November, 2021 | Hank Dunn

Compassionate, informed advice about healthcare decision making

Archive for November, 2021

Just Plain “Thank You” Period

Posted November 22, 2021 by [email protected]

[NOTE: This is an update of a blog first published in 2013.]

Can we be overwhelmed with gratitude but have no need to thank anyone or anything?

This question came to me as I finished the last pages of Wild: From Lost to Found on the Pacific Crest Trail by Cheryl Strayed. This 2012 memoir was reviewed in The New York Times and made into a movie starring Reese Witherspoon in 2014.

She took her grief on a 1,100-mile backpacking trip

The story is about loss and backpacking, two abiding interests in my life. I’d probably write favorably of anyone who takes their grief on a 1,100-mile backpacking trip. Cheryl Strayed did and wrote about it.

Strayed has an abusive father, her beloved mother dies prematurely, and her stepfather and siblings later drift away. After Strayed’s destructive behavior ends her marriage and leads her to addiction, she decides to hike the Pacific Crest Trail, inexperienced and alone. She encounters the elements, animals, people, and her own demons and angels on her months-long journey.

I have never attempted long-distance backpacking. The most I have ever lasted was four nights. So, I only have a hint of what Strayed went through on her arduous journey. I met many through-hikers on the Appalachian Trail within a half-hour of my home in Virginia. The people I met on the AT had completed one thousand miles on their way to Maine, another thousand miles to the north. Strayed’s stories of the people she hikes with for a few days at a time ring true.

In the end, GRATITUDE was the feeling at her core

At bottom, Strayed’s story is about her spiritual journey to emotional wholeness from what was once the wreck of her life. She never portrayed herself as a religious person in any sense of the word. But, in the end, gratitude was the feeling at her core.

There are many moving passages in the book, but I was caught by one line on the next-to-last page of the book. Cheryl touches the bridge on the Columbia River, the site at the end of her journey. She walks back to an ice cream stand to buy herself a treat with the last two dollars she has to her name. She enjoys her ice cream, chatting with a lawyer from Portland who stops for ice cream, too. She says goodbye to him and

“I leaned my head back and closed my eyes against the sun as the tears I’d expected earlier at the bridge began to seep from my eyes. Thank you, I thought over and over again. Thank you. Not just for the long walk, but for everything I could feel finally gathered up inside of me; for everything the trail had taught me and everything I couldn’t yet know, though I felt it somehow already contained within me.”

Religious types thank God. Others thank a “higher power” or “the universe.” Strayed felt no need to tell us who the “you” was in her “thank you.” In my life-long quest to understand the spiritual journey, I have never encountered a simpler yet profound expression of gratitude for being a recipient of the graciousness of life. Most of the dying people I met in my 30 years as a chaplain had that same humility and gratitude.

Thank you.

Just “thank you,” period.

Cheryl Strayed ends her book acknowledging the truth I try to capture in my poem “Giving Up, Letting Go, and Letting Be” with the words,

“How wild it was, to let it be.”

Thank you,

Hank

__________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

The “Serenity Prayer” Both In and Out of Jail

Posted November 18, 2021 by [email protected]

What word could I possibly bring to the men in jail? That was the question.

Each Wednesday afternoon, I join three other men from my church, and we sit in silent meditation with a group of inmates. These men at the Lafayette County Detention Center are awaiting trial or sentencing or transfer to another, more “permanent” place of incarceration.

Prayer on Alcoholics Anonymous medallion

Both our leaders were going to be out of town, and so leadership had fallen to me. We always start the group with a reading, usually from the Psalms. Surely, the psalms of lament ring true to those behind bars — “My God, why have you forsaken me?”

I could have defaulted to the oft-quoted and ever-favorite Psalm 23, “The Lord is my shepherd,” but I wanted to go a different route.

I have no idea what it is like to sit in jail. Guilty or not, these men face uncertain futures and life challenges of which I know nothing. The “Serenity Prayer” came to mind. Long a favorite of those in A.A., this simple prayer has given guidance to alcoholics and addicts for generations. Heck — it has given me guidance.

Originally, it was written as a prayer for worship at a small Christian congregation in Heath, Massachusetts, in the 1930s. Theologian Reinhold Niebuhr wrote it as part of a sermon for his flock. The most common version is just three lines asking for “serenity,” “courage,” and “wisdom.” I included these words in my book, Hard Choices for Loving People, to help those facing the end of life.

In the full prayer below you can see the influence of eastern thought with suffering as a “pathway to peace” and accepting the world “as it is.” This reminds me of the current cliché, “it is what it is.” These are words for all of us, jailed or free.

Here is the complete prayer:

Prayer for Serenity

by Reinhold Niebuhr

God, give us grace

to accept with serenity the things that cannot be changed,

courage to change the things which should be changed,

and the wisdom to distinguish the one from the other;

living one day at a time, enjoying one moment at a time;

accepting hardship as a pathway to peace;

taking, as Jesus did, this sinful world as it is,

not as I would have it;

trusting that You will make all things right if

I surrender to Your will;

so that I may be reasonably happy in this life and

supremely happy with You forever in the next. Amen

_______________________________________

The “Thin Places” Between the Physical and the Spiritual

Posted November 10, 2021 by [email protected]

Do you ever notice how often people post photos of sunrises or sunsets on social media? “Inspiring,” they say. Or the religious types write, “Good morning from God.”

