones voice, that tends to fade with time. Now, I donโ€™t know how that will change. If you have the avatar sitting in your laptop talking to you every night over dinner, I think itโ€™s too early to say totally. If this is going to mess up the the natural grieving process, but it certainly will disrupt it, disrupt natural grieving.ย 

00;19;13;02 โ€“ 00;19;50;27
Dr. Lydia Dugdale
Butย whetherย itโ€™sย itโ€™sย harmful is too early to say.ย 

Camille Hall-Ortega
Wow, what my first reaction to just even the thought of that is, gosh, thatย feels strange. And I thinkย itโ€™sย mostlyย because ofย ofย whatย youโ€™reย saying,ย thatย itโ€™sย notย whatโ€™sย meant to be happening.ย Right?ย Like thatโ€™sย not the natural course of things. And I wonder if there will be I imagine there would be some physiological consequences, almost like, couldnโ€™t you develop a dependency on, you know, Iโ€™m just thinking of the, the downsides like that that could begin to feel like a hit from a drug, you know.ย 

00;19;50;29 โ€“ 00;20;19;16
Camille Hall-Ortega
Ohย yeah. And I think, gosh,ย that I,ย I imagine the dangers and the downsides are there are pros that you can imagine in that context.ย ย 

Dr. Lydia Dugdale
I think it does sort of ease their pain.ย Right? I mean, in the same way I think now of, Iย donโ€™tย know,ย maybeย itโ€™sย just movies of, you know, the glory days on the battlefield where the guy takes out the photograph of his wife and, you know, kisses her well.ย 

00;20;19;19 โ€“ 00;20;43;24
Dr. Lydia Dugdale
Right. Is there a way in which that avatar is, in a sense, helping to soften the grief of, of separation and death? Just like thatย photograph in yourย in your pocket on theย battlefield?ย ย 

Marcus Goodyear
Might, might have doneย that perhaps.ย Yeah. Itย itย makes me think of the uncanny valley. You know,ย this idea that theย closer something gets to being human, itโ€™s.ย 

00;20;43;24 โ€“ 00;24;36;27
Marcusย Goodyear
I first learned about it with robotics that the closer a robot is to almostย human, the more likely it is to feel like a zombie or like a corpse. Andย soย when I have a sorry, this is a little dark, when I have a photo on the battlefield, likeย thereโ€™sย no mistaking the photo for my loved one. I understand it as a representation, but when I have a real time, realistic animation of my somebody who is close to me, who is now dead in my computer in a way that I have seen them there before when they were alive, it feels like weโ€™re crossing into someย someย kind of uncanny valley, although maybe itโ€™s notย even uncanny, itโ€™s just confusing. I donโ€™t know if to me it feels somehow dishonest and in a way that is new, but maybe Iโ€™m just being cranky about technology, I think. ย 

Dr. Lydia Dugdale
I thinkย youโ€™reย right. So, a colleague of mine.ย Yeah,ย weโ€™ve just Iโ€™veย just been at an AI conference. A colleague of mine was talking about how in traditional religious iconography,ย thereโ€™sย often a flawย thatโ€™sย introduced in theย into the icon, as if to tell the viewer this is not reality.ย You canย seeย thereโ€™sย a flaw.ย This is not thisย is not the person himself. This is just an icon. This is just an image.ย Yeah. And one of the tensions with the AI programmers who are developing this technology is that theyย donโ€™tย want to have to introduce flaws into their avatars, because the flaws suggest imperfection in their work.ย And yet then it does. It is inauthentic.ย Itโ€™sย deceptive. Right.ย Itโ€™s Iย think Iโ€™mย actually talkingย to Marcus Goodyear, but in fact, Iโ€™m just talking toย some sort of generated, avatar of Marcusย Goodyear. Thatโ€™s. Who are you? Really? What? Who with whom and not really speaking. Is this even a conversation? Thisย isnโ€™tย toย human beings, right?ย 

Dr. Lydia Dugdale
It starts to just really spin out of control. Butย thereโ€™sย a tensionย because the technology designers do not want to introduce flaws for the sake of ensuring that this is simply technology and not reality.ย Soย thereโ€™sย aย thereโ€™sย a reticence to make the distinction between reality and fiction clear.ย ย 

