Compassionate, informed advice about healthcare decision making

Archive for October, 2021

Our Struggle with Dying Starts When We’re Toddlers

Posted by

[Adapted from a chapter in Light in the Shadows by Hank.]

“This is where our struggle with dying starts,” was my first thought.

“Putting It Together”, J.D. Hillberry www.jdhillberry.com

Many summers ago, I was wandering through an arts festival in Crested Butte, Colorado, when I came across the works of an artist who made pencil drawings. I was fascinated by a sketch he had made of his two-year-old son, depicting him as an unfinished jigsaw puzzle.

The child is looking down at his hand, which appears to be emerging from the flat surface of the paper. There is a puzzle piece in his grasp. He is searching for the place where that piece of himself fits. The artist titled the picture “Putting It Together.”

This memory of that Colorado summer came as I am now, once again, hanging out with a toddler and his infant sibling. This is my third tour of duty caring for little humans. First, there were my children. Later, I provided daycare once a week for two of my grandchildren through their early years. Now, we occasionally watch a friend’s two sons, who are 18 months and four months old.

Toddlers and the “Denial of Death”

I was watching my two grands after reading Ernest Becker’s Pulitzer-Prize winning

Hank’s grandson learning control at the light switch

book, The Denial of Death. Now, under the influence of these two new little ones in my life, I am rereading Becker. His main thesis is that the prospect of death is THE driving force in human behavior. Both the building of our individual ego or self and our culture’s attempt to shield us from the horror of death’s finality. Here’s a sample:

“[A child] avoids [despair] by building defenses; and these defenses allow him to feel a basic sense of self-worth, of meaningfulness, of power. They allow him to feel that he controls his life and his death, that he really does live and act as a willful and free individual, that he has a unique and self-fashioned identity, that he is somebody.… We don’t want to admit that we are fundamentally dishonest about reality, that we do not really control our own lives.” (Ernest Becker, The Denial of Death. p 55.)

Play and learning to take control

The toddlers in my life have shown this behavior. I remember my grandson discovering the light switch. I would stand him on a chair, and he would play with the switch. He would flip it up and then jerk his head toward the ceiling to see the light appear. Then, down and the light goes off. His actions were affecting his environment.

Hank’s granddaughter and the “singing bowl”

Let a child play with a musical instrument. My grandchildren both loved to bang on the piano or hit my singing bowl with the mallet. Any noise accomplished their unconscious goal of finding out they could influence the world around them.

Even the delight I recently observed of our friend’s toddler playing with the garden hose in our backyard revealed a growing sense of self. He put his fingers in the nozzle and felt the water. He found he could direct the flow of water into the air or on me. He was gaining control.

Fortunately, gaining control of one’s life can be beneficial to everyone concerned. Eventually, the child learns that studying improves your grades. Exercise makes you feel better. Treating people kindly encourages them to return the kindness.

Even toward the end of life we can practice some control, choosing to seek a cure for a terminal disease or focus more on easing physical and spiritual pain.

Letting go of the illusions we created

Third tour of duty with little humans

Every child makes their own progress toward gaining a feeling of control. This positive self-image that gives us a sense of meaningfulness, safety, and stability, allows us to grow and thrive. What is truly happening is that WE are creating this ego with the material that is handed to us genetically and emotionally. If we do the job adequately, we can live a life enjoying emotional and spiritual health.

So why did the sketch of the child make me think, “This is where our struggle with dying starts”? One day, in the last phase of life, all this meticulously constructed personality we spent our whole lives creating is revealed for what it is — a mask. The root meaning of the words “person” and “personality” is from the Latin persona, a mask worn by actors in a play.

Last week I wrote about dying without illusions. Watch a toddler and see those illusions being created.

 

 

Dying Without Illusions: A Tribute to Susie De Porry

Posted by

[NOTE: Hank wrote this tribute in 1995 when he was chaplain at the Fairfax Nursing Center, Virginia.]

She died with no family around. No wealth. Few possessions. No children, grandchildren, or great-grandchildren. She was never married. No obituary in the Washington Post. Not even a death announcement. The world will not miss her. Few will grieve her passing save for her niece, brother, and sister.

And yet, she died without illusion.

She was just a lovable human being

Susie

Susie De Porry was one of the wonderful souls who had graced our lives at Fairfax Nursing Center. There was no brighter smile. There was no one more enthusiastic about rides and activities. There was no one more devout in the practice of her faith. And no one more content to sit and read for hours.

She had a special place in the hearts of those of us who cared for her. Maybe it was because she had no family living nearby. We were almost all she had. But more than that, she was just a lovable human being.

She was born in New York City in 1903. Her father died while Susie was quite young. She studied music, including some training in France. Susie delighted in telling of her time on the Continent and playing the organ at the Notre Dame Cathedral in Paris. She taught music but mostly cared for her aging mother and other elderly people. After her last client died, Susie moved directly into a home for adults in Vienna. Two years later, in 1986, she came here to the nursing home.

