Compassionate, informed advice about healthcare decision making

Archive for September, 2021

Aging as a Spiritualizing Process — Part Two

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The aging Presbyterian minister prayed, “…God, forgive us for our anger when the nurses do not answer the call bell. And for our annoyance when the food is cold. And for…” This went on for a few minutes. OH MY.

I thought it was a good idea. I was preparing to lead the nursing home’s Sunday morning worship service. I asked one of the residents, Horace, to give the morning prayer. He had pastored for well over 50 years and even performed a wedding for a nurses’ aid while he was a resident. Always the pastor.

So, I stood next to his wheelchair and handed him the wireless microphone at the proper time. He started well enough, “Dear Lord,” followed by some nice things to say about the day and the good Lord. Then the more honest prayer kicked in.

This was not what I had planned.

Then again, I had no idea what it was like to be so dependent on others, especially when those others let you down.

Aging forces us to grow spiritually

Last week, I started exploring “aging as a spiritualizing process.” My plan this week was to unpack an article in theJournal of Religion & Aging on this very topic. I first read that article around the time of the above-mentioned “honest prayer.”

That piece, “Aging as a Spiritualizing Process,” suggests that aging forces some spiritual practices and virtues on us that we should have learned years before. Here are a few bullets from that article:

  • Doing vs. Being: When physical limitations restrict our activities, we finally learn this lesson of the importance of just “being” rather than always “doing.”
  • Contingency: Intellectually, we all know we are going to die. As we age and more of our contemporaries die, it starts to sink in that this fact of death is beyond our control. We “take nothing for granted—thankful for even the next breath.”
  • Enfleshment: Aches, pain, and disabilities bring home the most basic Hebraic biblical understanding that “We do not have a body, we are a body.”

Not Pollyanna

This is no “Pollyanna approach” to aging and disability — no unflagging optimism, no “let’s see what we can be glad about.” And that’s okay. We can also express the honesty of my friend, the praying pastor, who was having trouble with the tardiness of nurses and cold food. Elisabeth Kübler-Ross did list “anger” and “depression” as aspects of dying.

No one put this more eloquently than Flannery O’Connor, the great writer of Southern fiction, who suffered from lupus for 13 years before she died at age 39 in 1964:

“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.”

Aging as a Spiritualizing Process — Part One

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“Growing old is no good,” the 95-year-old nursing home resident told me. I asked her when it got to being “no good.” She thought for a moment and then said, “About 80.”

“What made it ‘no good’ at that time?” I wanted to know. Without hesitation she said, “When I couldn’t do things for myself anymore.”

I told her daughter of this conversation and she said, “Oh yeah, it was about that time I came into her home, and she was standing on the kitchen table changing a light bulb in the ceiling fixture.”

This resident perfectly summarized the fear of aging; the issue is really the loss of independence. Who wants that? But decline and dependence is the future for most of us, except for the few who will die suddenly while still active.

The minister’s role of “presence and witness”

That conversation, which I also recount in my book, happened over thirty years ago. The young(ish) chaplain who heard those words is now part of the “elderly class.”

So I thought of my own elderly status and that long ago conversation as I read a recent article from Kaiser Health News, “Minister for Seniors at Famed Church Confronts Ageism and the Shame It Brings.”

Rev. Lynn Casteel Harper of the Riverside Church in New York City, sees her role with congregants in their decline as one of “presence and witness.” “Sometimes if people are going through really difficult experiences, especially medically, it’s easy for the story of the illness and the suffering to take over,” Rev. Harper said. “Part of my role is to affirm the other dimensions.”

Harper is right — it’s about presence. I found it was the same in ministering to nursing home residents and hospice patients. I could not take away the pain of loss of independence. I could not lighten the heavy weight that serious illness put on my patients’ psyches. But I could be present.

It was, in a way, easy. I just had to show up.

Acceptance of death without fear — why wait?

I was drawn to another of Harper’s comments. Yes, old folks do worry about what their last days will be like — whether there will be suffering. But she “rarely encounter[ed] a fearfulness about what will happen when someone dies.”

