Compassionate, informed advice about healthcare decision making

Archive for August, 2021

The Health Risks of Loneliness

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“Oh. It’s the chaplain. How nice,” she greeted me as I entered her room at the nursing home. Mable was often alone in her room by choice. She was blind and over 100 years old.

This is the same Mable from my book, who, when I asked her, “How do you live to be 102?” responded, “Just keep breathing!”

I thought of Mable as I listened to a recent GeriPal podcast titled “Loneliness and Social Isolation: Podcast with Carla Perissinotto and Ashwin Kotwal.” (“GeriPal,” as in, Geriatrics and Palliative Care.)

As I said, Mable was often alone in her room, isolated. But was she lonely? I don’t recall if I ever asked her. The researchers on the podcast did point out that some elderly folks may be isolated but not lonely.*

Listening to the podcast, one particular visit with Mable came to mind. When I walked into her room, she was in bed, her eyes closed. I gently touched her hand and quietly said her name, “Mable.” She opened her blind eyes suddenly, startled.

“I didn’t mean to scare you,” I assured her.

“That’s okay. I was in my dream world,” Mable said.

“What’s it like in your dream world?” I asked.

“It’s wonderful!”

A couple of quotes from the podcast:

“Loneliness is different than isolation and solitude. Loneliness is a subjective feeling where the connections we need are greater than the connections we have. In the gap, we experience loneliness. It’s distinct from the objective state of isolation, which is determined by the number of people around you.” – Vivek Murthy, two-time (and current) U.S. Surgeon General.

“Loneliness and isolation…are linked with pretty serious health outcomes.… [We] demonstrated that over a six-year period, people that reported higher rates of loneliness had higher risk of dying, 45% increased risk of dying, and 59% increased risk of loss of independence and functional decline, outcomes that are significant and important to our patients.”

Fighting Covid AND loneliness

Photo by Hank Dunn, Fairfax Nursing Center

Now keep in mind, the researchers completed their findings BEFORE the pandemic. COVID made their research even more relevant. Nursing homes kept residents in their rooms, and facilities were closed to visitors to prevent the spread of the virus. This isolation may have reduced deaths by COVID but, perhaps, invited death by loneliness.

There must be a better way to mitigate the risk of both these health threats. Yes, we need to avoid the spread of COVID among residents and staff. And, so too, loneliness.

*“Loneliness in Older Persons: A Predictor of Functional Decline and Death,” JAMA Internal Medicine; July 23, 2012. “The epidemiology of social isolation and loneliness among older adults during the last years of life, ” Journal of the American Geriatrics Society; July 11, 2021.

“Prince-of-Tides” Empathy

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My wife, Sally, and I decided to watch the 1991 movie, The Prince of Tides, for a date night at home. I had forgotten how sad, tragic, yet hopeful the film was. The next day, having lunch with a friend, we mentioned we watched it. Our friend said, “That is my favorite movie.”

It had been thirty years since we had seen it, and it was a little circuitous how The Prince of Tides came up on our radar. In researching the late Doug Marlette, creator of my favorite comic strip, Kudzu (I have a video where I talk about Marlette), I found out that Marlette was best friends with Pat Conroy, who wrote the novel and co-wrote the screenplay for The Prince of Tides.

You never know

The film’s main character, Tom, played by Nick Nolte, travels from his home on the coast of South Carolina to New York City to help his twin sister, who had just survived her third suicide attempt. Over the course of the film, we find out about how their family got so dysfunctional.

The twins, along with their brother and mother, had experienced a violently traumatic event. Their mother told the children never to talk to anyone about what happened to them. Through therapy, Tom and his sister revisited their long-suppressed past.

Curious, I asked our friend why this was her favorite movie. “Because you never know what is behind someone’s story. Why they act the way they do.” Indeed, once you know Tom’s family’s whole story, you’re more compassionate about the suicide attempts and other character flaws in the family.

We are talking about empathy here.

Assume Positive Intent

My new mantra in this age of text messages and emails: “Assume Positive Intent.” I picked this up while listening to Sam Harris’s podcast focused on communicating with colleagues at work.

If you are in the physical presence of someone, you not only hear their words, but you pick up on body language. That slight smile, the rolling of the eyes — none of which are present in a text message. A tech CEO Harris interviews reminds everyone in his company to “API,” or “Assume Positive Intent,” when reading an email or text message.

My wife occasionally says that my texts seem “curt.” At least, that’s how it feels to her. I protest, “No, that’s not what I meant at all.” API.

They’re doing the best they can

Long ago, I adopted another mantra that has served me well over the years. When I feel hurt by the actions or words of someone, I remind myself that they’re doing the best they can.

This brings us back to that Prince-of-Tides empathy. I don’t know why someone was mean or thoughtless, but something in their past (or present) brought us to this moment.

We’re all doing the best we can.

Grief Upon Grief, Upon Grief — A Funeral, FINALLY, 42 Years Later

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Can you have a funeral for someone who died 42 years ago? Last week, I wrote about having to delay the burial of my mother-in-law’s ashes for ten months because of COVID. Why not 42 years? In 1996, I officiated this long-delayed funeral, choking back tears.

The summer of 1996 turned out to be a terrible one for me. I went through an unspeakable loss that involved a major betrayal and abandonment. By August, I couldn’t get my dead brother, Randy, out of my mind amidst my grief and sadness. By that time, he had been gone over 41 years.

