Introduction
Most patients today want to know the truth about their diagnosis and prognosis, no matter how serious their condition may be. However, clinicians do not always receive training in the skills needed to communicate these matters effectively or to assess the patient’s attitudes and preferences. We are attentive to patients’ need for physical care or attention, but we often neglect their emotional and spiritual needs during these difficult times.

Physicians may have difficulty discussing disease progression and impending death because they are physicians! Studies have shown that doctors choose medicine as a career because of an inordinate fear of death. They choose medicine because it is dedicated to defeating death.1 When a patient dies or is no longer responsive to treatment, it is seen as a failure to perform on the part of the physician.

This course relates only to diseases that progress towards death, as opposed to those that progress to conditions such as blindness, deafness, or amputation. The intent is to provide practical guidance for communicating more effectively with patients and their families as they face the many issues involved in the total care of seriously ill and dying patients.

Communication is the Key
Because most patients want to know the truth about their diagnosis and prognosis, the ability to discuss these issues, and to solicit patients’ views about resuscitation or hospice care, are important verbal skills.

Why is good communication necessary?

Good communication is necessary in order to:

help establish rapport with the patient
identify the types of information the patient wants
ensure that patients understand enough to make informed decisions
address the patient’s emotions in a supportive way
help the patient express his or her major concerns
involve the patient in the treatment plan
Communication does not always depend on words. Older children, adolescents, and young adults (as well as older adults who are simply afraid to die) use “symbolic verbal language.” Unfortunately, we do not teach symbolic language sufficiently in our nursing schools, medical schools, seminaries, and social-work schools. This type of communication involves indirect, seemingly unrelated questions and comments, which need to be interpreted as the need for direct and honest conversation.

When asked, most patients say they would have been better off if their primary physician had been honest with them at the very beginning. If they had been informed very early that they had a terminal illness, they would have had time to come to grips with it and ask for further details when they were ready to hear them. This request, however, was accompanied by two conditions:

1. Allow for hope. Hope at the beginning of a serious illness is totally different from the hope at the end of life. At the beginning, a patient hopes that the diagnosis is not true. When diagnosis is verified, the hope becomes associated with cure, treatment, or prolongation of life. When those three outcomes are no longer probable, the patient’s hope changes to something not associated with cure, treatment, or prolongation of life. Rather a new hope emerges that “I hope my children will make it through this” or “I hope God accepts me in Heaven.”

2. Do not desert the patient. The physician needs to still care for the patient as a human being, even when his or her condition no longer fills the physician’s need to cure, to treat, or to prolong life.

Barriers to communication
Communication involving disease progression and end-of-life issues often suffers due to conflicts that arise between the physician and the family or designated proxy. Authors at the University of Michigan Medical Center have identified three general categories of conflicts regarding end-of-life care: family or proxy characteristics, physician characteristics, and organizational and social characteristics. “By considering this list of potential sources of conflict, clinicians can identify more readily and accurately the causes of difficult interactions with families of terminally ill patients regarding decisions to limit treatment.”

Family or proxy characteristics: One of the most difficult situations for health care providers to face is how to handle conflicts with families over forgoing life-sustaining treatment. Physicians may feel that their competence or judgment is not trusted, while families may feel isolated, misunderstood, or abandoned, and may begin to doubt the physician and staff’s commitment to the patient’s well being. “Families may disagree with clinicians because they do not understand the medical situation.”

Reasons for this lack of understanding include:
1. The family or proxy may be psychologically unprepared to hear the patient’s diagnosis or prognosis.

2. “Bad news” is often poorly processed and imperfectly remembered.

3. Poor communication with the physician may increase misunderstanding.

4. Families obtain information from multiple sources (TV, Internet, friends and relatives)

5. There may be a gap between the physician’s values and those of patients and/or their families.

Physician characteristics: Several physician characteristics contribute to conflicts regarding end-of-life communication and decision-making, including:

1. Physicians, like patients, may also be uncomfortable with prognostic uncertainty.

2. Physicians may be uncomfortable discussing death or they may be troubled by the thought of a medical “failure.”

3. Physicians tend to overestimate chronically ill patients’ quality of life, and are more likely than patients or families to think such patients would choose to forgo life-sustaining treatment.

4. Religious or philosophical beliefs about the sanctity of life may prevent physicians from offering treatments not intended to prolong life.

5. Physicians may vary in their beliefs and attitudes regarding the proper role of families and proxies in decisions involving end-of-life care.

6. Physicians may have difficulty dealing with the different value systems of others.

7. Physicians may be insecure about limitations of their own competency or skill

8. Physicians may be unaware of prognosis or treatment options and misinform the family or proxy.

9. Physicians may not understand ethical, legal, or hospital policies regarding end-of-life care.

10. Lack of training in symptom management may lead to inappropriate care.

11. Physicians may be poorly trained in interpersonal communication regarding end-of-life care decisions, leading to misunderstandings, confusion, and frustrations.

12. The culture of the hospital may lead to “high-tech” interventions and avoidance of time-consuming conferences with family members.

Social and organizational characteristics: Policies within hospitals and health-care organizations may also exacerbate communication conflicts:

1. Hospital policies (such as restrictive visiting hours) may interfere with end-of-life care decisions by minimizing contact between patient and family or proxy. 2. Organizational policies often require that physicians write orders limiting the duration or extent of life-support treatments. 3. Organizations and physicians may have legal fears regarding end-of-life care decisions, and these fears may influence decisions about life-sustaining treatment.

Coping with Long-Term Illness
The major issue for patients facing long-term illness is loss of such valued assets as dignity, mobility, or physical appearance. They need support and encouragement in coping with the profound changes resulting from these losses.

You can help patients and families navigate the maze of options and responsibilities that arise during this time, by familiarizing yourself with available options that may be helpful for each individual patient. The goal is to help patients change their attitude from “dying of an illness” to “living with an illness.”

Major issues faced by patients include finding appropriate care, paying for care, and obtaining counseling and support services.

Finding long-term care
Long-term care options include skilled nursing home, assisted-living facility, and home-care services. Selection depends largely on the patient’s ability to function and perform activities of daily living, availability of services, and on ability to pay for these services. A hospital social worker or discharge coordinator may be able to assist patients in locating appropriate facilities and services.

Paying for long-term care
The United States has no coherent policy for dealing with long-term care needs. Medicare, available to the elderly and disabled, covers acute medical care and very limited nursing home care as long as it is linked to a hospital stay. Federal Medicare rules allow coverage if:

The patient has had a prior hospital stay of at least three days and is admitted to a nursing home within 30 days of discharge for the same condition.
The patient requires daily skilled nursing or rehabilitation services.
The nursing home is Medicare certified.
A medical professional certifies that skilled nursing is needed.
Medicare covers home services as long as they are “medically reasonable and necessary.” This means that coverage applies for services of skilled nurses, home health aides, medical social workers, and physical and occupational therapists. Medicare also covers the full cost of some medical supplies at 80% of the approved amount of durable medical equipment such as wheelchairs, hospital beds, oxygen supplies, and walkers.

Medicare pays for home care when a patient requires intermittent skilled nursing care, physical therapy, or speech therapy, under the following conditions:

The patient is confined to home.
The doctor determines that home care is necessary at sets up a plan for receiving care.
The home health agency participates in Medicare.
Medicaid spends 44% of its outlays for long-term care, by paying for about half of the nation’s $70 billion nursing home bill. Two of every three nursing home residents (mostly elderly) receive assistance from Medicaid.

Private long-term care insurance pays about 2% of the nursing home bill, and 14% of nursing home residents start by paying the cost themselves, and end up qualifying for Medicaid within a year, after spending their life savings.

Counseling and support services
Patients and caregivers may benefit from the services of a counselor, therapist, or psychologist, as well as religious counseling. Counseling may be disease-related or caregiver-related, such as that provided by disease-related support groups and organizations. As the patient’s disease progresses, counseling may become increasingly important, especially for caregivers who must respond to the stresses and responsibilities that accompany sometimes devastating changes in the patient’s condition.

Other types of counseling, such as spiritual help or family counseling, may be needed or sought. Relationships become strained and older issues emerge as people try to deal with catastrophic illness and new responsibilities.

Breaking the News
In the late stages of disease, there comes a point when treatments are no longer effective, or when added treatment only brings added suffering not justified by the results. Physicians can help families by communicating honestly at this point, rather than continuing to suggest new treatments that will probably fail or only add to the patient’s suffering.

Key principles on communicating with patients and families about end-of-life issues

1. Talk directly with the patient first. Do not assume that he or she won’t be able to take the bad news. The physician’s role in most cases is to be a catalyst for determining how much a patient knows or understands.1

2. Solicit easily obtainable information from a patient first, such as major worries and expectations.

3. Try to clarify any faulty or incomplete information the patient may have.

4. Look for any inconsistencies between the family’s view and the patient’s view of the situation, and encourage more interaction. A recent study of family members at tertiary care centers resulted in three suggestions for health care providers: facilitate improved interaction between the dying patient and the family; improve interactions between caregivers and patients/families; and create a setting more conducive to these interactions.5

5. Encourage questions and answer them appropriately. Don’t avoid answering any questions the patient or family may ask. Be direct but kind.

6. Be careful in giving a time frame. After all, miracles do happen. If asked, you might give a “best guess” statement such as “80% of patients at this stage can expect to live another 4 to 6 months.”

7. Look for “symbolic” cues that may express indirectly the real feelings of the patient or family.

8. Obtain information about the patient’s personal, family, and social situation, including any problems that may exist.

9. Find out how the patient really feels about his or her illness.

10. Ask open-ended questions, avoid interruptions, and let the patient talk freely.

11. Provide adequate information about diagnosis, treatment, side effects, and prognosis, checking to be sure you are understood. Be sure to describe consequences as well as potential benefits for any treatment options that are available, and assure patients that withholding such treatments is also an option.

12. Try to understand the patient’s viewpoint and be supportive.

13. Reassure patients that you will continue to be involved in their care.

The five stages of grief
Keep in mind the five stages of grief and do your best to respond to each stage as you observe it:

1. Denial (“no, not me”). Ask honest, straightforward questions. The patient will tell you how much he or she knows. Often patients show “pseudodenial” requiring only direct conversation to reveal that they know more than they wanted to let on. “When a patient has one human being with whom he can talk openly, he is then able to drop his stage of denial and go on to the second stage.”

2. Rage and anger (why me? or why now?). Patients in this stage may be nasty, ungrateful, cynical, and make life difficult for people around them. Physicians need to try not to judge these patients, but rather try to understand what they are really angry about. They are not usually angry with you, but at what you represent ‘health, energy, and all the other aspects of life they are losing. “If we can help them to ventilate their feelings of grief, anguish, rage, and anger without judging them, then they will proceed to the peculiar stage of bargaining.”

3. Bargaining (yes, it’s me, but?). Patients in this stage typically promise something, usually to God (such as going to church or synagogue or donating eyes or kidneys), often in exchange for prolongation of life. The patient looks rather comfortable and is at relative peace. During this time, patients start to concern themselves with putting their house in order, making a will, or arranging care for their children. Patients hardly ever keep their promises, and more bargains are added as each time extension arrives. When the patient finishes bargaining, he or she often becomes sad and enters the next stage.

4. Depression (yes, it’s me). Patients go through two types of depression. In reactive depression, they mourn past losses and talk about the meaning of a lost breast or leg, or about their colostomy. Since we have all experienced losses, we generally do fairly well with empathizing with these patients. It is more difficult when they move into silent grief or preparatory grief, a different type of depression where they stop mourning past losses and start mourning future losses. They start to mourn their own death and the fact that they are losing all the people and things that have meaning to them. They do not talk much during this stage, because they are unable to verbalize their anguish and sadness. They prefer to sit quietly with one or two loved ones, and holding a hand or receiving a touch becomes more important than words. “Men have much more difficulty than women during this stage, because in our society it is supposed to be unmanly to cry.” We need to resist the urge to deflect our feelings of discomfort when we are with these patients, by “checking infusions and transfusions that run perfectly well” or by coming into the room saying “Cheer up, it’s not so bad!” Rather, we need to allow patients to grieve and encourage patients to cry, not hide their tears. They are then able to get through preparatory grief more quickly and reach the last stage.

5. Acceptance. At this stage, the patient does not want visitors, does not want to talk with anyone, has usually finished any unfinished business, and no longer hopes for cure, treatment, or prolongation of life. “It is a feeling of inner and outer peace.” Some patients reach the acceptance stage before their families do. A loved one may beg for additional procedures to prolong the patient’s life or frantically implore, “Don’t die on me!” This behavior makes the dying patient feel guilty, and it is then difficult to reach a peaceful stage of acceptance. “If you truly want to help dying patients, you cannot exclude the family.” If the family can finish their unfinished business before a patient dies, then there is no grief work to do whatsoever after death, although there will always be natural grief.”