Marcus Goodyear
It feelsย like weโ€™ve,ย weโ€™veย drifted away from hope.ย 
Althoughย Iโ€™mย very curious to hear you talk about just the ways in which people are placing very strange hope in AI. Have you experienced that as well, or am I?ย ย 

Dr. Lydia Dugdale
Well, so.ย Soย if we want to take this back to my work on hope, I will say this, that I thinkย itโ€™sย very importantย to distinguish between hope in an object or a person, and hope as a fundamental orientation toward a future.ย One is a posture and one the latter is a posture, this orientation toward a future good.ย Itโ€™sย a disposition.ย Itโ€™sย a habit. Whereas when I say Iโ€™m hopingย inย something, itโ€™s puttingย all ofย the weight,ย all ofย the work into the object of my hope.ย And that objectย has toย then be able to do that work.ย And as Christians, we would say no object can do that work, right? Only God can do that work. Andย thatโ€™sย whyย itโ€™sย very commonย for Christians to say, well, I hope in God my hope is God. My hope is Jesus.ย Right? Andย soย thereโ€™sย a way in which we could say ofย AI, ifย my hope isย in AI,ย AI cannot do the work of bearingย all ofย our existential,ย all ofย our eternal, ultimate questions.

00;24;36;27 โ€“ 00;24;59;10
Dr. Lydia Dugdale
Iย cannot, cannotย hold those.ย I can do someย really coolย stuff.ย Itโ€™sย a great tool.ย Itโ€™sย a great research assistant.ย Itโ€™sย greatย at confusingย us andย sendingย usย down a rabbit hole.ย Yes, I can do some really,ย really phenomenalย things.ย But AI is not God and will never be God.ย ย 

Marcus Goodyear
I mean, I feelย like youโ€™veย youโ€™veย cued us up here.ย 

00;24;59;10 โ€“ 00;26;49;03
Marcus Goodyear
Weย haveย an audio clipย fromย 1982. This is Howardย Buttย Jr.ย again,ย heโ€™sย a heโ€™sย a voice we hear from time to time because, we are the H. E. Butt Foundation, sponsored by theย H. E. Buttย Foundation.ย And,ย that means Howardย Buttย Jr.ย .ย Soย he used to speak at Laity Lodge. He helped startย Laityย Lodge.ย And,ย here he is talking about hope in, inย a very similarย way from 1982.ย 

Howard Butt Jr. Audio
Apart from hope, what happens is we fall off one side of the horse or the other.ย We fall into despair, or we go to the other extreme and fall into presumption. This is the manic side where too high or this is the depressive side, weย are toย too low. The problem of life is to avoid the extreme of presumption or despair. Andย thatโ€™sย what hope offers us, because hope does not fall off the horse on either side.ย Hope sits steady in the saddle. Hopeย has itย all together. It isย neither toย upย orย to down.ย ย 

Camille Hall-Ortega
Weโ€™veย heard a lot of that sentiment from you, Lydia. What are your reactions to that clip?ย ย 

Dr. Lydia Dugdale
Yeah, I love that.ย I think heย totally hits the nail on the head. I had never thought of despair as well.ย Iย had thought of despair as a kind of depression, sure, but to think of false hope or presumption as mania wasย definitely aย novel thought for me.ย 

00;26;49;03 โ€“ 00;27;38;02
Dr. Lydia Dugdale
But he, Howard, captures itย really beautifully.ย What Augustine said, which is that hope is theย mean.ย Itโ€™sย the middle.ย Itโ€™sย sitting on the horse between the extremes of despair and presumption or false hope. And how do youย sort of stayย on the saddle? I mean, the beautiful thing is that I thinkย thereโ€™sย a little bit ofย thereโ€™sย for all of us,ย thereโ€™sย a little bit of jostling in the saddle.ย Right? Sometimes we are leaning a little bit towardsย the despair. Sometimes we are leaning a little bit too much toward expecting it to go the way we think it should go, andย itย betterย goย that way. Andย soย itโ€™sย okay thatย weโ€™reย not sitting perfectly on the saddle as we should be, but ifย weโ€™reย just sort of, you know, sliding away from hope in one direction or the other and we can course correct.ย 

00;27;38;02 โ€“ 00;27;57;24
Dr. Lydia Dugdale
Then we get back on the saddle.ย ย 

Camille Hall-Ortega
Lydia, we heard, you know, even from some of the AI stuff that we were discussing, but just in general that obviously, especially in the medical context, some of us can get a little bit dark. There can be times when itโ€™s, you know, some of this isย kind of sadย to talk about.ย 

