Hope, Optimism, and the Data Within Us

I was emailing with one of my colleagues, the fantastic Rebecca Swan, about The Let Them Theory by Mel Robbins and how it might be especially relevant now, given the tectonic shifts in academic medicine. (If you want my take on the topic, you can find it here: Let Them. Let Me.)

In the few weeks since I finished the book, the medical–academic–political landscape has changed yet again. As we scale ever-new heights of “unrecognizable” in the U.S., I wrote to Rebecca: “I think I need to figure out what I think about ‘hope’ next. ‘Let me have hope’ seems like a big ask—but it also feels deeply necessary.”

I’ve always considered hope something akin to faith, a belief without evidence. Optimism, on the other hand? That feels like hope with data. I’ve said of patients, “I’m hopeful,” when all I could do was hope for the best. I’ve also said, “I’m optimistic,” when the vitals were stabilizing and the labs were trending in the right direction. Data. Objectivity. Tangibles.

Both are important, so important, in fact, that many of us hold one (or both) as values. We speak of hope all the time in the pediatric ICU. In the “good parent” literature, parents of critically ill children often describe hope for recovery, even against the odds, as a defining part of being a “good” parent. If I have a problem with the concept of hope (and I’m not saying I do, just thinking out loud here), it’s that it sometimes feels… flimsy? Like having hope is “just” a gut feeling?

Not that I’m here to knock gut feelings. I’ve escaped more clinical disasters via intuition than anything resembling technical skill. (I even teach people how to describe a gut feeling in a way that sounds more academic: just call it a “moral intuition.” Use that phrase in front of the right crowd, and even the most skeptical academic will sit up straighter.)

But I may have made those definitions up. (Isn’t it funny how often we look up a word we use all the time and think, “Wait… I’ve been using that wrong?” For the Inigo Montoya fans in the room: “You keep using that word. I do not think it means what you think it means.”)

Oxford says hope is “a feeling of expectation and desire for a certain thing to happen.” Optimism is “hopefulness and confidence about the future or the successful outcome of something.” 

Both involve some form of data. To expect something implies that there is a reason to expect it. To have confidence suggests that there is a foundation for it. So is it foolish, given the current data about the medical-academic-political landscape, to think: “Let me have hope?”

Let’s look at the data. Headlines from the last several months include: “How Could the New Trump Administration Impact Medical Meetings?” (Nov 2024), “Trump Issues Executive Actions Relevant to Academic Medicine” (Jan 2025), and “How Trump 2.0 is Slashing NIH-Backed Research—In Charts” (Apr 2025). A bird’s-eye view, and it’s not a pretty one.

Still, I return to those ICU parents, the ones who, even as they agree to the withdrawal of life-sustaining therapy, continue to hope for their child’s recovery. “I know they’re dying,” they say. “And I hope they get better.” They are holding two deeply disparate truths at once.

If they can do that, if they can hold devastation in one hand and hope in the other, surely I can hold the tension between “This landscape is unrecognizable” and “We, in academic medicine, and our patients, are going to be okay.”

But where does that kind of hope come from?

I don’t think it comes from the clinical trajectory or the published prognosis. I think it comes from them: from what they know about themselves, their child, and the bond they share. Their data isn’t found in imaging or labs. It’s found in bedtime routines and Mother's Day cards. In the thousand tiny acts of resilience they've lived through already. In how they’ve shown up for one another, over and over again.

Their hope isn’t sustained by external facts; it’s sustained by internal truth.

And maybe that’s where mine comes from, too.

My belief that we’ll be okay isn’t grounded in what I see happening around me.  It’s grounded in what I know about myself. I’m smart. I’m creative. I have grit. I know how to pivot. I can figure things out even when the rules change. I can do hard things.

Hell, I do hard things.

That’s how people maintain hope when the evidence says otherwise. We take what we know about ourselves—and each other—and build belief systems that sustain us in unrecognizable terrain.

So maybe the ask isn’t really, “Let me have hope.”  

Maybe it’s: Let me remember who I am.  

And let me trust that’s enough.