It is important to differentiate between acceptance and resignation. Acceptance is a feeling of victory, peace, serenity, and positive submission to what cannot be changed. Resignation is a feeling of defeat, bitterness, and “what’s the use, I’m tired of fighting. Dr. K’bler-Ross estimates that about 80% of nursing home patients are in a stage of resignation.

“Dying patients are marvelous teachers. When you make a mistake, and you will make many mistakes in this type of counseling, the patient will most often correct you immediately.”

Preparing for Death
Once it is clear that the patient’s death is approaching, you and your staff will need to work closely with the patient and family to ensure that the patient’s wishes are understood and followed. If the patient wishes unlimited visits from family or loved ones, try to arrange for this, especially in the case of dying children. Encourage the patient and family to prepare or review documentation of the patient’s wishes and preferences.

Documentation should be based on shared communication between physician, patient, and family. Discussions should be continual and broad in scope.

Encourage patients and families to attend to legal issues such as exploring insurance benefit coverage, qualification for entitlements (such as Social Security disability benefits, veteran’s benefits, Medicaid, or legal aid), and it is recommended that all patients complete a will, regardless of the size of their estate.

If a patient is expected to die at home, there may be questions about who is legally recognized in your state to pronounce the patient dead and to sign the death certificate. It may be helpful for the attending physician to write a letter in advance stating that the patient is terminally ill and planning to die at home without life-support measures, and/or to sign an out-of-hospital DNR order that would be legally recognized in your state.

Patients also need to address preferences regarding funerals, burial, or cremation, and how they want to be remembered. Some patients may want to donate their body or body parts to medicine, a decision that requires special procedures at the time of death to ensure that body parts are usable. “The more of these questions that can be answered in advance, the fewer decisions must be made by family members in the acute shock immediately following the death.”

Advance directives
By definition, advance directives are written documents that provide instructions for providing health care should the individual become unable to express his or her desires about medical treatment. Although any competent adult has the right to consent to or refuse any medical treatment, today’s high-tech, complicated medical systems can make this right difficult to ensure.

Advance directives such as living wills or durable power of attorney (DPA) for health care (health-care proxy) give people the opportunity to declare their treatment preferences in advance, before they are no longer able to communicate. A living will lists the types of treatments a person might want or not want under certain medical circumstances (for example, no heroic measures if there is no chance for recovery). A DPA allows people to express such preferences and also to name a trusted friend or relative to speak on their behalf about treatment decisions, if they cannot. A DPA is generally more useful than a living will, because the designated proxy can make decisions that may not be clear from a written document. However, a living will may be a better choice for patients who have no one else to make decisions for them.

Although advance directives provide only crude directions for situations where complex choices are needed, they can lend a focus for the patient’s values and goals for medical treatment, especially if they also designate a trusted proxy to represent the patient’s feelings in such situations.

Laws about advance directives vary from state to state. Check out the laws in your state regarding the scope and requirements that apply to advance directives.

Do-Not-Resuscitate (DNR) orders
A do-not-resuscitate order is a request from patients to withhold cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing. Unless such an instruction is given, hospital or emergency staff personnel will try to help all patients in such circumstances. Doctors and hospitals in all states accept DNR orders.

Patients who are not likely to benefit from CPR include people with metastatic cancer, kidney failure, severe infections such as pneumonia, and people who need lots of help with daily activities. Patients with these conditions need to be aware that they can use an advance directive form to issue a DNR order.

Other considerations
Patients may want to use their time to “get their lives in order” by resolving relationships, distributing their property through wills and other documents, and making arrangements for funerals, interments, and memorial services.

Patients from various religious and cultural backgrounds have traditions that need to be followed and respected.7

A social worker or chaplain may be able to help indigent families or patients who are alone.

End-of-Life options and Issues
Sudden-death issues
So far we have talked only about terminally ill patients and the adjustments they and their families need to make to help them pass through this difficult time. Of course, this is possible only if there is time between the onset of illness and the resulting death. What about the thousands of adults and children who die suddenly and unexpectedly in emergency rooms and on operating tables? Survivors are not at all prepared and they often react with great shock to the tragic news that death is imminent, just at a time when clear thinking and fast actions are needed.

The emergency room physician must immediately do whatever is necessary to maintain cardiac function, clear airways, or start oxygen or IV fluids. No one has time to answer desperate questions from relatives while trying to take care of the physical demands of the patient. The critically ill or injured patient is often in a state of shock, and is usually not even aware of what is happening.

At such times, a specially trained volunteer, social worker, or hospital chaplain could help by being immediately available for the comfort of relatives. Volunteers can sit with relatives, listen to them, or offer to make phone calls. These workers would be on call 24-hours a day, especially at night when the need may be greatest. Relatives should not be left alone, except at their own request and only if they do not seem to be in emotional turmoil.

It is important to provide privacy for relatives in the form of conference rooms or a so-called “screaming room” where families can vent their feelings in privacy.

Physicians may wonder in the case of a family accident, where several people are seriously injured, what to say to a man who asks about his wife who may have died. If the man is in critical condition, perhaps needing surgery, it is best to wait to tell him that his wife has died. He might go into shock or lose his will to live if he gets the news immediately. If he asks directly if she is dead, however, tell him the truth, perhaps asking him to fight for his own recovery “for her sake.”

In general, we need to be sensitive to each individual and decide how much the patient is able to hear. It is best to be honest without shocking or giving unnecessary information. The people who have the most difficulty are those to whom information is given in a kind of black-and-white fashion, without allowing for hope. The patient needs to know that you are not going to lie to him but you are going to try to prevent this from happening.

“Breaking the news” is never easy, but it becomes especially difficult when death is sudden or unexpected. If done skillfully, someone else might prepare the family that the situation is grave, but often there is no time to prepare the family. In any case, the doctor should always be the one who actually tells the family.

It is very hard to predict how anyone will react. People who are not in a state of denial may berate the doctors and nurses, accusing them of not doing enough or of not doing the right things. They may be angry with other medical personnel or with each other. All we can do is try to understand that this behavior is a natural expression of their anguish, pain, and grief.

Give families the opportunity to see the body (after washing and preparation) before they leave the hospital. (Leave the face uncovered if it is not too mutilated, and if necessary, elevate the head a few moments to clear the sinuses. Bandage mutilated parts as for a postoperative patient.) Inform the family of any disfigurement. Many people who have not been allowed (or didn’t want) to see the body have had trouble later on in facing the reality of the death.

It is often helpful to families if someone on the emergency room staff (particularly the volunteer or worker who assisted them) would call families about one month after the accident. By this time, people are usually past the stages of shock and denial. Invite them to return to the emergency room to talk. Many families appreciate this opportunity to ask questions as well as knowing they are not alone in their grief.

Staff issues
Nurses and physicians are involved in many unsuccessful resuscitation attempts, and they bring with them their own special feelings, religious beliefs, and perhaps unresolved grief or bereavement. As soon as possible, it is important to take time to talk about the situation they have been through, so everyone on staff can vent their feelings too. Staff members need a screaming room as badly as family members of accident victims!

Heroic measures
“Heroic measures” refer to interventions that may be applied without consideration of the patient’s condition. Examples include cardiopulmonary resuscitation or insertion of feeding tube. Families facing decisions about such treatments need to know the difference between consciousness and awareness, the latter not being dependent on a functioning brain.

Controversy surrounds the use of artificial means for prolonging life in patients who have no real chance of having any real quality of life. These patients exist but don’t live in nursing homes, extended care facilities, or at home, and are a tremendous burden (financially, emotionally, and physically) to families and caregivers. How long do we need to keep these people alive at all costs? Even the decision to use antibiotics must be considered carefully for these patients.

Palliative care (comfort care)
Palliative care, also called comfort care, is directed primarily toward providing relief to the terminally ill person through symptom management and pain management. The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. Well-rounded palliative care programs also address mental health and spiritual needs. The focus is not on death, but on compassionate specialized care for the living. Palliative care is well suited to an interdisciplinary team approach that provides support for dying individuals as well as those who love them.

Palliative care may be delivered in hospice or home care settings. Because medical needs vary depending on the patient’s disease, specialized palliative care programs exist for cancer, AIDS, and organic changes in the brain that lead to coma or dementia. Good quality palliative care can make the difference between a gentle death and one in which suffering is so terrible or prolonged that assisted suicide becomes an attractive alternative.

Because it can take some time to tailor palliative care to each person, it is best to offer some level of professional care before a crisis exists. Families often feel it is “to soon” to start palliative care and wait until death is very near. This limits its effectiveness. A better approach is to arrange introductory home meetings or hospice visits before palliative care is needed and obtain counseling from a hospice professional who can provide suggestions about care arrangements. In other words, put the support network in place before you need it.

When people start receiving palliative care, their loved ones may experience increased feelings of grief and bereavement. These feelings may intensify over time, so that providers need to be sensitive to changing needs for support and encouragement. Many support groups are available to help patients and families through this process.

Pain control issues
Pain management is one of the most important aspects of care for terminally ill patients. Aggressive pain management is a specialized area, often requiring consultation with a pain management specialist. Patients may wish to obtain a specialist opinion if their own physician is unable or unwilling to provide adequate pain management.

Although acute pain (which is sharp, localized to a physical source, and limited in duration), is usually intermittent or short-lived, chronic pain becomes a constant companion, dominating the patient’s future through dread of more pain, as well as memory of past pain. It creates a sense of helplessness often accompanied by depression or anxiety.

Chronic pain from cancer has three basic sources: 1) the direct result of the tumor’s growth, by invading, compressing, or obstructing parts of the body; 2) side effects of medical treatments such as surgery, chemotherapy, or radiation therapy; and 3) coincidental pain (such as bedsores), as a byproduct of the illness.

Hospice patients can use a body chart to pinpoint where their pain is located, rating their pain from 0 to 10. They need to be reassured that their pain is taken seriously, and dosages must be adapted and frequently modified according to changing needs.

“It is better to prevent chronic pain, when possible, than to treat it each time it reappears” Patients and families should be educated about the goals of pain treatment and why it is essential that pain medications be given on schedule around the clock,” in order to keep a constant minimum level of pain medication in the bloodstream, so the patient can relax or sleep. They also need to know that once the cycle of pain and fear is broken, dosages can be cut back to a lower level.

Although related, “pain and suffering are not identical experiences.” Some people in extreme pain, such as during childbirth, do not experience their pain as suffering, which the medical philosopher Eric J Cassell, MD defines as “a threat to the person’s integrity or sense of wholeness.” Patients may suffer from an attack to their wholeness even when their physical pain is not so severe.

Alternative treatments may help. These include many holistic methods, such as visualization, active relaxation, music and color healing, or hypnotherapy.

“Pulling the plug” on futile treatments
When life-sustaining treatment is discontinued because of medical futility or patient decision, we become uneasy about our actions, often because we fail to distinguish clearly between causing a patient’s death or merely allowing the patient to die. For example, a permanently unconscious ventilator patient is alive until the physician removes the ventilator, after which the patient dies. If the ventilator is never used, however, death is neither caused nor precipitated by the physician, but is clearly the result of the patient’s disease process. Because of this conflict, many physicians are more comfortable with not starting treatment than with stopping it.

The counter to this concern is to regard the ventilator as an optional form of external support. Although the ventilator does sustain life, it is clear that the patient may refuse to use it. If the terminally ill patient had prepared an advance directive refusing mechanical ventilation, then the ventilator would not have been started. On the other hand, if the ventilator was started before the patient became terminal and irreversibly incapacitated, the ventilator should be discontinued once these conditions have been clearly met. In discontinuing use of the ventilator, the physician is not causing death but is appropriately removing a form of external medical support that the patient had refused in advance. The natural forces of the patient’s illness continue unopposed once the ventilator is removed, and the patient dies. In situations such as these, families need to understand that the patient’s death is caused by the disease rather than by the physician or by failure on their part to do all they could for the patient.

Physicians have no ethical obligation to provide treatment that is futile. Unfortunately, medical futility can have several meanings. Failure to clarify the term can lead to miscommunication. For example, in explaining to a patient that CPR would be futile, it is not uncommon for the physician to mean that CPR would have a very low chance of success, while the patient interprets this to mean that CPR has no possibility of success. If the patient then agrees to forgo CPR, the decision would have been based on a misunderstanding. “For this reason, it is important to be explicit about these matters by using plain language instead of hiding value judgments under the cloak of medical futility.”

Physicians occasionally encounter dilemmas in end-of-life care when a patient uses an advance directive to demand treatment in order to live as long as possible without any regard to quality of life. If continued treatment is then judged to be futile, serious conflicts may arise. Such conflicts may be avoided in several ways:

1. Potential conflicts in end-of-life care management philosophy should be addressed early in the patient-physician relationship. Experience has shown that African-American patients and families are more likely than other ethnic groups to resist when the option to withhold or discontinue treatment is suggested.