This acceptance of death without fear is common. It may or may not have a religious element to it but, in general, those approaching death have reached a degree of serenity. Acceptance without fear.

I say this acceptance is a spiritual process whether one expresses it in religious terms or not. In a sense, aging forces this spiritual acceptance upon us all. We could do it earlier in life, and many do, but toward the end, after losing independence, we tend to accept and just let things be.

If we could learn how to accept the certainty of death earlier in life, our whole life could be more peaceful. Growing old forces this spiritual practice upon us. This is just one facet of aging as a spiritualizing process.

Come On, Y’all — Read the Blog First, THEN Comment!

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I was trying to be playful. An ironic blog post title took on a life of its own.

Like many people, I have a love/hate relationship with Facebook. I love seeing pictures of my grandkids. I have enjoyed connecting with high school friends more than fifty years post-graduation. I love the possibility of reaching new “friends” with my messages about end-of-life care and spiritual musings.

But my post two weeks ago, announcing my 100th blog entry, reminded me of some of what I hate about Facebook.

I maintain two Facebook pages. There is plain old “Hank Dunn” for more personal interactions, and then there is the more professional Hard Choices for Loving People (HCLP) page. Obviously, I want to sell more books and increase my reach digitally.

So, it should come as no surprise that, for a fee, Facebook will push my posts into people’s news feeds whether they want it or not. This “boost,” as they call it, works…until it doesn’t.

Happy birthday to me?

My playful title about my 100th blog post read: “My Life At 100.” Eleven words into my blog, I made it clear this was a post about my 100th blog entry, and not my 100th birthday.

My true friends on my personal page got the joke. One long-time friend wrote, “Hank, you don’t look a day over 85. Oh, wait…” Others also showed they had indeed read the blog.

Not so on the HCLP page, where we boosted the post to thousands of strangers. On this page, there were birthday wishes, fireworks, and birthday cakes. Hundreds “Liked” it; dozens even “Loved” it. I can imagine their thinking, “This guy turned 100; surely he deserves recognition.”

It is one of the things I HATE about Facebook: People commenting on a post they never read. Though I am sure these folks were well-meaning, it illustrated how fast misinformation can multiply. Fortunately, wishing me a “happy birthday” when there was no birthday does little harm.

Falsehoods are faster than truth

In my post, I mentioned our short attention spans. This fake birthday news only brings this home even more. It was clear people did not take the time to read the post, they just went with the title.

In 2018, a report in the journal, Science, put numbers to the spread of misinformation. “Falsehoods are 70 percent more likely to be retweeted on Twitter than the truth, researchers found. And false news reached 1,500 people about six times faster than the truth.” They found the phenomenon was even worse for political falsehoods.

I think regardless of what next week’s post is about, I will title it, “100-Year-Old Guy Goes Broke” so hundreds of well-meaning strangers might start a Go Fund Me — or, at least, buy my book.

Overdiagnosis of Kidney Failure vs Normal Aging

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We are treating elderly people for a disease they do NOT have. These treatments are burdensome, expensive, and make the patients’ lives worse, not better. More on this in a moment.

My friend was having problems with his bridgework and got a consult from a recommended dentist. Upon examination, the dentist said he could replace the old bridge and fix some other problems…for $10,000.

Needless to say, my friend got a second opinion. He went to another dentist who suggested first trying to repair the old bridge for $125 before replacing it. That was five years ago, and my friend says the less extensive solution is still holding.

I will very generously assume that the $10K dentist truly believed all his proposed work was needed. But I imagine the money played some role in the high-ball proposal.

Overtreatment is a big issue

I have written before about treatments pushed onto old folks that have no benefit. Some may even harm the patient. For example, research is clear that feeding tubes for advanced dementia patients offer no benefit and make these poor souls worse. I wrote about this here and here.

Also, the use of CPR offers certain patients no benefit and may make the possibility of a peaceful death less likely. I wrote about this here.