During her last days and hours, several of us spent some special time alone with Susie. She was barely responsive. She would hold my hand. I wasn’t sure she recognized me. Though at one moment, she looked at me and smiled. I asked how she was feeling, and she said, “I’m doing fine.” Those were the last words I heard her say.

She is more heroic than most of us

As I sat next to her only hours before she died, I could not help but try to gain some sense out of Susie’s life and death. Susie’s story is not tragic at all. In a sense, she is more heroic than most of us. She was free from the illusions most of us work at gathering during our lifetimes. We work at accumulating financial resources, excelling in our careers, or perpetuating our lives through our children and grandchildren.

Susie De Porry had none of the above. She was just Susie. Alone she approached the ending of her mortal days. Alone and without illusion.

I will have to make a conscious decision to see myself in this light. It would be an illusion to see myself as anything but one man passing from a human race that spans millennia in length and billions of people in width. Susie taught me that this could be done and done quite serenely.

Thanks, Susie.

“God has told me my wife is not going to die!”

Posted by

“God has told me my wife is not going to die!” That’s how my new hospice patient’s husband greeted me.

The nurse warned me that this was coming. The patient had breast cancer that had metastasized to the bone — a usually fatal prognosis.

Photo by National Cancer Institute on Unsplash

He went on to say, “I don’t want any talk about death or dying, only hope and healing.” Months before, I was asked not to return to a home where I had pushed a family to discuss possible death before they were ready.

I was wrong then, and I did not want to blow it again. As a chaplain, I was a guest in their home, so I would abide by his rules. I did say that if the topic of death came up, I would pursue it but would leave it up to them to introduce it. Until then, hope and healing.

Hope and optimism are all around us

There is hope at weddings. I have led many couples to repeat the phrase, “Till death do us part.” One pair deleted this phrase from their vows. It was his third marriage and her second. Another bride asked me to remove, “for richer, for poorer.”

The couples who didn’t edit their vows were being optimistic. The truth is half of all marriages end in divorce.

There’s hope in business. Would entrepreneurs start new ventures if they were not hopeful? Sure, they have a business plan and capital. Yet, there has got to be some self-deception, a bit of hopefulness in the face of long odds.

People who study such things call this self-deception the optimism bias. “The optimism bias is defined as the difference between a person’s expectation and the outcome that follows. If expectations are better than reality, the bias is optimistic; if reality is better than expected, the bias is pessimistic.”

Diversifying hope

It turns out optimists are happier and live longer than pessimists. I wrote in a previous blog about how the self-deception of the placebo effect can take away pain. With these kinds of benefits, so what if an optimist’s expectations are better than reality?

The Journal of the American Medical Association recently published an opinion piece, “Holding Hope for Patients With Serious Illness.” It is about doctors who encounter patients or family members who are hopeful for a happy outcome in the face of a fatal illness. What do they do? They don’t take away the hope but diversify it. Here is their summary:

“How can clinicians help patients hold multiple hopes? One approach may be to ask patients what they have heard about their prognosis from their clinical team. Patients could then be asked, ‘Given what is coming, what are you hoping for?’ It is not necessary to contest the answers nor convince patients to consider other futures. Instead, the clinician could acknowledge the response and ask, ‘What else are you hoping for?’ And then again, ‘What else?’ The point is to help patients balance and diversify their hopes, providing flexible future directions and possibilities.”

“Satan is trying to get me to doubt it.”

I stumbled onto this idea of diversifying hope on my own with the husband who heard a message from God. As I arrived for one visit, he was about to leave for work. He said, “Hank. You know how I said, ‘God told me my wife is not going to die’? Well, I still believe that, but Satan is trying to get me to doubt it. Would you pray for me?” I said I would, and he left.

I turned to the wife, who had just found out the cancer had spread to her liver. “Do you have as much confidence as your husband that you will not die?” She burst into tears and said, “I am afraid if I die, my husband will be disappointed in me.” My heart sank for them both.

Photo by Gus Moretta on Unsplash

On the next visit, I sat with the two of them. I told the husband about my conversation with his sick wife. He immediately got up from his chair, took this poor woman’s hand, and said, “I would never be disappointed in you. You have done all you can to fight this.”

I told them I had two concerns about people in their situation not contemplating the possibility of death. One was some people, believing a patient is not dying, refuse narcotics for extreme pain. (This was not the case with these two.) My other concern was that they might miss some crucial conversations. Conversations about their love for one another, saying good-bye, or finding ways to live fully in the limited time she had left.

The couple assured me they had been doing that, too. They were still hoping for a cure, but they also hoped for enough time to say all that needed to be said. They hoped for freedom from pain by accepting pain medication.

They had already diversified their hopes.

Becoming a Whiskeypalian: A place where people know my name

Posted by

In my younger days, as a Southern Baptist, I was somewhat jealous of my Episcopalian friends. We called them “whiskeypalians.” They got to dance and drink, and we did not. Or, more accurately, they got to dance and drink without GUILT. We felt guilty about doing almost anything fun.