2. Patients and proxies should be made aware that physicians are under no obligation to provide futile care.

3. Futile or medically inappropriate care should not be offered “theoretically” with the expectation that it will be refused.

4. The advance directive can guide end-of-life care but does not substitute for physician judgments.

5. A “fair process” end-of-life care management process (facilitated by subspecialist and ethics committee consultations) can provide limited structure to the process of patient-physician deliberation and conflict resolution in such cases.

Physician-assisted suicide
The term euthanasia applies to any situation where the physician actually takes the patient’s life, rather than allowing the patient to die from natural disease processes. Although the term has been variously defined, euthanasia usually refers to an act in which the physician directly and intentionally causes a patient’s death by medical means. For example, a physician commits euthanasia when he or she injects a lethal amount of potassium chloride into a patient for the purpose of terminating the patient’s life. This situation distinguishes euthanasia from murder because its motive is merciful rather than malicious. Nevertheless, it is a form of homicide and remains illegal in the United States.

When the physician performs euthanasia with the consent of the patient, it is called voluntary euthanasia. When performed without patient choice, such as when the patient is incapacitated, it is called nonvoluntary or nonchoice euthanasia.

Physician-assisted suicide is a form of voluntary euthanasia that is legal in the state of Oregon. In November 1994, Oregon voters approved a ballot initiative that made it legal for a physician, at the request of a terminally ill patient, to prescribe a lethal dose of medication for administration by the patient. Similar legislation is being considered in other states. These developments, along with growing pressure from advocacy groups and information from opinion polls, suggest that the legalization of physician-assisted suicide has substantial public support. Although major health care organizations (AMA, American Nurses’ Association, and American Geriatrics Society) oppose the legalization of physician-assisted suicide, the medical profession is increasingly acknowledging that physician-assisted suicide may have a role in terminal care.

If physician-assisted suicide is legalized, physicians will need to gain expertise related to understanding motivations for requesting such an option, maximizing palliative interventions, and other considerations. The onset of functional and cognitive decline will need to be estimated along with life expectancy. The physician’s position on physician-assisted suicide must be open to discussion with the patient. Protecting the patient’s right to confidentiality must be balanced against the need for health care professionals and institutions to know about the patient’s choice. Insurance coverage and managed care options may be affected. These are just some of the issues that need to be addressed through research, education, and decision making by individual physicians as the debate continues.

Patients may ask you about this option. If you practice in a state where physician-assisted suicide is legal, you may refer the patient to a physician who is known to provide this service without relinquishing your relationship with the patient. Patients often perceive this option as a comforting alternative, even if they never use it.

REDEFINING HOPE CONFERENCE

NATIVE AMERICAN
O Great Spirit, whose Voice I hear in the Winds,
Hear me -- for I am small and weak:
I need Your Strength and Wisdom.
I seek Strength, O Great One, not to be superior to my Brothers --
But to conquer my greatest enemy: Myself.
I seek Wisdom: the Lessons You have hidden
In every Leaf and Rock so that I may learn
And carry these messages of Life and Hope to my People.
May my hands respect the many beautiful things You have made;
May my ears be sharp - to hear Your voice.
May I always walk in Your beauty;
And let my eyes behold the red and purple Sunset
So that when Life fades with the setting Sun,
My Spirit will come to You without shame.

HINDU
Look to this day!
For it is life, the very life of life.
In its brief course
Lie all the verities and realities of your existence:
The bliss of growth;
The glory of action;
The splendor of achievement;
For yesterday is but a dream,
And tomorrow is only a vision;
But today, well lived, makes every yesterday
a dream of happiness,
And every tomorrow a vision of hope.

BUDDHIST
May I become at all times, both now and forever
A protector for those without protection
A guide for those who have lost their way
A ship for those with oceans to cross
A bridge for those with rivers to cross
A sanctuary for those in danger
A lamp for those without light
A place of refuge for those who lack shelter
And a servant to all in need.
Tenzin Gyatso, the 14th Dalai Lama

JEWISH
Yea, though I walk through the valley of the shadow of death, I will fear no evil, for Thou art with me; Thy rod and Thy staff, they comfort me.

PROTESTANT: O Lord, you have made us very small, and we bring our years to an end like a tale that is told. Help us to remember that beyond our brief day is the eternity of your love.
Reinhold Niebuhr (1892-1971

CATHOLIC

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love,
Where there is injury, pardon
Where there is doubt, faith,
Where there is despair, hope,
Where there is darkness, light,
Where there is sadness, joy.
O Divine Master, grant that I may not so much
seek to be consoled as to console,
not so much to be understood as to understand,
not so much to be loved, as to love;
for it is in giving that we receive,
it is in pardoning that we are pardoned,
it is in dying that we awake to eternal life.
St. Francis of Assisi

**********************************************
1 Corinthians 13:13
And now these three remain: faith, hope and love. But the greatest of these is love.

Epictetus:
A ship ought not to be held by one anchor, nor life by a singe hope.

Oliver Wendell Holmes:
Beware how you take away hope from any human being.

Roman saying:
While there's life, there's hope.

Thomas Fuller:
If it were not for hopes, the heart would break.

Henry Wadsworth Longfellow:
Hope has as many lives as a cat or a king.

Hope is necessary in every condition.
Samuel Johnson (1709 - 1784)

Hope is that thing with feathers that perches in the soul and sings the tune without the words and never stops... at all. ~Emily Dickinson









Reinhold Niebuhr:
Nothing worth doing is completed in our lifetime,
Therefore, we are saved by hope.

Nothing true or beautiful or good makes complete sense in any immediate context of history;
Therefore, we are saved by faith.

Nothing we do, however virtuous, can be accomplished alone.
Therefore, we are saved by love.

No virtuous act is quite a virtuous from the standpoint of our friend or foe as from our own;
Therefore, we are saved by the final form of love which is forgiveness.
***************************
Czech President Vacel Havel once said of hope:
Hope is not the conviction that something will turn out well but the certainty that something makes sense, regardless of how it turns out.

Children's hospice programs are helping children and families hold on to hope...how ever that hope may be defined...by helping things to turn out well and embracing healing even when there is no cure.

Children's Hospice and Palliative Care Coalition vision is:
To ensure that seriously ill children and their families get the compassionate medical, emotional, and spiritual support they need to hold on to hope - whatever form hope takes- whether it be hope for a cure, a family vacation, time with family and friends, finishing the school year, graduation, or relief of pain and a peaceful death.
************************
IRA BYOCK
Because accidents and sudden illness do happen, it is never too soon to express forgiveness, to say thank you and I love you to the people who have been an integral or intimate part of our lives, and to say good-bye as a blessing. These simple words hold essential wisdom for transforming that which matters most in our lives-our relationships with the people we love.

“All religions stress the power of forgiveness, and this power is never more necessary, nor more deeply felt, than when someone is dying. Through forgiving and being forgiven, we purify ourselves of the darkness of what we have done, and prepare ourselves most completely for the journey through death.”
- The Tibetan Book of Living and Dying

“What keeps us alive, what allows us to endure?
I think it is the hope of loving, Or being loved.”
Meister Eckhart, Love Poems from God
********************
It Takes a Village to Say Goodbye
Doug Smith – Oct 10

Giving your current capabilities, how would you want to spend your time?

Focusing on the client’s resources rather than mine.

ANEMNESIS

In remembering something from the past, in the present we make it present.

Sometimes this is used in the prayer of consecration, when the elements are transformed, we make it present. The doctrine of the Real Presence: “really, really, present.”

That is what love really means.
Something in your past that you are proud and which you experienced love.

Do in remembrance of me

Where would you go to find peace?

Children's Hospice

The article concludes with a look at hope, the concept of simultaneous care and the vision of Children's Hospice for the future. ______________________________
Vacel Havel once said of hope:
Hope is not the conviction that something will turn out well but the certainty that something makes sense, regardless of how it turns out.Children's hospice programs are helping children and families hold on to hope...how ever that hope may be defined...by helping things to turn out well and embracing healing even when there is no cure.
Hopes for Children's Hospice Programs Two of the major children's hospice organizations have offered their look at the future of children's hospice.
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The first comes from the Children's Hospice and Palliative Care Coalition. Their vision is:
To ensure that seriously ill children and their families get the compassionate medical, emotional, and spiritual support they need to hold on to hope - whatever form hope takes- whether it be hope for a cure, a family vacation, time with family and friends, finishing the school year, graduation, or relief of pain and a peaceful death.
Finally Ann Armstrong-Dailey, Founding Director and CEO of Children's Hospice International hopes for Children's Hospice are that an integrative approach to care will emerge:
Our ultimate goal is to so ingrain the hospice concept into pediatrics that it isn't considered a separate specialty, rather, an integral part of health care for children and adolescents.
Therefore, the goal for children's hospice programs is to make the hospice style of care available for all children who need it, regardless of where they are in the treatment, whether they have a terminal illness or not. The elements of hospice or palliative care are offered at the time of diagnosis and continued throughout the course of illness, whether the outcomes ends in cure or death. Hospice becoems part of an integrative approach to medical care.
Simultaneous Care - Care Throughout the Course of Illness
The goals for the future of children's hospice are similar to the approach being called Simultaneous Care. With a Simultaneous Care approach the system of care is one that enhances patient choice by allowing patients and families to have access at the same time to two beneficial options--palliative care and continued medical therapies.
The Simultaneous Care approach optimizes hospice and palliative care goals of treatment while at the same time offering patients with advanced cancer access to new and potentially better therapies. According to one of my adult hospice mentors, Dr. Fred Meyers, simultaneous care...
...is not about giving up. It's about increased quality of life and enhanced coordination of care. It is not about dying. It is about living with cancer. It's not less care. It's more care.
With this kind of simultaneous approach to care, hospice or palliative care becomes one of the many options available to children's physician to take care of their young patients. ______________________________
© 2006 Kirsti A. Dyer MD, MS, FT. Licensed for use to About.com.
About Children's Hospice and Palliative Care Coalition The Children's Hospice and Palliative Care Coalition places the priority on the needs of the entire family when a child is diagnosed with a life-threatening condition. Children's Hospice works with hospitals, hospices and community organizations to improve the well-being of the child by promoting compassionate, family-centered care from the time of diagnosis and throughout the course of treatment. Their mission is to ensure that children with life-threatening conditions can live well and die gently.
About Children's Hospice International Children's Hospice International (CHI), a non-profit organization, was founded in 1983 to promote hospice support through pediatric care facilities, encourage the inclusion of children in existing and developing hospice, palliative, and home care programs and include the hospice perspectives in all areas of pediatric care, education, and the public arena. CHI provides education, training and technical assistance to those who care for children with life-threatening conditions and their families. Their mission is to ensure that the hospice concept becomes an integrated and integral part of health care for children and adolescents.
Sources: Children's Hospice International. Who We Are. 9 December 2006. <http://www.chionline.org/whoweare> Children's Hospice and Palliative Care Coalition. Mission Possible: About Us. 9 December 2006. <http://www.childrenshospice.org/about/> Committee on Bioethics and Committee on Hospital Care. American Academy of Pediatrics: Policy Statement. Palliative Care for Children. Pediatrics 2000 106;2:351-357. <http://aappolicy.aappublications.org/cgi/content/full/pediatrics;106/2/351> Morain C. It's About Living. UC Davis Magazine. Fall 2005. Vol. 23: No. 1. 9 December 2006. <http://ucdavismagazine.ucdavis.edu/issues/fall05/feature_1.html> Meyers FJ, Linder J, Beckett L, Christensen S, Blais J, Gandara DR. Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care. J Pain Symptom Manage. 2004 Dec;28(6):548-56.
Additional Resources
Hospice, Palliative Care for Newborns, Infants and Children
The Nick Snow Children's Hospice and Palliative Care Act of 2006
What is Hospice?
What is Palliative Care?
What is Simultaneous Care?
Support Children's Hospice by Purchasing a Hospice Bracelet
When Children Die: Improving Palliative and End-of-Life Care for Child - Online Book Resource


Children's Hospice - End of Life Care for Children
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About.com Health's Disease and Condition content is reviewed by our Medical Review Board
Embracing Healing - Even When There is No Cure
Children ≠ Hospice When most people think of hospice care, or care provided at the end of a life, they don't usually think about children, perhaps because the concepts of children and dying and death don't go together in the typical American culture.
Melissa Gilbert, President of the Board of Directors for Children's Hospice and Palliative Care Coalition offers some wise words on this topic:
...the words 'children' and 'hospice' shouldn't go together, but they do. Children should be allowed to pass on with grace and dignity. Children's Hospice addresses the needs of the entire family...mind, body and spirit...embracing healing even when there is no cure. The support that the Children's Hospice and Palliative Care Coalition provides is invaluable.
While no one would electively choose to have their child need hospice care, it is good to know that the climate and the options for children needing hospice is changing.
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Sponsored Links