More recently, I wrote about a controversial, newly-approved drug that allegedly treats Alzheimer’s. It is expensive and requires the patient to receive it by IV. Worse, there is no evidence anyone’s life is improved (except maybe the shareholders in the drug company).

Now, what’s new with kidney failure?

The Journal of the American Medical Association (JAMA) Internal Medicine reported that elderly patients are routinely diagnosed with kidney failure, even though their kidney function is actually normal. This is a clear case of overdiagnosis leading to overtreatment. A related editorial also appears in the same issue of JAMA.

In 2002, the National Kidney Foundation published clinical practice guidelines on the evaluation, classification, and stratification of chronic kidney disease (CKD). These guidelines were based on levels found in a patient’s blood chemistry. Patients are classified as “normal/mild,” “moderate,” or “severe.” Those with more severe conditions may be put on dialysis.

What this new research found is that our kidney function declines normally as we age. For most of us, this decline does not affect how we feel, nor does it lead to an early death. Yet, many people are dialyzed just because the “numbers” say they need it.

Why?

The JAMA authors speculate about why doctors are reluctant to adopt new guidelines based on research known since 2012. They name three possible reasons: (1) a strong belief in the magnitude of the problem and the importance of early detection; (2) a desire to maintain the status quo; or (3) financial considerations. There is much money to be made when someone is on dialysis.

In 2017, John Oliver did a piece on HBO about dialysis and the financial incentives to providers. Over 11 million people have viewed it. If you have never seen Oliver, be warned — he drops a few f-bombs and makes you laugh at a very serious subject.

This IS very serious. If you are concerned about kidney failure, seek the advice of your trusted healthcare provider. Share this new research with them. Decide what course of treatment, if any, is best for you.

My Life At 100

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I made it to one hundred! 100. The Big One-Oh-Oh.

This is my 100th blog post. It took a while. I started blogging in 2011 and made six blog posts that year. For the first nine years, I only published 51.

From my very first blog post, May 11, 2011: “How to start a blog about end-of-life decisions? I have been professionally dealing with these issues for 27 years.… One thing for certain . . . the fact that patients and families often struggle with decisions about medical treatment at the end of life will not go away.”

(BTW, shout out to Kelly Brachle, of Quality of Life Publishing Co., who edits my ramblings into a coherent thought. And while I am shouting out, nothing leaves our home without the approval of my wife as she stands in for the “average reader” [when I showed her this post, she reminded me she is “above average”]. More than once, her suggestions have saved me some embarrassment.)

It’s all about the stories — family, friends, wilderness

Although I often stick to the theme of making end-of-life decisions, other topics get some attention. I share my own family’s experience with death and dying, like with my mom’s decline and death in “How did your mom feel about her dementia?” Grief is a repeated theme, like my recent post on the funeral ritual for my brother 42 years after he died.

I really try to tell stories, like the post about my friend who died with dementia. I wrote about our friendship since junior high and how we fished together in the years before his death. Occasionally, I share my adventures in the wilderness, like the one about my love of swamps.

I have been writing my whole adult life – before the days of the blog. A few of those older writings made it into the collection. I reprinted a story about riding my bicycle the length of the Outer Banks from a 1993 newsletter published by the nursing home where I was chaplain. For several years following a difficult time in my life, I sent letters (essays, really) to family and friends. In a 2014 post, I shared a piece I did in 1998 about my friend, mentor, and author, Elizabeth O’Connor.

Writing and videos for short attention spans

We have become a people with short attention spans, so I try to limit each post to about 500 words. I have even ventured into producing two-minute videos on various topics. Sometimes I’ll tell the same story in both formats. I did a blog about the lesson my father taught me about letting go in the blog “How to get to ‘It doesn’t Matter!’” I then did a YouTube video about the same story.

By the way, you can subscribe to my YouTube channel and look through my “Hank’s Deep Thoughts” playlist.

I have found that writing for others helps me think things through. I can clarify thoughts in my mind when I have to explain things in a way others can understand. So even if no one else reads these, I will keep on writing these blog posts.

Oops! I just passed 500 words. Bye!

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