St. Peter’s Episcopal Church, Oxford, Miss.

Had I fallen? Or, to borrow Father Richard Rohr’s words, had I “fallen upward”?

Or had my faith journey followed the words of the Apostle Paul, “When I was a child, I spoke like a child, I thought like a child, I reasoned like a child; when I became an adult, I put an end to childish ways”? (1 Corinthians 13:11)

My failed attempt to leave the church behind

I have always been a church-type guy ever since my parents put me on the “cradle roll” at the Palma Ceia Baptist Church in Tampa, 1948. Even during my college days, when I rarely went to church on Sunday, I substituted attendance with feeling guilty about sleeping in.

I tried to get my name off the membership roll of the church I had joined during college. My faith journey had led me to a summer ministry in the inner city of Newark, New Jersey, in 1968, a year after the riots. I was so appalled by the lack of a church presence in the face of such urban poverty, I wrote to my church and asked to have my name removed.

They replied that there were two ways to get my name off the roll. One was to transfer my membership to another church. The other was to die. Neither option was appealing.

They got the last laugh. By the time I was about to graduate, I had decided to go into the ministry. I needed the church’s endorsement to get into The Southern Baptist Theological Seminary.

I groveled. They endorsed.

The long and winding road, Southern Baptist to Episcopalian

Hank, Southern Baptist youth minister, 1976

After ordination, I served a Southern Baptist church in Macon, Georgia, and for a number of years was a member at the ecumenical Church of the Saviour (CofS) in D.C. Having left the professional ministry at that time, I asked myself, “Do I have a spiritual life…even when my job does not require it?”

The answer was “yes.”

For the next 32 years, while I was a healthcare chaplain, I was deeply involved in a more liberal American Baptist church. In a story too long to recount here, my wife and I found ourselves living in Oxford, Mississippi, with no church to call home.

I had moved so far – physically and spiritually – from my Southern Baptist roots. Now that we were back in the deep South, where to turn? Freed of any expectations, I asked myself, “What do I want in a church?”

Discovering what I wanted in a church

I walked into St. Peter’s Episcopal Church. The building had been erected in the 1850s with slave labor. [See my video about this experience.] Here is what I found out about myself in the process of becoming an Episcopalian:

  • I am nourished by the excellent biblical preaching I encounter every Sunday. Who knew?
  • I have lived most of my adult life by scripture, tradition, and reason, the “three-legged stool” that retired bishop Duncan Gray taught us about during confirmation class. It was nice to have a metaphor to explain it.
  • I am touched by Christian mysticism; or the experience of God’s presence. [I did a short video about my reverence for the silence I found in Trappist monasteries.] After further conversation with bishop Gray, I added a fourth legexperience.
  • I found the Christian words and symbols were a familiar home. I could now be instructed by those same metaphors while leaving behind the orthodox baggage that was no longer helpful.
  • Perhaps my greatest discovery was learning how much I value engagement with small groups of people. A place where people know my name, a community on mission together. For example, on Wednesday afternoons, I go with three men from St. Peter’s to sit in silent meditation with a dozen incarcerated men at the county jail across the street from the church. Jailed and free, White and Black, church-types and seekers. We sit.

I can now dance and drink without guilt.

Quality of Life Publishing Logo

Quality of Life Publishing Co. is the proud publisher of Hank’s books, as well as other branded educational materials for health care & end-of-life care.

www.QOLpublishing.com

Copyright 2024, Hank Dunn. All rights reserved. Website design by Brian Joseph Studios

Volume Discounts for Branded Book Orders

Minimum quantity for branded books is 100. English and Spanish branded books are sold separately. Click here for more information or contact us with questions.

Black

  • 100 to 249 copies: $4.50 each
  • 250 to 499 copies: $3.50 each
  • 500 to 999 copies: $3.00 each
  • 1000 to 1499 copies: $2.25 each
  • 1500 to 1999 copies: $1.75 each
  • 2000 to 3999 copies: $1.60 each
  • 4000+ copies: $1.45 each

Color

  • 100 to 249 copies: $7.00 each
  • 250 to 499 copies: $4.50 each
  • 500 to 999 copies: $3.50 each
  • 1000 to 1499 copies: $2.50 each
  • 1500 to 1999 copies: $2.00 each
  • 2000 to 3999 copies: $1.85 each
  • 4000+ copies: $1.70 each


Volume Discounts for Unbranded Book Orders

Each title/language sold separately.

  • 1 to 9 copies: $8.00 each
  • 10 to 24 copies: $5.75 each
  • 25 to 49 copies: $4.50 each
  • 50 to 99 copies: $4.00 each
  • 100 to 249 copies: $3.50 each
  • 250 to 499 copies: $3.00 each
  • 500 to 999 copies: $2.50 each
  • 1000 to 1499 copies: $2.00 each
  • 1500 to 1999 copies: $1.50 each
  • 2000 to 3999 copies: $1.35 each
  • 4000+ copies: $1.20 each