Children's hospice programs focus on treating the whole person and the family; they also embrace healing even when there is no cure. Most of all they are helping children and families hold on to hope...however that hope may be defined.
History of Children's Hospice The hospice and palliative care movement has grown rapidly in the past years, with more than 4,160 hospices in the United States. Sadly, children have often not been included in many hospice programs for a variety of reasons. The Children's Hospice International (CHI) estimate that there are more than 7 million children and their families around the world could benefit from children's hospice programs or palliative care. Additionally, CHI estimates that less than one percent of children needing hospice care in the United States receive it.
In 1983 there were 1,400 hospices in the United States, but only four were able to accept children. Through the efforts of dedicated individuals and groups by 2006 many of the hospices in the United States now consider accepting children as patients for hospice care. In addition, there are over 450 programs have children-specific hospice, palliative or home care programs.
Being Eligible for Hospice or Palliative Care Children may have problems receiving hospice care because of the current requirements to be eligible for care. In order to qualify for hospice care the child's doctor must state that the child has only six months to live and the child must agree to stop all treatment to try and cure their disease.
While a standard requirement for adult hospice programs, this concept of an "all or nothing" approach is difficult for many who have or treat children to understand. This dichotomy can cause a great deal of heart-ache, unnecessary confusion, anxiety and stress among the patients, medical professionals, families and caregivers that can ultimately compromise the child's care.
Nick Snow, neuroblastoma survivor and former spokesperson for Children's Hospice, was the child known to have "flunked" hospice twice. He had once said about this dichotomy of care:
I don't understand why you should lose all this great support just because you want to live.
Fortunately things are starting change.
Changing Views on Children's Hospice Mattie Stepanek, inspirational child poet and peace-maker who was afflicted with Dysautonomic Mitochondrial Myopathy, offered these wise words about children and hospice support or palliative care in February of 2000:
We don't have to wait until we are very sick and know that this might be 'it.' We can get support from the day we learn something could happen.
Later in 2000, the Committee on Bioethics and Committee of Hospital Care of the American Academy of Pediatrics published a policy statement on "Palliative Care for Children" that stated their views on providing palliative care. The American Academy of Pediatrics supports an integrated model of palliative care, one in which "the components of palliative care are offered at diagnosis and continued throughout the course of illness, whether the outcomes ends in cure or death."
Furthermore, they went on to state in their position paper that:
If palliative care is reserved for children who are dying or have a terminal condition, other patients who may benefit from these services may not receive them....With a broader definition that includes children living with a life-threatening condition, all children who need palliative care may benefit.
Another benefit of introducing an integrated palliative care approach (or a simultaneous care model) is that including symptom management and counseling early on in the course is beneficial in helping the child and the family to better cope with the illness.
Changing Legislation - The Nick Snow Children's Hospice and Palliative Care Act In September 2006 California Governor Arnold Schwarzenegger signed Assembly Bill 1745 into law. The new law, also know as "The Nick Snow Children's Hospice and Palliative Care Act of 2006," was named after Nick Snow, a child hospice patient and advocate. Nick died in April 2006, cancer free, following an intestinal infection.
This landmark legislation allows children in California diagnosed with serious illnesses to receive hospice and palliative care. The new law replaces older regulations that only provided hospice and palliative care to children whose families had legally given up all chance of their recovery. It is estimated that 10,000 to 14,000 children in California and their families will benefit yearly from the new legislation.

FAITH HOPE AND LOVE

1 Corinthians 13:13
And now these three remain: faith, hope and love. But the greatest of these is love.

1 Thessalonians 1:3
Remembering without ceasing your work of faith, and labour of love, and patience of hope in our Lord Jesus Christ, in the sight of God and our Father;

1 Thessalonians 5:8
But let us, who are of the day, be sober, putting on the breastplate of faith and love; and for an helmet, the hope of salvation.

BIBLE

Psalm 9:18
18 But the needy will not always be forgotten,
nor the hope of the afflicted ever perish.

Psalm 39:7
7 "But now, Lord, what do I look for?
My hope is in you.

Psalm 43:5
5 Why are you downcast, O my soul?
Why so disturbed within me?
Put your hope in God,
for I will yet praise him,
my Savior and my God.

THE MESSAGE

1. Genesis 49:18
I wait in hope for your salvation, God.

2. Joshua 2:8
Before the spies were down for the night, the woman came up to them on the roof and said, "I know that God has given you the land. We're all afraid. Everyone in the country feels hopeless. We heard how God dried up the waters of the Red Sea before you when you left Egypt, and what he did to the two Amorite kings east of the Jordan, Sihon and Og, whom you put under a holy curse and destroyed. We heard it and our hearts sank. We all had the wind knocked out of us. And all because of you, you and God, your God, God of the heavens above and God of the earth below.

3. Ruth 1:11
But Naomi was firm: "Go back, my dear daughters. Why would you come with me? Do you suppose I still have sons in my womb who can become your future husbands? Go back, dear daughters—on your way, please! I'm too old to get a husband. Why, even if I said, 'There's still hope!' and this very night got a man and had sons, can you imagine being satisfied to wait until they were grown? Would you wait that long to get married again? No, dear daughters; this is a bitter pill for me to swallow—more bitter for me than for you. God has dealt me a hard blow."

4. 1 Samuel 2:6
God brings death and God brings life, brings down to the grave and raises up. God brings poverty and God brings wealth; he lowers, he also lifts up. He puts poor people on their feet again; he rekindles burned-out lives with fresh hope, Restoring dignity and respect to their lives— a place in the sun! For the very structures of earth are God's; he has laid out his operations on a firm foundation. He protectively cares for his faithful friends, step by step, but leaves the wicked to stumble in the dark. No one makes it in this life by sheer muscle! God's enemies will be blasted out of the sky, crashed in a heap and burned. God will set things right all over the earth, he'll give strength to his king, he'll set his anointed on top of the world!

5. 1 Samuel 17:11
When Saul and his troops heard the Philistine's challenge, they were terrified and lost all hope.

6. 1 Samuel 17:32
"Master," said David, "don't give up hope. I'm ready to go and fight this Philistine."

7. 2 Samuel 1:26
O my dear brother Jonathan, I'm crushed by your death. Your friendship was a miracle-wonder, love far exceeding anything I've known— or ever hope to know.

8. 2 Kings 4:28
Then she spoke up: "Did I ask for a son, master? Didn't I tell you, 'Don't tease me with false hopes'?"

9. 2 Kings 1:4
They were absolutely terrified at the letter. They said, "Two kings have already been wiped out by him; what hope do we have?"

10. 2 Kings 14:26
God was fully aware of the trouble in Israel, its bitterly hard times. No one was exempt, whether slave or citizen, and no hope of help anywhere was in sight. But God wasn't yet ready to blot out the name of Israel from history, so he used Jeroboam son of Jehoash to save them.

11. 2 Kings 18:23
"So be reasonable. Make a deal with my master, the king of Assyria. I'll give you two thousand horses if you think you can provide riders for them. You can't do it? Well, then, how do you think you're going to turn back even one raw buck private from my master's troops? How long are you going to hold on to that figment of your imagination, these hoped-for Egyptian chariots and horses?

12. Ezra 10:2
Shecaniah son of Jehiel of the family of Elam, acting as spokesman, said to Ezra: "We betrayed our God by marrying foreign wives from the people around here. But all is not lost; there is still hope for Israel. Let's make a covenant right now with our God, agreeing to get rid of all these wives and their children, just as my master and those who honor God's commandment are saying. It's what The Revelation says, so let's do it.

13. Job 4:1
[ Eliphaz Speaks Out ] [ Now You're the One in Trouble ] Then Eliphaz from Teman spoke up: "Would you mind if I said something to you? Under the circumstances it's hard to keep quiet. You yourself have done this plenty of times, spoken words that clarify, encouraged those who were about to quit. Your words have put stumbling people on their feet, put fresh hope in people about to collapse. But now you're the one in trouble—you're hurting! You've been hit hard and you're reeling from the blow. But shouldn't your devout life give you confidence now? Shouldn't your exemplary life give you hope?

14. Job 5:8
[ What a Blessing When God Corrects You! ] "If I were in your shoes, I'd go straight to God, I'd throw myself on the mercy of God. After all, he's famous for great and unexpected acts; there's no end to his surprises. He gives rain, for instance, across the wide earth, sends water to irrigate the fields. He raises up the down-and-out, gives firm footing to those sinking in grief. He aborts the schemes of conniving crooks, so that none of their plots come to term. He catches the know-it-alls in their conspiracies— all that intricate intrigue swept out with the trash! Suddenly they're disoriented, plunged into darkness; they can't see to put one foot in front of the other. But the downtrodden are saved by God, saved from the murderous plots, saved from the iron fist. And so the poor continue to hope, while injustice is bound and gagged.

15. Job 6:8
[ Pressed Past the Limits ] "All I want is an answer to one prayer, a last request to be honored: Let God step on me—squash me like a bug, and be done with me for good. I'd at least have the satisfaction of not having blasphemed the Holy God, before being pressed past the limits. Where's the strength to keep my hopes up? What future do I have to keep me going? Do you think I have nerves of steel? Do you think I'm made of iron? Do you think I can pull myself up by my bootstraps? Why, I don't even have any boots!

16. Job 6:14
[ My So-Called Friends ] "When desperate people give up on God Almighty, their friends, at least, should stick with them. But my brothers are fickle as a gulch in the desert— one day they're gushing with water From melting ice and snow cascading out of the mountains, But by midsummer they're dry, gullies baked dry in the sun. Travelers who spot them and go out of their way for a drink end up in a waterless gulch and die of thirst. Merchant caravans from Tema see them and expect water, tourists from Sheba hope for a cool drink. They arrive so confident—but what a disappointment! They get there, and their faces fall! And you, my so-called friends, are no better— there's nothing to you! One look at a hard scene and you shrink in fear. It's not as though I asked you for anything— I didn't ask you for one red cent— Nor did I beg you to go out on a limb for me. So why all this dodging and shuffling?

17. Job 7:1
[ There's Nothing to My Life ] "Human life is a struggle, isn't it? It's a life sentence to hard labor. Like field hands longing for quitting time and working stiffs with nothing to hope for but payday, I'm given a life that meanders and goes nowhere— months of aimlessness, nights of misery! I go to bed and think, 'How long till I can get up?' I toss and turn as the night drags on—and I'm fed up! I'm covered with maggots and scabs. My skin gets scaly and hard, then oozes with pus. My days come and go swifter than the click of knitting needles, and then the yarn runs out—an unfinished life!

18. Job 8:8
[ To Hang Your Life from One Thin Thread ] "Put the question to our ancestors, study what they learned from their ancestors. For we're newcomers at this, with a lot to learn, and not too long to learn it. So why not let the ancients teach you, tell you what's what, instruct you in what they knew from experience? Can mighty pine trees grow tall without soil? Can luscious tomatoes flourish without water? Blossoming flowers look great before they're cut or picked, but without soil or water they wither more quickly than grass. That's what happens to all who forget God— all their hopes come to nothing. They hang their life from one thin thread, they hitch their fate to a spider web. One jiggle and the thread breaks, one jab and the web collapses. Or they're like weeds springing up in the sunshine, invading the garden, Spreading everywhere, overtaking the flowers, getting a foothold even in the rocks. But when the gardener rips them out by the roots, the garden doesn't miss them one bit. The sooner the godless are gone, the better; then good plants can grow in their place.

19. Job 11:13
[ Reach Out to God ] "Still, if you set your heart on God and reach out to him, If you scrub your hands of sin and refuse to entertain evil in your home, You'll be able to face the world unashamed and keep a firm grip on life, guiltless and fearless. You'll forget your troubles; they'll be like old, faded photographs. Your world will be washed in sunshine, every shadow dispersed by dayspring. Full of hope, you'll relax, confident again; you'll look around, sit back, and take it easy. Expansive, without a care in the world, you'll be hunted out by many for your blessing. But the wicked will see none of this. They're headed down a dead-end road with nothing to look forward to—nothing."

20. Job 14:1
[ If We Die, Will We Live Again? ] "We're all adrift in the same boat: too few days, too many troubles. We spring up like wildflowers in the desert and then wilt, transient as the shadow of a cloud. Do you occupy your time with such fragile wisps? Why even bother hauling me into court? There's nothing much to us to start with; how do you expect us to amount to anything? Mortals have a limited life span. You've already decided how long we'll live— you set the boundary and no one can cross it. So why not give us a break? Ease up! Even ditchdiggers get occasional days off. For a tree there is always hope. Chop it down and it still has a chance— its roots can put out fresh sprouts. Even if its roots are old and gnarled, its stump long dormant, At the first whiff of water it comes to life, buds and grows like a sapling. But men and women? They die and stay dead. They breathe their last, and that's it. Like lakes and rivers that have dried up, parched reminders of what once was, So mortals lie down and never get up, never wake up again—never. Why don't you just bury me alive, get me out of the way until your anger cools? But don't leave me there! Set a date when you'll see me again. If we humans die, will we live again? That's my question. All through these difficult days I keep hoping, waiting for the final change—for resurrection! Homesick with longing for the creature you made, you'll call—and I'll answer! You'll watch over every step I take, but you won't keep track of my missteps. My sins will be stuffed in a sack and thrown into the sea—sunk in deep ocean.