00;27;57;26 โ€“ 00;28;35;14
Camille Hall-Ortega
Iโ€™mย curious, justย kind of onย a personal level, whatย itโ€™sย like to study death and dying is that does that take a personal toll?ย ย 

Dr. Lydia Dugdale
No, not really.ย Yeah.ย Thatโ€™sย good,ย thatโ€™sย great.ย Thatโ€™sย goodย news.ย Yeah.ย Soย hereโ€™sย the thing on, well,ย thereโ€™sย several things I do think people who think about these questionsย sort of routinelyย areย probably moreย comfortable just based on personality type, disposition, upbringing,ย all ofย those things.ย 

00;28;35;17 โ€“ 00;31;23;17
Dr. Lydia Dugdale
So, I grew up in a household where my grandfather had been a bomber pilot. He had a plane crash during flight school. He was shot down during World War Two. He was taken prisoner of war. He was in one of the worst prison camps in Europe, before finally being released.ย Hadย lifelong,ย medical problems because of what happened to him in prison camp.ย Anyway, but he was also a very hilarious man, and he was always joking about, being on good terms with The Undertaker. Andย heโ€™sย going to have coffee with The Undertaker. And if any of the grandkids got a tattoo, he was going to write the grandkids out of the will. And, you know, so everything was this constant conversation aboutย sort of theย exuberance of life mixed with the reality of death.ย And he was making jokes about it all the time.ย Soย I grew up in that context, and I thought that was normal. And then I got into medical training and realized, oh, wow, so many of my colleaguesย donโ€™tย even want to talk about death. Oh, I had a colleague say, oh, Iย donโ€™tย know why you think about death.ย I do everything I can to avoid talking to my patients about death becauseย I myselfย am so afraid of death. I have read physician writers who describe their drive to study medicine was motivated in large part because of their own death anxiety. They needed to study the body to be able to master the body, because they themselves are so afraid to die.ย Soย my upbringingย then,ย isnโ€™tย the norm for people in medicine. I came toย realize. But theย flip sideย is that because I was comfortable thinking and talking about death, and because death is the great equalizer, right? Every single one of my patients will die.ย Yeah, every single one of us will die. It made sense to try to help prepare my patients, because it turns out that so many of them were coming into the hospital woefully unprepared.ย Yeah, with, relationships they wished they had mended. But nowย theyโ€™reย sick and dying, andย itโ€™sย too late with religious questions. They had avoided their whole lives, but nowย theyโ€™reย sick and dying andย itโ€™sย too late. And nowย Iโ€™mย assigned as their doctor in this very unfortunate setting, andย theyโ€™reย often not with it enough to even be able to do the work of preparing for death.ย Andย soย I thought, well, let me start alerting people to the fact that if you want to die, well, youย have toย live well. And those two go hand in hand.ย Soย for me, the work of preparing patients to die well isย actually aย very hopeful kind of work, because it means they live such better lives. So good.ย 

00;31;23;17 โ€“ 00;31;45;22
Camille Hall-Ortega
I think thatโ€™s kind ofย the, theย way to frame it in thisย really positiveย way that I thinkย itโ€™sย really helpful.ย Soย thank you for that. Youย have weโ€™veย heard you speak a little bit about how imagination plays into hope, and I would love to hear more about that.ย ย 

Dr. Lydia Dugdale
Camille,ย I know you have thought about kids playingย imaginatively.

00;31;45;26 โ€“ 00;33;18;21
Dr. Lydia Dugdale
Yes. Butย actuallyย most children, when they make believe play, they makeย believeย things that they have seen their parents do.ย Yeah.ย Soย youย play house, you play school, you play doctor, you play, you know, railroad trains.ย Youโ€™reย iterating on things for which you have knowledge.ย Yeah.ย Itโ€™sย very rareย for a child to make believe about something thatย theyโ€™veย never been exposed to, of which they have zero knowledge.ย Soย some psychologists say youย canโ€™tย imagine if youย donโ€™tย have knowledge.ย Soย if you really want to expand your imagination, you need to gain more knowledge.ย I think thisย is mostly true. But then we have these prophetic, mystical, poetic experiences in our tradition that suggest that sometimes there can be inspiration given that is otherworldly from the divine, cosmic whatever.ย And then weย have toย make space for saying, well, sometimes imagination can be stretched not by your own acquisition of knowledge, but by something beingย sort of imposedย on you from without.ย Yeah. Soย thatโ€™sย why I want to make space for that. Butย generallyย the thinking is,ย yeah, we and this is even what Albert Einstein said that you need to expand your knowledge baseย in order toย expand your imagination.ย 

