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An excerpt from Tuesdays with Morrie:

At the same time, I had my first serious encounter with death. My favorite uncle, my mother’s brother, the man who had taught me music, taught me to drive, teased me about girls, thrown me a football—that one adult whom I targeted as a child and said, “That’s who I want to be when I grow up”—died of pancreatic cancer at the age of forty-four. He was a short, handsome man with a thick mustache, and I was with him for the last year of his life, living in an apartment just below his. I watched his strong body wither, then bloat, saw him suffer, night after night, doubled over at the dinner table, pressing on his stomach, his eyes shut, his mouth contorted in pain. “Ahhhhh, God,” he would moan. “Ahhhhhh, Jesus!” The rest of us—my aunt, his two young sons, me—stood there, silently, cleaning the plates, averting our eyes.

It was the most helpless I have ever felt in my life. One night in May, my uncle and I sat on the balcony of his apartment. It was breezy and warm. He looked out toward the horizon and said, through gritted teeth, that he wouldn’t be around to see his kids into the next school year. He asked if I would look after them. I told him not to talk that way. He stared at me sadly.

He died a few weeks later.

What does the most helpless exactly mean in this context?

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The author has never felt more hopeless in their life. –  ZenLogic Jul 26 at 14:55

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It is the superlative form of hopeless:

I feel helpless today. I feel more helpless than I did yesterday. However, I felt the most helpless last week. In fact, last week was the most helpless I've ever felt in my life.

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