This is the explanation for how some people can seem okay, and then when life brings them something hard that shatters their worldview, they fall apart. I had a patient named Mr. Andrews, and his wife was the prototypical Crasher. She based her whole world on her husband being well, and when he died, she did, too, even though her body kept on living. She lost hope.

This also explains how others believe their lives to be destined for misery, feel affirmed in that thinking when they become ill, but then are shocked as people come alongside them, care and pray for them, and love them. Even in the midst of their “massive thing”, Climbers find something that makes them feel better and more hopeful than they ever did when they were well. Joey was a troubled soul, a castaway, and he found love and faith in the cancer center during the last year of his short life, which he told me was his “best year ever” (his whole story is told in I’ve Seen the End of You). He found hope.

And the story clarifies further in people who dip and then recover.

They have their faith challenged, but it turns out that the bottom holds for them, and they climb back up to being happy again, apart from their outcome. Samuel, a young man with a beautiful family, died of glioblastoma, but he finished his story strong. He found his faith to be real, and his quality of life was determined by being grateful for what he had, independent of how long he got to have it.

Untouchables, like my patient Rupert Chang, can absorb life’s blows and not seem to flinch. Rupert had a strong faith that was not anchored on the daily circumstances of life, and he had always told his family that no matter what happened, God was enough to get him through. And when something bad actually happened, when he learned he had fatal brain cancer, he lived out what he said he believed.

I saw it so clearly: In all cases, a person’s ultimate position on the quality-of-life axis depends on their ability to separate their happiness from their circumstances. In other words, the people who manage to be okay again when they go through hard things are those who do not define being okay as having a life that is pain-free.