21. Job 14:18
"Meanwhile, mountains wear down and boulders break up, Stones wear smooth and soil erodes, as you relentlessly grind down our hope. You're too much for us. As always, you get the last word. We don't like it and our faces show it, but you send us off anyway. If our children do well for themselves, we never know it; if they do badly, we're spared the hurt. Body and soul, that's it for us— a lifetime of pain, a lifetime of sorrow."

22. Job 17:10
"Maybe you'd all like to start over, to try it again, the bunch of you. So far I haven't come across one scrap of wisdom in anything you've said. My life's about over. All my plans are smashed, all my hopes are snuffed out— My hope that night would turn into day, my hope that dawn was about to break. If all I have to look forward to is a home in the graveyard, if my only hope for comfort is a well-built coffin, If a family reunion means going six feet under, and the only family that shows up is worms, Do you call that hope? Who on earth could find any hope in that? No. If hope and I are to be buried together, I suppose you'll all come to the double funeral!"

23. Job 19:7
"Look at me—I shout 'Murder!' and I'm ignored; I call for help and no one bothers to stop. God threw a barricade across my path—I'm stymied; he turned out all the lights—I'm stuck in the dark. He destroyed my reputation, robbed me of all self-respect. He tore me apart piece by piece—I'm ruined! Then he yanked out hope by the roots. He's angry with me—oh, how he's angry! He treats me like his worst enemy. He has launched a major campaign against me, using every weapon he can think of, coming at me from all sides at once.

24. Job 27:7
"Let my enemy be exposed as wicked! Let my adversary be proven guilty! What hope do people without God have when life is cut short? when God puts an end to life? Do you think God will listen to their cry for help when disaster hits? What interest have they ever shown in the Almighty? Have they ever been known to pray before?

25. Job 41:1
[ I Run This Universe ] "Or can you pull in the sea beast, Leviathan, with a fly rod and stuff him in your creel? Can you lasso him with a rope, or snag him with an anchor? Will he beg you over and over for mercy, or flatter you with flowery speech? Will he apply for a job with you to run errands and serve you the rest of your life? Will you play with him as if he were a pet goldfish? Will you make him the mascot of the neighborhood children? Will you put him on display in the market and have shoppers haggle over the price? Could you shoot him full of arrows like a pin cushion, or drive harpoons into his huge head? If you so much as lay a hand on him, you won't live to tell the story. What hope would you have with such a creature? Why, one look at him would do you in! If you can't hold your own against his glowering visage, how, then, do you expect to stand up to me? Who could confront me and get by with it? I'm in charge of all this—I run this universe!

26. Proverbs 11:7
When the wicked die, that's it— the story's over, end of hope.

27. Proverbs 24:13
[ 26 ] Eat honey, dear child—it's good for you— and delicacies that melt in your mouth. Likewise knowledge, and wisdom for your soul— Get that and your future's secured, your hope is on solid rock.

28. Ecclesiastes 2:20
That's when I called it quits, gave up on anything that could be hoped for on this earth. What's the point of working your fingers to the bone if you hand over what you worked for to someone who never lifted a finger for it? Smoke, that's what it is. A bad business from start to finish. So what do you get from a life of hard labor? Pain and grief from dawn to dusk. Never a decent night's rest. Nothing but smoke.

29. Ecclesiastes 9:4
[ Seize Life! ] Still, anyone selected out for life has hope, for, as they say, "A living dog is better than a dead lion." The living at least know something, even if it's only that they're going to die. But the dead know nothing and get nothing. They're a minus that no one remembers. Their loves, their hates, yes, even their dreams, are long gone. There's not a trace of them left in the affairs of this earth.

30. Song of Solomon 4:8
Come with me from Lebanon, my bride. Leave Lebanon behind, and come. Leave your high mountain hideaway. Abandon your wilderness seclusion, Where you keep company with lions and panthers guard your safety. You've captured my heart, dear friend. You looked at me, and I fell in love. One look my way and I was hopelessly in love! How beautiful your love, dear, dear friend— far more pleasing than a fine, rare wine, your fragrance more exotic than select spices. The kisses of your lips are honey, my love, every syllable you speak a delicacy to savor. Your clothes smell like the wild outdoors, the ozone scent of high mountains. Dear lover and friend, you're a secret garden, a private and pure fountain. Body and soul, you are paradise, a whole orchard of succulent fruits— Ripe apricots and peaches, oranges and pears; Nut trees and cinnamon, and all scented woods; Mint and lavender, and all herbs aromatic; A garden fountain, sparkling and splashing, fed by spring waters from the Lebanon mountains.

31. Isaiah 8:16
Gather up the testimony, preserve the teaching for my followers, While I wait for God as long as he remains in hiding, while I wait and hope for him. I stand my ground and hope, I and the children God gave me as signs to Israel, Warning signs and hope signs from God-of-the-Angel-Armies, who makes his home in Mount Zion.

32. Isaiah 19:11
The princes of Zoan are fools, the advisors of Pharaoh stupid. How could any of you dare tell Pharaoh, "Trust me: I'm wise. I know what's going on. Why, I'm descended from the old wisdom of Egypt"? There's not a wise man or woman left in the country. If there were, one of them would tell you what God-of-the-Angel-Armies has in mind for Egypt. As it is, the princes of Zoan are all fools and the princes of Memphis, dunces. The honored pillars of your society have led Egypt into detours and dead ends. God has scrambled their brains, Egypt's become a falling-down-in-his-own-vomit drunk. Egypt's hopeless, past helping, a senile, doddering old fool.

33. Isaiah 20:3
Then God said, "Just as my servant Isaiah has walked around town naked and barefooted for three years as a warning sign to Egypt and Ethiopia, so the king of Assyria is going to come and take the Egyptians as captives and the Ethiopians as exiles. He'll take young and old alike and march them out of there naked and barefooted, exposed to mockery and jeers—the bared buttocks of Egypt on parade! Everyone who has put hope in Ethiopia and expected help from Egypt will be thrown into confusion. Everyone who lives along this coast will say, 'Look at them! Naked and barefooted, shuffling off to exile! And we thought they were our best hope, that they'd rescue us from the king of Assyria. Now what's going to happen to us? How are we going to get out of this?'"

34. Isaiah 21:1
[ The Betrayer Betrayed ] A Message concerning the desert at the sea: As tempests drive through the Negev Desert, coming out of the desert, that terror-filled place, A hard vision is given me: The betrayer betrayed, the plunderer plundered. Attack, Elam! Lay siege, Media! Persians, attack! Attack, Babylon! I'll put an end to all the moaning and groaning. Because of this news I'm doubled up in pain, writhing in pain like a woman having a baby, Baffled by what I hear, undone by what I see. Absolutely stunned, horror-stricken, I had hoped for a relaxed evening, but it has turned into a nightmare.

35. Isaiah 33:2
God, treat us kindly. You're our only hope. First thing in the morning, be there for us! When things go bad, help us out! You spoke in thunder and everyone ran. You showed up and nations scattered. Your people, for a change, got in on the loot, picking the field clean of the enemy spoils.

36. Isaiah 49:22
The Master, God, says: "Look! I signal to the nations, I raise my flag to summon the people. Here they'll come: women carrying your little boys in their arms, men carrying your little girls on their shoulders. Kings will be your babysitters, princesses will be your nursemaids. They'll offer to do all your drudge work— scrub your floors, do your laundry. You'll know then that I am God. No one who hopes in me ever regrets it."

37. Isaiah 51:4
"Pay attention, my people. Listen to me, nations. Revelation flows from me. My decisions light up the world. My deliverance arrives on the run, my salvation right on time. I'll bring justice to the peoples. Even faraway islands will look to me and take hope in my saving power. Look up at the skies, ponder the earth under your feet. The skies will fade out like smoke, the earth will wear out like work pants, and the people will die off like flies. But my salvation will last forever, my setting-things-right will never be obsolete.

38. Isaiah 56:1
[ Messages of Hope ] [ Salvation Is Just Around the Corner ] God's Message: "Guard my common good: Do what's right and do it in the right way, For salvation is just around the corner, my setting-things-right is about to go into action. How blessed are you who enter into these things, you men and women who embrace them, Who keep Sabbath and don't defile it, who watch your step and don't do anything evil! Make sure no outsider who now follows God ever has occasion to say, 'God put me in second-class. I don't really belong.' And make sure no physically mutilated person is ever made to think, 'I'm damaged goods. I don't really belong.'"

39. Isaiah 64:1
[ Can We Be Saved? ] Oh, that you would rip open the heavens and descend, make the mountains shudder at your presence— As when a forest catches fire, as when fire makes a pot to boil— To shock your enemies into facing you, make the nations shake in their boots! You did terrible things we never expected, descended and made the mountains shudder at your presence. Since before time began no one has ever imagined, No ear heard, no eye seen, a God like you who works for those who wait for him. You meet those who happily do what is right, who keep a good memory of the way you work. But how angry you've been with us! We've sinned and kept at it so long! Is there any hope for us? Can we be saved? We're all sin-infected, sin-contaminated. Our best efforts are grease-stained rags. We dry up like autumn leaves— sin-dried, we're blown off by the wind. No one prays to you or makes the effort to reach out to you Because you've turned away from us, left us to stew in our sins.

40. Jeremiah 6:10
[ Is Anybody Listening? ] "I've got something to say. Is anybody listening? I've a warning to post. Will anyone notice? It's hopeless! Their ears are stuffed with wax— deaf as a post, blind as a bat. It's hopeless! They've tuned out God. They don't want to hear from me. But I'm bursting with the wrath of God. I can't hold it in much longer.

41. Jeremiah 6:13
"Everyone's after the dishonest dollar, little people and big people alike. Prophets and priests and everyone in between twist words and doctor truth. My people are broken—shattered!— and they put on Band-Aids, Saying, 'It's not so bad. You'll be just fine.' But things are not 'just fine'! Do you suppose they are embarrassed over this outrage? No, they have no shame. They don't even know how to blush. There's no hope for them. They've hit bottom and there's no getting up. As far as I'm concerned, they're finished." God has spoken.

42. Jeremiah 8:10
"'So here's what will happen to the know-it-alls: I'll make them wifeless and homeless. Everyone's after the dishonest dollar, little people and big people alike. Prophets and priests and everyone in between twist words and doctor truth. My dear Daughter—my people—broken, shattered, and yet they put on Band-Aids, Saying, "It's not so bad. You'll be just fine." But things are not "just fine"! Do you suppose they are embarrassed over this outrage? Not really. They have no shame. They don't even know how to blush. There's no hope for them. They've hit bottom and there's no getting up. As far as I'm concerned, they're finished.'" God has spoken.

43. Jeremiah 8:14
So why are we sitting here, doing nothing? Let's get organized. Let's go to the big city and at least die fighting. We've gotten God's ultimatum: We're damned if we do and damned if we don't— damned because of our sin against him. We hoped things would turn out for the best, but it didn't happen that way. We were waiting around for healing— and terror showed up! From Dan at the northern borders we hear the hooves of horses, Horses galloping, horses neighing. The ground shudders and quakes. They're going to swallow up the whole country. Towns and people alike—fodder for war.

44. Jeremiah 10:19
But it's a black day for me! Hopelessly wounded, I said, "Why, oh why did I think I could bear it?" My house is ruined— the roof caved in. Our children are gone— we'll never see them again. No one left to help in rebuilding, no one to make a new start!

45. Jeremiah 13:24
"I'll blow these people away— like wind-blown leaves. You have it coming to you. I've measured it out precisely." God's Decree. "It's because you forgot me and embraced the Big Lie, that so-called god Baal. I'm the one who will rip off your clothes, expose and shame you before the watching world. Your obsessions with gods, gods, and more gods, your goddess affairs, your god-adulteries. Gods on the hills, gods in the fields— every time I look you're off with another god. O Jerusalem, what a sordid life! Is there any hope for you!"

46. Jeremiah 14:7
We know we're guilty. We've lived bad lives— but do something, God. Do it for your sake! Time and time again we've betrayed you. No doubt about it—we've sinned against you. Hope of Israel! Our only hope! Israel's last chance in this trouble! Why are you acting like a tourist, taking in the sights, here today and gone tomorrow? Why do you just stand there and stare, like someone who doesn't know what to do in a crisis? But God, you are, in fact, here, here with us! You know who we are—you named us! Don't leave us in the lurch.