00;33;18;23 โ€“ 00;33;40;17
Camille Hall-Ortega
Reallyย reallyย good.ย ย 

Marcus Goodyear
Does that also expand ourย hope so.ย Right.ย ย 

Dr. Lydia Dugdale
Soย if hope is the orientation toward that future good. That is ill defined. Right.ย Weโ€™reย not exactly sure what it is. We know that we need some futureย good. Right. Whatever our circumstances areย nowย the world isย collapsingย Iย donโ€™tย know.ย Yeahย I know theย theย country is becoming more divided.ย 

00;33;40;17 โ€“ 00;34;28;22
Dr. Lydia Dugdale
Whatever you want to name, you know, a loved one is diagnosed with disease X, whatever it is that makes it feel like our world, my world is collapsing and I need to orient toward that future good that is difficult yet possible to achieve that is ill defined. While imagination then helps us begin the work of of in a sense, testing.ย Right? Could it be this? Is this the good that will come? Could it be this good? Could it be that good? Andย itย expands our capacity for hope? Well, with an expanded imagination,ย maybe youย can see 10 or 15 different futures. Not exactly sure howย itโ€™sย going to be realized, but that gives you substance for leaning in toward this future good rather than having no future.

00;34;28;24 โ€“ 00;35;27;04
Camille Hall-Ortega
Lydia, all of this is so good. I wonder if, as we wrap up, thereโ€™s just kind of a word of encouragement. I know youโ€™ve spoken about hope as the long game and youโ€™ve just talked about endurance. What do you say to folks who say, you know, Iโ€™m trying my best to hope Iโ€™m pretty tired? Whatever my situation is, Iโ€™m pretty tired.ย You have a word of encouragement for them.ย ย 

Dr. Lydia Dugdale
Hope isย theย long game. Life is a race. But we alsoย donโ€™tย run alone. Andย thatโ€™sย the piece right. We are on a team and we need one another. We need theย church,ย we need the Lord.ย And so yes, running the long race is so hard and you will have uphillย momentsย and you will have downhill moments and you will have moments when that, you know, cramp in your side or in your calf muscles is just too much to keep going.ย 

00;35;27;09 โ€“ 00;35;53;06
Dr. Lydia Dugdale
Right. Andย thatโ€™sย when somebody comes along side and says, keep going, keep going.ย Iโ€™mย withย youย right? And even whenย thereโ€™sย not a human being sayingย that,ย thatโ€™sย the beauty of the Holy Spirit.ย Yeah. Iย wonโ€™tย leave you or forsake you.ย Right?ย Iโ€™mย here running alongside you.ย ย 

Camille Hall-Ortega
Beautiful. Lydia,ย weโ€™reย so grateful for your time. Thank you so much for everythingย youโ€™veย shared.

00;35;53;13 โ€“ 00;36;17;15
Camille Hall-Ortega
We appreciate you.ย ย 

Dr. Lydia Dugdale
Thank thanksย so much for having me.ย ย 

Camille Hall-Ortega
The podcast is written and produced by Marcus Goodyear, Rob Stennett and me, Camilleย Hall-Ortega.ย Itโ€™sย edited by Rob Stennett and Kim Stone. Our executive producers are Pattonย Dodd and David Rogers. Special thanks to our guest today, Dr.ย Lydia Dugdale. We recently featured Lydia in Echoes magazine, and you can read the article online atย echoesmagazine.org.ย 

00;36;17;18 โ€“ 00;37;21;04
Camille Hall-Ortega
Whileย youโ€™reย there, consider subscribing.ย Youโ€™llย receive a beautiful print magazine each quarter, andย itโ€™sย free. You can find a linkย inย our show notes. Theย Echoesย Podcastย and Theย Echoesย magazine are both productions brought to you by the H. E. Buttย Foundation. You can learn more about our vision and missionย atย hebfdn.org.ย