Randy only lived a week, and never left the hospital. He was born without functioning intestines. It was clear that he would die within days. This was back when children were not permitted to visit hospitals, and I was just six years old. I never saw Randy. I never held him. I did not know what it was like to look upon his face.

And yet, during that summer, I missed him. Fresh grief has a way of bringing up old grief you didn’t even know you had.

The backstory

Mom and Dad were visiting for our son’s high school graduation in 1993. After dinner one evening, Randy somehow came up in conversation. I said to my parents, “Tell me about Randy’s death.”

Instantly, Mom burst into tears. Once she could speak, she said, “My father would not let me go to Randy’s funeral.”

My grandfather was a funeral director and arranged to remove my brother’s body quickly from the hospital. Mom had already been sent home, leaving her newborn son behind to die alone. Dad attended the graveside service, but my grieving mother was not allowed. My controlling, alcoholic grandfather decided it would be better for Mom to avoid the pain of putting her child in the ground.

In somewhat of a defense of my grandfather, this was how things were done in 1954. Avoid the pain and go on with your life as if nothing happened. At the time, funeral directors were the only grief experts. Granddaddy was doing what he thought best.

Nowadays, we encourage the parents, and even siblings, to hold their lifeless child. Some families even wash their children, preparing them for burial. These rituals are such an important part of the grief process.

Fresh grief, old grief

Although I always was aware of Randy’s short life, I can never remember him coming up in conversation until my inquiry in 1993. Just mentioning his name opened the floodgates. My mother carried that huge ocean of grief just below the surface all these years.

Did thoughts about Randy painfully arise when Granddaddy died? Randy died on November 22nd. Did Mom think about Randy when President Kennedy was killed on that same day nine years later? Did she think about Randy at my graduation from high school? I am guessing she thought of Randy all the time. I never knew.

When my father was taking his last breath in 2002, Mom’s parting words to him were, “You’re going to see Randy before me.”

Grief never goes away

Although I was not conscious of it, the loss of my brother was always a part of me, too. It didn’t occur to me until I was in the depths of despair that summer of 1996.

As Thanksgiving approached that year, I got an idea. My daughter and I were going to spend it with my parents in Florida. I decided to go to Randy’s grave and conduct a personal graveside service — a ritual. I called Mom and Dad and told them my plan, inviting them to join me. Mom said, “I would love to. You know what I told you about my father.” Indeed, I did.

So, on Thanksgiving 1996, 42 years after his death, we had a funeral for my brother. Mom, Dad in his wheelchair, my brother, his wife, my daughter, and I gathered at the grave. I read the words of committal (“Ashes to ashes, dust to dust”) and Psalm 23 (“The Lord is my shepherd”), we said the Lord’s Prayer, and I stammered through a prayer about Randy.

We turned toward each other. We embraced. We wept deeply. Forty-two years of sorrow ran down our cheeks.

Better-Late-Than-Never Rituals

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I was talking to a friend whose husband died unexpectedly last year from a heart attack. No warning. He died in his sleep. Because of the pandemic, they had no wake, no visitation, no funeral, no public events. She told me, “It’s like he just vanished.”

My mother-in-law, Sue, also died last year amidst COVID. We were fortunate to have a church funeral at the time, although it was only for immediate family. We sat spread out in family “pods.” The priest said all the familiar words that get said at these things. He knew her well, so it was very personal too.

Family and friends gather to say “good-bye” in COVID-delayed ritual

As meaningful as that service was, there remained a huge hole missing. There would have been scores, if not hundreds, who would have come from near and far to be with us in normal times. Family and friends would have filled the church, hugged our necks, and told us meaningful and funny stories about Sue. It didn’t happen.

Fast forward to last week. We finally buried Sue’s ashes in a public ritual. Those friends and family members did indeed come from near and far — from Dallas, Seattle, New York, Arizona, Chicago, Virginia, Wisconsin, Minnesota, Cleveland, and from just a few blocks away. Necks got hugged, and stories got told. You never get over grieving, but these public rituals can be an important part of the process.

Rituals denied by choice of the dead

As I write this, I think back to my brother’s death four years ago and what we missed. My sister, brother-in-law, and I traveled from Colorado and Virginia to visit Dennis barely two weeks before he died. I cherish the photo taken during that visit. The three of us stood outside his “cracker house” home on farmland north of Tallahassee. We would not see him again.

Hank and his sister Janice with their brother Dennis two weeks before he died

Dennis was a very private person. As he knew his death approached, he told his wife he did not want any services to remember him. Our only ritual was the dreaded phone call from my sister, “He’s gone!” It was my birthday, and my now widowed sister-in-law suggested that my sister not call me until a day later. You know — “don’t ruin his birthday.”

So, my sister and I cried together over the phone. That was that. We are now the last two of the six in our family of origin.

It is curious that we give the deceased such control over survivors’ grief rituals. How did my now-dead brother get the right to deny me gathering with family and friends to remember him? He won’t even be there. It would have been about us and not him — our needs, not his.

“Thanks for all the laughs.”

So, last week, we gathered at the columbarium of St. Paul’s on the Lake Catholic Church in Grosse Pointe, Michigan. Sue’s 88-year-old, life-long best friend, going back to their childhood days, reached into the niche, touched the urn, and said, “Thanks for all the laughs.”

These rituals are so important. It really is “better late than never.”

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