47. Jeremiah 14:17
"And you, Jeremiah, will say this to them: "'My eyes pour out tears. Day and night, the tears never quit. My dear, dear people are battered and bruised, hopelessly and cruelly wounded. I walk out into the fields, shocked by the killing fields strewn with corpses. I walk into the city, shocked by the sight of starving bodies. And I watch the preachers and priests going about their business as if nothing's happened!'"

48. Jeremiah 14:19
God, have you said your final No to Judah? Can you simply not stand Zion any longer? If not, why have you treated us like this, beaten us nearly to death? We hoped for peace— nothing good came from it; We looked for healing— and got kicked in the stomach. We admit, O God, how badly we've lived, and our ancestors, how bad they were. We've sinned, they've sinned, we've all sinned against you! Your reputation is at stake! Don't quit on us! Don't walk out and abandon your glorious Temple! Remember your covenant. Don't break faith with us! Can the no-gods of the godless nations cause rain? Can the sky water the earth by itself? You're the one, O God, who does this. So you're the one for whom we wait. You made it all, you do it all.

49. Jeremiah 17:1
[ The Heart Is Hopelessly Dark and Deceitful ] "Judah's sin is engraved with a steel chisel, A steel chisel with a diamond point— engraved on their granite hearts, engraved on the stone corners of their altars. The evidence against them is plain to see: sex-and-religion altars and sacred sex shrines Anywhere there's a grove of trees, anywhere there's an available hill.

50. Jeremiah 17:9
"The heart is hopelessly dark and deceitful, a puzzle that no one can figure out. But I, God, search the heart and examine the mind. I get to the heart of the human. I get to the root of things. I treat them as they really are, not as they pretend to be."

51. Jeremiah 17:12
From early on your Sanctuary was set high, a throne of glory, exalted! O God, you're the hope of Israel. All who leave you end up as fools, Deserters with nothing to show for their lives, who walk off from God, fountain of living waters— and wind up dead!

52. Jeremiah 29:1
[ Plans to Give You the Future You Hope For ] This is the letter that the prophet Jeremiah sent from Jerusalem to what was left of the elders among the exiles, to the priests and prophets and all the exiles whom Nebuchadnezzar had taken to Babylon from Jerusalem, including King Jehoiachin, the queen mother, the government leaders, and all the skilled laborers and craftsmen.

53. Jeremiah 29:10
This is God's Word on the subject: "As soon as Babylon's seventy years are up and not a day before, I'll show up and take care of you as I promised and bring you back home. I know what I'm doing. I have it all planned out—plans to take care of you, not abandon you, plans to give you the future you hope for.

54. Jeremiah 30:12
"This is God's Message: "'You're a burned-out case, as good as dead. Everyone has given up on you. You're hopeless. All your fair-weather friends have skipped town without giving you a second thought. But I delivered the knockout blow, a punishment you will never forget, Because of the enormity of your guilt, the endless list of your sins. So why all this self-pity, licking your wounds? You deserve all this, and more. Because of the enormity of your guilt, the endless list of your sins, I've done all this to you.

55. Jeremiah 30:16
"'Everyone who hurt you will be hurt; your enemies will end up as slaves. Your plunderers will be plundered; your looters will become loot. As for you, I'll come with healing, curing the incurable, Because they all gave up on you and dismissed you as hopeless— that good-for-nothing Zion.'

56. Jeremiah 31:15
Again, God's Message: "Listen to this! Laments coming out of Ramah, wild and bitter weeping. It's Rachel weeping for her children, Rachel refusing all solace. Her children are gone, gone—long gone into exile." But God says, "Stop your incessant weeping, hold back your tears. Collect wages from your grief work." God's Decree. "They'll be coming back home! There's hope for your children." God's Decree.

57. Jeremiah 47:1
[ It's Doomsday for Philistines ] God's Message to the prophet Jeremiah regarding the Philistines just before Pharaoh attacked Gaza. This is what God says: "Look out! Water will rise in the north country, swelling like a river in flood. The torrent will flood the land, washing away city and citizen. Men and women will scream in terror, wails from every door and window, As the thunder from the hooves of the horses will be heard, the clatter of chariots, the banging of wheels. Fathers, paralyzed by fear, won't even grab up their babies Because it will be doomsday for Philistines, one and all, no hope of help for Tyre and Sidon. God will finish off the Philistines, what's left of those from the island of Crete. Gaza will be shaved bald as an egg, Ashkelon struck dumb as a post. You're on your last legs. How long will you keep flailing?

58. Jeremiah 50:6
"My people were lost sheep. Their shepherds led them astray. They abandoned them in the mountains where they wandered aimless through the hills. They lost track of home, couldn't remember where they came from. Everyone who met them took advantage of them. Their enemies had no qualms: 'Fair game,' they said. 'They walked out on God. They abandoned the True Pasture, the hope of their parents.'

59. Jeremiah 51:41
"Babylon is finished— the pride of the whole earth is flat on her face. What a comedown for Babylon, to end up inglorious in the sewer! Babylon drowned in chaos, battered by waves of enemy soldiers. Her towns stink with decay and rot, the land empty and bare and sterile. No one lives in these towns anymore. Travelers give them a wide berth. I'll bring doom on the glutton god-Bel in Babylon. I'll make him vomit up all he gulped down. No more visitors stream into this place, admiring and gawking at the wonders of Babylon. The wonders of Babylon are no more. Run for your lives, my dear people! Run, and don't look back! Get out of this place while you can, this place torched by God's raging anger. Don't lose hope. Don't ever give up when the rumors pour in hot and heavy. One year it's this, the next year it's that— rumors of violence, rumors of war. Trust me, the time is coming when I'll put the no-gods of Babylon in their place. I'll show up the whole country as a sickening fraud, with dead bodies strewn all over the place. Heaven and earth, angels and people, will throw a victory party over Babylon When the avenging armies from the north descend on her." God's Decree!

60. Lamentations 3:19
[ It's a Good Thing to Hope for Help from God ] I'll never forget the trouble, the utter lostness, the taste of ashes, the poison I've swallowed. I remember it all—oh, how well I remember— the feeling of hitting the bottom. But there's one other thing I remember, and remembering, I keep a grip on hope:

61. Lamentations 3:25
God proves to be good to the man who passionately waits, to the woman who diligently seeks. It's a good thing to quietly hope, quietly hope for help from God. It's a good thing when you're young to stick it out through the hard times.

62. Lamentations 3:28
When life is heavy and hard to take, go off by yourself. Enter the silence. Bow in prayer. Don't ask questions: Wait for hope to appear. Don't run from trouble. Take it full-face. The "worst" is never the worst.

63. Ezekiel 19:5
When the lioness saw she was luckless, that her hope for that cub was gone, She took her other cub and made him a strong young lion. He prowled with the lions, a robust young lion. He learned to hunt. He ate men. He rampaged through their defenses, left their cities in ruins. The country and everyone in it was terrorized by the roars of the lion. The nations got together to hunt him. Everyone joined the hunt. They set out their traps and caught him. They put a wooden collar on him and took him to the king of Babylon. No more would that voice be heard disturbing the peace in the mountains of Israel!

64. Ezekiel 24:9
"'Therefore, this is what God, the Master, says: "'Doom to the city of murder! I, too, will pile on the wood. Stack the wood high, light the match, Cook the meat, spice it well, pour out the broth, and then burn the bones. Then I'll set the empty pot on the coals and heat it red-hot so the bronze glows, So the germs are killed and the corruption is burned off. But it's hopeless. It's too far gone. The filth is too thick.

65. Ezekiel 29:21
"'And then I'll stir up fresh hope in Israel—the dawn of deliverance!— and I'll give you, Ezekiel, bold and confident words to speak. And they'll realize that I am God.'"

66. Ezekiel 37:11
Then God said to me, "Son of man, these bones are the whole house of Israel. Listen to what they're saying: 'Our bones are dried up, our hope is gone, there's nothing left of us.'

67. Daniel 9:9
"'Compassion is our only hope, the compassion of you, the Master, our God, since in our rebellion we've forfeited our rights. We paid no attention to you when you told us how to live, the clear teaching that came through your servants the prophets. All of us in Israel ignored what you said. We defied your instructions and did what we pleased. And now we're paying for it: The solemn curse written out plainly in the revelation to God's servant Moses is now doing its work among us, the wages of our sin against you. You did to us and our rulers what you said you would do: You brought this catastrophic disaster on us, the worst disaster on record—and in Jerusalem!

68. Daniel 9:18
"'Turn your ears our way, God, and listen. Open your eyes and take a long look at our ruined city, this city named after you. We know that we don't deserve a hearing from you. Our appeal is to your compassion. This prayer is our last and only hope:

69. Hosea 2:14
[ To Start All Over Again ] "And now, here's what I'm going to do: I'm going to start all over again. I'm taking her back out into the wilderness where we had our first date, and I'll court her. I'll give her bouquets of roses. I'll turn Heartbreak Valley into Acres of Hope. She'll respond like she did as a young girl, those days when she was fresh out of Egypt.

70. Hosea 14:1
[ Come Back! Return to Your God! ] O Israel, come back! Return to your God! You're down but you're not out. Prepare your confession and come back to God. Pray to him, "Take away our sin, accept our confession. Receive as restitution our repentant prayers. Assyria won't save us; horses won't get us where we want to go. We'll never again say 'our god' to something we've made or made up. You're our last hope. Is it not true that in you the orphan finds mercy?"

71. Zechariah 1:21
I asked, "And what are these all about?" He said, "Since the 'horns' scattered Judah so badly that no one had any hope left, these blacksmiths have arrived to combat the horns. They'll dehorn the godless nations who used their horns to scatter Judah to the four winds."

72. Zechariah 9:11
"And you, because of my blood covenant with you, I'll release your prisoners from their hopeless cells. Come home, hope-filled prisoners! This very day I'm declaring a double bonus— everything you lost returned twice-over! Judah is now my weapon, the bow I'll pull, setting Ephraim as an arrow to the string. I'll wake up your sons, O Zion, to counter your sons, O Greece. From now on people are my swords."

73. Matthew 12:15
[ In Charge of Everything ] Jesus, knowing they were out to get him, moved on. A lot of people followed him, and he healed them all. He also cautioned them to keep it quiet, following guidelines set down by Isaiah: Look well at my handpicked servant; I love him so much, take such delight in him. I've placed my Spirit on him; he'll decree justice to the nations. But he won't yell, won't raise his voice; there'll be no commotion in the streets. He won't walk over anyone's feelings, won't push you into a corner. Before you know it, his justice will triumph; the mere sound of his name will signal hope, even among far-off unbelievers.

74. Matthew 19:13
[ To Enter God's Kingdom ] One day children were brought to Jesus in the hope that he would lay hands on them and pray over them. The disciples shooed them off. But Jesus intervened: "Let the children alone, don't prevent them from coming to me. God's kingdom is made up of people like these." After laying hands on them, he left.

75. Matthew 22:34
[ The Most Important Command ] When the Pharisees heard how he had bested the Sadducees, they gathered their forces for an assault. One of their religion scholars spoke for them, posing a question they hoped would show him up: "Teacher, which command in God's Law is the most important?"

76. Matthew 23:13
[ Frauds! ] "I've had it with you! You're hopeless, you religion scholars, you Pharisees! Frauds! Your lives are roadblocks to God's kingdom. You refuse to enter, and won't let anyone else in either.

77. Matthew 23:15
"You're hopeless, you religion scholars and Pharisees! Frauds! You go halfway around the world to make a convert, but once you get him you make him into a replica of yourselves, double-damned.

78. Matthew 23:16
"You're hopeless! What arrogant stupidity! You say, 'If someone makes a promise with his fingers crossed, that's nothing; but if he swears with his hand on the Bible, that's serious.' What ignorance! Does the leather on the Bible carry more weight than the skin on your hands? And what about this piece of trivia: 'If you shake hands on a promise, that's nothing; but if you raise your hand that God is your witness, that's serious'? What ridiculous hairsplitting! What difference does it make whether you shake hands or raise hands? A promise is a promise. What difference does it make if you make your promise inside or outside a house of worship? A promise is a promise. God is present, watching and holding you to account regardless.

79. Matthew 23:23
"You're hopeless, you religion scholars and Pharisees! Frauds! You keep meticulous account books, tithing on every nickel and dime you get, but on the meat of God's Law, things like fairness and compassion and commitment—the absolute basics!—you carelessly take it or leave it. Careful bookkeeping is commendable, but the basics are required. Do you have any idea how silly you look, writing a life story that's wrong from start to finish, nitpicking over commas and semicolons?

80. Matthew 23:25
"You're hopeless, you religion scholars and Pharisees! Frauds! You burnish the surface of your cups and bowls so they sparkle in the sun, while the insides are maggoty with your greed and gluttony. Stupid Pharisee! Scour the insides, and then the gleaming surface will mean something.

