From time immemorial the stars have been solicited to guide us. For mariners using an astrolobe to find their way across the oceans. For philosophers to reflect on the infinite and eternal. For lovers to dream of the future.

A thing eternal must be spoken of in the present tense, in order to capture the notion of timelessness and the perpetual motion of consciousness. One cannot constrain eternity to either the past or the future. William Blake, the 18th century poet–artist–seer used a lyrical metaphor: “To see a World in a grain of sand and a Heaven in a wild flower; hold Infinity in the palm of your hand and Eternity in an hour” (Blake, 1956). Astrologers and star-gazers have long invoked the power of Heaven's inhabitants to control our lives and, more specifically, to predict the future.

The permanence and immutability of the stars in the firmament creates in man a sense of security in time and place. From Biblical times, the stars have been used as metaphors of prophecy to ensure the eternity of a people. The stars' unknowability—like the future—paradoxically does not detract from their function of conjuring dreams and facilitating hope. The opposite.

For some people though, meditating on the stars creates an anxiety about the futility and insignificance of our lives here on earth. Not even a grain of sand. However, as Yalom said: in the therapeutic relationship the focus should be on the meaning of our individual life, not on the meaning of life itself (Yalom, 1980). A question of context.

Boris teaches us that stars, by virtue of their unknowability yet permanence, are like hope. Boris of course is speaking of hope as an abstract noun in the present tense. However, when an individual hopes (as a verb) it is by definition into the future, which for man is the unknown. Hoping creates hope.

Hope is the common human experience, intimately, if not penultimately linked to consciousness. Boris presents hope in the singular, reflecting that it is the individual human that harbors subjective hopes—dum spiro spero (while I hope I breathe).

How do such lofty thoughts relate to people with life-threatening illnesses? What role does hope play in someone who knows his consciousness will soon be extinguished? Should doctors encourage patients to hope even in the face of death? Can doctors prescribe hope? Is that cruel when the end is in sight? What is “false” hope? Should we unsubscribe to hope, at the end of life? Is courage a more practical paradigm?

Many studies, both qualitative and quantitative, have attempted to describe hope. It is an Herculean task, but by no means a thankless one. The very process of exploration seems to provide sustenance.

Just as we expend great efforts to diagnose and manage anxiety and depression, so we should become skilled at exploring the nature and function of hope in our patients, and indeed, ourselves.