81. Matthew 23:27
"You're hopeless, you religion scholars and Pharisees! Frauds! You're like manicured grave plots, grass clipped and the flowers bright, but six feet down it's all rotting bones and worm-eaten flesh. People look at you and think you're saints, but beneath the skin you're total frauds.

82. Matthew 23:29
"You're hopeless, you religion scholars and Pharisees! Frauds! You build granite tombs for your prophets and marble monuments for your saints. And you say that if you had lived in the days of your ancestors, no blood would have been on your hands. You protest too much! You're cut from the same cloth as those murderers, and daily add to the death count.

83. Matthew 24:15
[ The Monster of Desecration ] "But be ready to run for it when you see the monster of desecration set up in the Temple sanctuary. The prophet Daniel described this. If you've read Daniel, you'll know what I'm talking about. If you're living in Judea at the time, run for the hills; if you're working in the yard, don't return to the house to get anything; if you're out in the field, don't go back and get your coat. Pregnant and nursing mothers will have it especially hard. Hope and pray this won't happen during the winter or on a Sabbath.

84. Mark 13:14
[ Run for the Hills ] "But be ready to run for it when you see the monster of desecration set up where it should never be. You who can read, make sure you understand what I'm talking about. If you're living in Judea at the time, run for the hills; if you're working in the yard, don't go back to the house to get anything; if you're out in the field, don't go back to get your coat. Pregnant and nursing mothers will have it especially hard. Hope and pray this won't happen in the middle of winter.

85. Luke 6:31
"Here is a simple rule of thumb for behavior: Ask yourself what you want people to do for you; then grab the initiative and do it for them! If you only love the lovable, do you expect a pat on the back? Run-of-the-mill sinners do that. If you only help those who help you, do you expect a medal? Garden-variety sinners do that. If you only give for what you hope to get out of it, do you think that's charity? The stingiest of pawnbrokers does that.

86. Luke 11:42
"I've had it with you! You're hopeless, you Pharisees! Frauds! You keep meticulous account books, tithing on every nickel and dime you get, but manage to find loopholes for getting around basic matters of justice and God's love. Careful bookkeeping is commendable, but the basics are required.

87. Luke 11:43
"You're hopeless, you Pharisees! Frauds! You love sitting at the head table at church dinners, love preening yourselves in the radiance of public flattery. Frauds! You're just like unmarked graves: People walk over that nice, grassy surface, never suspecting the rot and corruption that is six feet under."

88. Luke 11:46
He said, "Yes, and I can be even more explicit. You're hopeless, you religion scholars! You load people down with rules and regulations, nearly breaking their backs, but never lift even a finger to help.

89. Luke 11:47
"You're hopeless! You build tombs for the prophets your ancestors killed. The tombs you build are monuments to your murdering ancestors more than to the murdered prophets. That accounts for God's Wisdom saying, 'I will send them prophets and apostles, but they'll kill them and run them off.' What it means is that every drop of righteous blood ever spilled from the time earth began until now, from the blood of Abel to the blood of Zechariah, who was struck down between altar and sanctuary, is on your heads. Yes, it's on the bill of this generation and this generation will pay.

90. Luke 11:52
"You're hopeless, you religion scholars! You took the key of knowledge, but instead of unlocking doors, you locked them. You won't go in yourself, and won't let anyone else in either."

91. Luke 16:14
When the Pharisees, a money-obsessed bunch, heard him say these things, they rolled their eyes, dismissing him as hopelessly out of touch. So Jesus spoke to them: "You are masters at making yourselves look good in front of others, but God knows what's behind the appearance. What society sees and calls monumental, God sees through and calls monstrous. God's Law and the Prophets climaxed in John; Now it's all kingdom of God—the glad news and compelling invitation to every man and woman. The sky will disintegrate and the earth dissolve before a single letter of God's Law wears out. Using the legalities of divorce as a cover for lust is adultery; Using the legalities of marriage as a cover for lust is adultery.

92. Luke 23:8
Herod was delighted when Jesus showed up. He had wanted for a long time to see him, he'd heard so much about him. He hoped to see him do something spectacular. He peppered him with questions. Jesus didn't answer—not one word. But the high priests and religion scholars were right there, saying their piece, strident and shrill in their accusations.

93. Luke 24:19
He said, "What has happened?" They said, "The things that happened to Jesus the Nazarene. He was a man of God, a prophet, dynamic in work and word, blessed by both God and all the people. Then our high priests and leaders betrayed him, got him sentenced to death, and crucified him. And we had our hopes up that he was the One, the One about to deliver Israel. And it is now the third day since it happened. But now some of our women have completely confused us. Early this morning they were at the tomb and couldn't find his body. They came back with the story that they had seen a vision of angels who said he was alive. Some of our friends went off to the tomb to check and found it empty just as the women said, but they didn't see Jesus."

94. Acts 2:22
"Fellow Israelites, listen carefully to these words: Jesus the Nazarene, a man thoroughly accredited by God to you—the miracles and wonders and signs that God did through him are common knowledge—this Jesus, following the deliberate and well-thought-out plan of God, was betrayed by men who took the law into their own hands, and was handed over to you. And you pinned him to a cross and killed him. But God untied the death ropes and raised him up. Death was no match for him. David said it all: I saw God before me for all time. Nothing can shake me; he's right by my side. I'm glad from the inside out, ecstatic; I've pitched my tent in the land of hope. I know you'll never dump me in Hades; I'll never even smell the stench of death. You've got my feet on the life-path, with your face shining sun-joy all around.

95. Acts 15:30
And so off they went to Antioch. On arrival, they gathered the church and read the letter. The people were greatly relieved and pleased. Judas and Silas, good preachers both of them, strengthened their new friends with many words of courage and hope. Then it was time to go home. They were sent off by their new friends with laughter and embraces all around to report back to those who had sent them.

96. Acts 20:1
[ Macedonia and Greece ] With things back to normal, Paul called the disciples together and encouraged them to keep up the good work in Ephesus. Then, saying his good-byes, he left for Macedonia. Traveling through the country, passing from one gathering to another, he gave constant encouragement, lifting their spirits and charging them with fresh hope.

97. Acts 23:6
Paul, knowing some of the council was made up of Sadducees and others of Pharisees and how they hated each other, decided to exploit their antagonism: "Friends, I am a stalwart Pharisee from a long line of Pharisees. It's because of my Pharisee convictions—the hope and resurrection of the dead—that I've been hauled into this court."

98. Acts 24:14
"But I do freely admit this: In regard to the Way, which they malign as a dead-end street, I serve and worship the very same God served and worshiped by all our ancestors and embrace everything written in all our Scriptures. And I admit to living in hopeful anticipation that God will raise the dead, both the good and the bad. If that's my crime, my accusers are just as guilty as I am.

99. Acts 26:4
"From the time of my youth, my life has been lived among my own people in Jerusalem. Practically every Jew in town who watched me grow up—and if they were willing to stick their necks out they'd tell you in person—knows that I lived as a strict Pharisee, the most demanding branch of our religion. It's because I believed it and took it seriously, committed myself heart and soul to what God promised my ancestors—the identical hope, mind you, that the twelve tribes have lived for night and day all these centuries—it's because I have held on to this tested and tried hope that I'm being called on the carpet by the Jews. They should be the ones standing trial here, not me! For the life of me, I can't see why it's a criminal offense to believe that God raises the dead.

100. Acts 27:18
Next day, out on the high seas again and badly damaged now by the storm, we dumped the cargo overboard. The third day the sailors lightened the ship further by throwing off all the tackle and provisions. It had been many days since we had seen either sun or stars. Wind and waves were battering us unmercifully, and we lost all hope of rescue.

101. Acts 28:17
Three days later, Paul called the Jewish leaders together for a meeting at his house. He said, "The Jews in Jerusalem arrested me on trumped-up charges, and I was taken into custody by the Romans. I assure you that I did absolutely nothing against Jewish laws or Jewish customs. After the Romans investigated the charges and found there was nothing to them, they wanted to set me free, but the Jews objected so fiercely that I was forced to appeal to Caesar. I did this not to accuse them of any wrongdoing or to get our people in trouble with Rome. We've had enough trouble through the years that way. I did it for Israel. I asked you to come and listen to me today to make it clear that I'm on Israel's side, not against her. I'm a hostage here for hope, not doom."

102. Romans 4:17
We call Abraham "father" not because he got God's attention by living like a saint, but because God made something out of Abraham when he was a nobody. Isn't that what we've always read in Scripture, God saying to Abraham, "I set you up as father of many peoples"? Abraham was first named "father" and then became a father because he dared to trust God to do what only God could do: raise the dead to life, with a word make something out of nothing. When everything was hopeless, Abraham believed anyway, deciding to live not on the basis of what he saw he couldn't do but on what God said he would do. And so he was made father of a multitude of peoples. God himself said to him, "You're going to have a big family, Abraham!"

103. Romans 4:19
Abraham didn't focus on his own impotence and say, "It's hopeless. This hundred-year-old body could never father a child." Nor did he survey Sarah's decades of infertility and give up. He didn't tiptoe around God's promise asking cautiously skeptical questions. He plunged into the promise and came up strong, ready for God, sure that God would make good on what he had said. That's why it is said, "Abraham was declared fit before God by trusting God to set him right." But it's not just Abraham; it's also us! The same thing gets said about us when we embrace and believe the One who brought Jesus to life when the conditions were equally hopeless. The sacrificed Jesus made us fit for God, set us right with God.

104. Romans 5:1
[ Developing Patience ] By entering through faith into what God has always wanted to do for us—set us right with him, make us fit for him—we have it all together with God because of our Master Jesus. And that's not all: We throw open our doors to God and discover at the same moment that he has already thrown open his door to us. We find ourselves standing where we always hoped we might stand—out in the wide open spaces of God's grace and glory, standing tall and shouting our praise.

105. Romans 6:1
[ When Death Becomes Life ] So what do we do? Keep on sinning so God can keep on forgiving? I should hope not! If we've left the country where sin is sovereign, how can we still live in our old house there? Or didn't you realize we packed up and left there for good? That is what happened in baptism. When we went under the water, we left the old country of sin behind; when we came up out of the water, we entered into the new country of grace—a new life in a new land!

106. Romans 11:7
And then what happened? Well, when Israel tried to be right with God on her own, pursuing her own self-interest, she didn't succeed. The chosen ones of God were those who let God pursue his interest in them, and as a result received his stamp of legitimacy. The "self-interest Israel" became thick-skinned toward God. Moses and Isaiah both commented on this: Fed up with their quarrelsome, self-centered ways, God blurred their eyes and dulled their ears, Shut them in on themselves in a hall of mirrors, and they're there to this day. David was upset about the same thing: I hope they get sick eating self-serving meals, break a leg walking their self-serving ways. I hope they go blind staring in their mirrors, get ulcers from playing at god.

107. Romans 11:23
And don't get to feeling superior to those pruned branches down on the ground. If they don't persist in remaining deadwood, they could very well get grafted back in. God can do that. He can perform miracle grafts. Why, if he could graft you—branches cut from a tree out in the wild—into an orchard tree, he certainly isn't going to have any trouble grafting branches back into the tree they grew from in the first place. Just be glad you're in the tree, and hope for the best for the others.

108. Romans 15:7
So reach out and welcome one another to God's glory. Jesus did it; now you do it! Jesus, staying true to God's purposes, reached out in a special way to the Jewish insiders so that the old ancestral promises would come true for them. As a result, the non-Jewish outsiders have been able to experience mercy and to show appreciation to God. Just think of all the Scriptures that will come true in what we do! For instance: Then I'll join outsiders in a hymn-sing; I'll sing to your name! And this one: Outsiders and insiders, rejoice together! And again: People of all nations, celebrate God! All colors and races, give hearty praise! And Isaiah's word: There's the root of our ancestor Jesse, breaking through the earth and growing tree tall, Tall enough for everyone everywhere to see and take hope! Oh! May the God of green hope fill you up with joy, fill you up with peace, so that your believing lives, filled with the life-giving energy of the Holy Spirit, will brim over with hope!

109. Romans 15:25
First, though, I'm going to Jerusalem to deliver a relief offering to the followers of Jesus there. The Greeks—all the way from the Macedonians in the north to the Achaians in the south—decided they wanted to take up a collection for the poor among the believers in Jerusalem. They were happy to do this, but it was also their duty. Seeing that they got in on all the spiritual gifts that flowed out of the Jerusalem community so generously, it is only right that they do what they can to relieve their poverty. As soon as I have done this—personally handed over this "fruit basket"—I'm off to Spain, with a stopover with you in Rome. My hope is that my visit with you is going to be one of Christ's more extravagant blessings.

110. 1 Corinthians 5:3
I'll tell you what I would do. Even though I'm not there in person, consider me right there with you, because I can fully see what's going on. I'm telling you that this is wrong. You must not simply look the other way and hope it goes away on its own. Bring it out in the open and deal with it in the authority of Jesus our Master. Assemble the community—I'll be present in spirit with you and our Master Jesus will be present in power. Hold this man's conduct up to public scrutiny. Let him defend it if he can! But if he can't, then out with him! It will be totally devastating to him, of course, and embarrassing to you. But better devastation and embarrassment than damnation. You want him on his feet and forgiven before the Master on the Day of Judgment.

111. 1 Corinthians 6:14
God honored the Master's body by raising it from the grave. He'll treat yours with the same resurrection power. Until that time, remember that your bodies are created with the same dignity as the Master's body. You wouldn't take the Master's body off to a whorehouse, would you? I should hope not.

112. 1 Corinthians 10:31
So eat your meals heartily, not worrying about what others say about you—you're eating to God's glory, after all, not to please them. As a matter of fact, do everything that way, heartily and freely to God's glory. At the same time, don't be callous in your exercise of freedom, thoughtlessly stepping on the toes of those who aren't as free as you are. I try my best to be considerate of everyone's feelings in all these matters; I hope you will be, too.

113. 1 Corinthians 11:13
Don't you agree there is something naturally powerful in the symbolism—a woman, her beautiful hair reminiscent of angels, praying in adoration; a man, his head bared in reverence, praying in submission? I hope you're not going to be argumentative about this. All God's churches see it this way; I don't want you standing out as an exception.

114. 1 Corinthians 13:13
But for right now, until that completeness, we have three things to do to lead us toward that consummation: Trust steadily in God, hope unswervingly, love extravagantly. And the best of the three is love.

115. 2 Corinthians 3:12
With that kind of hope to excite us, nothing holds us back. Unlike Moses, we have nothing to hide. Everything is out in the open with us. He wore a veil so the children of Israel wouldn't notice that the glory was fading away—and they didn't notice. They didn't notice it then and they don't notice it now, don't notice that there's nothing left behind that veil. Even today when the proclamations of that old, bankrupt government are read out, they can't see through it. Only Christ can get rid of the veil so they can see for themselves that there's nothing there.

116. 2 Corinthians 5:11
That keeps us vigilant, you can be sure. It's no light thing to know that we'll all one day stand in that place of Judgment. That's why we work urgently with everyone we meet to get them ready to face God. God alone knows how well we do this, but I hope you realize how much and deeply we care. We're not saying this to make ourselves look good to you. We just thought it would make you feel good, proud even, that we're on your side and not just nice to your face as so many people are. If I acted crazy, I did it for God; if I acted overly serious, I did it for you. Christ's love has moved me to such extremes. His love has the first and last word in everything we do.

117. 2 Corinthians 12:19
I hope you don't think that all along we've been making our defense before you, the jury. You're not the jury; God is the jury—God revealed in Christ—and we make our case before him. And we've gone to all the trouble of supporting ourselves so that we won't be in the way or get in the way of your growing up.

118. 2 Corinthians 13:5
Test yourselves to make sure you are solid in the faith. Don't drift along taking everything for granted. Give yourselves regular checkups. You need firsthand evidence, not mere hearsay, that Jesus Christ is in you. Test it out. If you fail the test, do something about it. I hope the test won't show that we have failed. But if it comes to that, we'd rather the test showed our failure than yours. We're rooting for the truth to win out in you. We couldn't possibly do otherwise. We don't just put up with our limitations; we celebrate them, and then go on to celebrate every strength, every triumph of the truth in you. We pray hard that it will all come together in your lives.

119. Ephesians 1:11
It's in Christ that we find out who we are and what we are living for. Long before we first heard of Christ and got our hopes up, he had his eye on us, had designs on us for glorious living, part of the overall purpose he is working out in everything and everyone.

120. Philippians 1:7
It's not at all fanciful for me to think this way about you. My prayers and hopes have deep roots in reality. You have, after all, stuck with me all the way from the time I was thrown in jail, put on trial, and came out of it in one piece. All along you have experienced with me the most generous help from God. He knows how much I love and miss you these days. Sometimes I think I feel as strongly about you as Christ does!

121. Philippians 3:1
[ To Know Him Personally ] And that's about it, friends. Be glad in God! I don't mind repeating what I have written in earlier letters, and I hope you don't mind hearing it again. Better safe than sorry—so here goes.

122. Colossians 1:3
[ Working in His Orchard ] Our prayers for you are always spilling over into thanksgivings. We can't quit thanking God our Father and Jesus our Messiah for you! We keep getting reports on your steady faith in Christ, our Jesus, and the love you continuously extend to all Christians. The lines of purpose in your lives never grow slack, tightly tied as they are to your future in heaven, kept taut by hope.

123. 1 Thessalonians 1:2
[ Convictions of Steel ] Every time we think of you, we thank God for you. Day and night you're in our prayers as we call to mind your work of faith, your labor of love, and your patience of hope in following our Master, Jesus Christ, before God our Father. It is clear to us, friends, that God not only loves you very much but also has put his hand on you for something special. When the Message we preached came to you, it wasn't just words. Something happened in you. The Holy Spirit put steel in your convictions.

124. 1 Thessalonians 5:4
But friends, you're not in the dark, so how could you be taken off guard by any of this? You're sons of Light, daughters of Day. We live under wide open skies and know where we stand. So let's not sleepwalk through life like those others. Let's keep our eyes open and be smart. People sleep at night and get drunk at night. But not us! Since we're creatures of Day, let's act like it. Walk out into the daylight sober, dressed up in faith, love, and the hope of salvation.

125. 1 Thessalonians 5:9
God didn't set us up for an angry rejection but for salvation by our Master, Jesus Christ. He died for us, a death that triggered life. Whether we're awake with the living or asleep with the dead, we're alive with him! So speak encouraging words to one another. Build up hope so you'll all be together in this, no one left out, no one left behind. I know you're already doing this; just keep on doing it.

126. 1 Timothy 1:1
I, Paul, am an apostle on special assignment for Christ, our living hope. Under God our Savior's command, I'm writing this to you, Timothy, my son in the faith. All the best from our God and Christ be yours!

127. 1 Timothy 3:14
I hope to visit you soon, but just in case I'm delayed, I'm writing this letter so you'll know how things ought to go in God's household, this God-alive church, bastion of truth. This Christian life is a great mystery, far exceeding our understanding, but some things are clear enough: He appeared in a human body, was proved right by the invisible Spirit, was seen by angels. He was proclaimed among all kinds of peoples, believed in all over the world, taken up into heavenly glory.

128. 1 Timothy 5:3
Take care of widows who are destitute. If a widow has family members to take care of her, let them learn that religion begins at their own doorstep and that they should pay back with gratitude some of what they have received. This pleases God immensely. You can tell a legitimate widow by the way she has put all her hope in God, praying to him constantly for the needs of others as well as her own. But a widow who exploits people's emotions and pocketbooks—well, there's nothing to her. Tell these things to the people so that they will do the right thing in their extended family. Anyone who neglects to care for family members in need repudiates the faith. That's worse than refusing to believe in the first place.

129. Titus 1:1
I, Paul, am God's slave and Christ's agent for promoting the faith among God's chosen people, getting out the accurate word on God and how to respond rightly to it. My aim is to raise hopes by pointing the way to life without end. This is the life God promised long ago—and he doesn't break promises! And then when the time was ripe, he went public with his truth. I've been entrusted to proclaim this Message by order of our Savior, God himself. Dear Titus, legitimate son in the faith: Receive everything God our Father and Jesus our Savior give you!

130. Hebrews 6:9
I'm sure that won't happen to you, friends. I have better things in mind for you—salvation things! God doesn't miss anything. He knows perfectly well all the love you've shown him by helping needy Christians, and that you keep at it. And now I want each of you to extend that same intensity toward a full-bodied hope, and keep at it till the finish. Don't drag your feet. Be like those who stay the course with committed faith and then get everything promised to them.

131. Hebrews 6:18
We who have run for our very lives to God have every reason to grab the promised hope with both hands and never let go. It's an unbreakable spiritual lifeline, reaching past all appearances right to the very presence of God where Jesus, running on ahead of us, has taken up his permanent post as high priest for us, in the order of Melchizedek.

132. 2 John 1:12
I have a lot more things to tell you, but I'd rather not use paper and ink. I hope to be there soon in person and have a heart-to-heart talk. That will be far more satisfying to both you and me. Everyone here in your sister congregation sends greetings.

133. 3 John 1:13
I have a lot more things to tell you, but I'd rather not use pen and ink. I hope to be there soon in person and have a heart-to-heart talk. Peace to you. The friends here say hello. Greet our friends there by name.

134. Psalm 10:17
The victim's faint pulse picks up; the hearts of the hopeless pump red blood as you put your ear to their lips. Orphans get parents, the homeless get homes. The reign of terror is over, the rule of the gang lords is ended.

135. Psalm 52:9
I thank you always that you went into action. And I'll stay right here, your good name my hope, in company with your faithful friends.

136. Psalm 62:5
God, the one and only— I'll wait as long as he says. Everything I hope for comes from him, so why not? He's solid rock under my feet, breathing room for my soul, An impregnable castle: I'm set for life.

137. Psalm 69:6
Don't let those who look to you in hope Be discouraged by what happens to me, Dear Lord! God of the armies! Don't let those out looking for you Come to a dead end by following me— Please, dear God of Israel!

138. Psalm 88:1
[ A Korah Prayer of Heman ] God, you're my last chance of the day. I spend the night on my knees before you. Put me on your salvation agenda; take notes on the trouble I'm in. I've had my fill of trouble; I'm camped on the edge of hell. I'm written off as a lost cause, one more statistic, a hopeless case. Abandoned as already dead, one more body in a stack of corpses, And not so much as a gravestone— I'm a black hole in oblivion. You've dropped me into a bottomless pit, sunk me in a pitch-black abyss. I'm battered senseless by your rage, relentlessly pounded by your waves of anger. You turned my friends against me, made me horrible to them. I'm caught in a maze and can't find my way out, blinded by tears of pain and frustration.

139. Psalm 119:81
I'm homesick—longing for your salvation; I'm waiting for your word of hope. My eyes grow heavy watching for some sign of your promise; how long must I wait for your comfort? There's smoke in my eyes—they burn and water, but I keep a steady gaze on the instructions you post. How long do I have to put up with all this? How long till you haul my tormentors into court? The arrogant godless try to throw me off track, ignorant as they are of God and his ways. Everything you command is a sure thing, but they harass me with lies. Help! They've pushed and pushed—they never let up— but I haven't relaxed my grip on your counsel. In your great love revive me so I can alertly obey your every word.

140. Psalm 119:113
I hate the two-faced, but I love your clear-cut revelation. You're my place of quiet retreat; I wait for your Word to renew me. Get out of my life, evildoers, so I can keep my God's commands. Take my side as you promised; I'll live then for sure. Don't disappoint all my grand hopes. Stick with me and I'll be all right; I'll give total allegiance to your definitions of life. Expose all who drift away from your sayings; their casual idolatry is lethal. You reject earth's wicked as so much rubbish; therefore I lovingly embrace everything you say. I shiver in awe before you; your decisions leave me speechless with reverence.

141. Psalm 131:3
Wait, Israel, for God. Wait with hope. Hope now; hope always!

142. Psalm 142:3
"As I sink in despair, my spirit ebbing away, you know how I'm feeling, Know the danger I'm in, the traps hidden in my path. Look right, look left— there's not a soul who cares what happens! I'm up against it, with no exit— bereft, left alone. I cry out, God, call out: 'You're my last chance, my only hope for life!' Oh listen, please listen; I've never been this low. Rescue me from those who are hunting me down; I'm no match for them. Get me out of this dungeon so I can thank you in public. Your people will form a circle around me and you'll bring me showers of blessing!"

143. Psalm 143:7
Hurry with your answer, God! I'm nearly at the end of my rope. Don't turn away; don't ignore me! That would be certain death. If you wake me each morning with the sound of your loving voice, I'll go to sleep each night trusting in you. Point out the road I must travel; I'm all ears, all eyes before you. Save me from my enemies, God— you're my only hope! Teach me how to live to please you, because you're my God. Lead me by your blessed Spirit into cleared and level pastureland.

144. Psalm 146:3
Don't put your life in the hands of experts who know nothing of life, of salvation life. Mere humans don't have what it takes; when they die, their projects die with them. Instead, get help from the God of Jacob, put your hope in God and know real blessing! God made sky and soil, sea and all the fish in it. He always does what he says— he defends the wronged, he feeds the hungry. God frees prisoners— he gives sight to the blind, he lifts up the fallen. God loves good people, protects strangers, takes the side of orphans and widows, but makes short work of the wicked.