In my personal photo collection, I have scads of dawns and dusks. Sunrise in the swamp. Sunset from a mountaintop.

Then there was the sunrise etched in my memory when I found myself without a camera. I spent the night alone on a platform in the Blue Ridge Mountains in North Carolina. It was chilly, so I braced myself against the cold covered up in my sleeping bag. At first light, I sensed something special was about to happen.

Indeed, it did. I sat up with a start and looked east. Moments before the sun inched above the distant ridge of mountains, a deep purple line separated the night sky from the ridgeline. It couldn’t have lasted more than a few minutes. I had never seen such a beautiful mountain dawn before. I haven’t since.

The “Thin Place” between physical and spiritual worlds

Iona Abbey, Scotland

That mountain was a “thin place.” The term is used to describe places of sacred power, where the separation between physical and spiritual worlds seems “thin.” There are sermons about thin places, like in the story of the Transfiguration.

In that story, Jesus shines with bright light on a mountaintop before his disciples. The mountain becomes a symbol of the meeting point between humans and God – between the physical and spiritual – with Jesus representing the connection between both worlds. Long before cameras or social media, Peter wanted to capture the moment and build three shrines to contain this heavenly appearance. Jesus would have none of it.

Thin places are most often associated with spiritual retreats, like the Scottish island of Iona, which I visited while on a Celtic Christianity pilgrimage. Being in places like this invites thoughts of things spiritual.

Hank’s “thin place” – campsite on The Big Schloss

There’s also a thin place, for me, on The Big Schloss, a rock outcrop on the Virginia-West Virginia border. I have probably spent thirty nights sleeping near the peak of this mountain, watching the sun rise and set. My children slept up there with me. We saw Halley’s comet there.

Even atheist author Sam Harris speaks of his own thin place experience. In his book, he describes how he was touched by a walk in Jesus’ footsteps. This happened on “an afternoon on the northwestern shore of the Sea of Galilee, atop the mount where Jesus is believed to have preached his most famous sermon,” Harris writes. “As I gazed at the surrounding hills, a feeling of peace came over me. It soon grew to a blissful stillness that silenced my thoughts. In an instant, the sense of being a separate self — an ‘I’ or a ‘me’ — vanished.” (Waking Up: A Guide to Spirituality Without Religion, p. 81)

“Thin Moments”

Photo by RODRIGO GONZALEZ on Unsplash

There are also “thin moments,” or moments in time that are transformed into a spiritual experience. In an earlier blog, I wrote about my sense of connection with others at the post office the first time I wore a mask inside. I quoted the monk (and sometimes hermit), Thomas Merton, and his sense of connection to all the busy shoppers at an intersection in Louisville.

Photo by Filip Mroz on Unsplash

More thin moments: Gazing into the face of an infant who is smiling for the first time. Walking outside at night and hearing an owl or a whip-poor-will. Listening to music that moves you. Then of course, there is always watching those sunsets and sunrises.

Thin moments could happen more often if we just paused long enough or weren’t so distracted or busy taking pictures to post. We don’t have to be at the top of a mountain or by the seashore. The promise from scripture is, “I am with you always.”

__________________________________________

Race and the Place of Death of Our Choosing

Posted November 3, 2021 by [email protected]

If you had a choice, where would you want to die? At home? In a hospital ICU? In a hospice in-patient unit?

It has only been recently that more people have died at home than in the hospital. I used to discourage death in the hospital. As a nursing home and hospice chaplain, I cared for hundreds of patients in non-hospital settings. It seemed to me that dying outside the hospital was the better way to go.

Photo by Alvin Leopold on Unsplash

When I was writing the third edition of my book, Hard Choices for Loving People, I included a section strongly discouraging people from going to the hospital to die. I sent a draft to Dr. Christina Puchalski, who leads the George Washington Institute for Spirituality and Health.

Dr. Puchalski is a pioneer in encouraging physicians to assess patients’ spiritual resources. She also was in active practice at the time, caring for patients in a Washington D.C. clinic. Many of her patients were African Americans with limited income.

She read my draft and saw through my attempt to manipulate readers. “Hank, many of my patients and their families feel more comfortable dying in the hospital,” she told me. “It is very common for people in the neighborhoods I serve to want to go to the hospital in the end.”

So, I modified that section. I listed all the possible downsides to hospitalization but acknowledged some would still prefer to go to a hospital.

A rural physician taught me a lesson

About that same time, I started traveling around the country making presentations to healthcare professionals. My most popular talk, “Helping Patients and Families with End-of-Life Decisions,” includes a series of slides with “Hank’s Theorems” on various end-of-life issues. The first slide says, “The peacefulness of a death is directly proportional to the distance from the hospital ICU.”

I was speaking at a resort in Button Bay, Vermont. A woman came up to me after my lecture and said she took issue with that slide. “I am an ICU doctor in a small rural hospital here in Vermont, and we do not have a lot of resources. We use our ICU as an in-patient hospice and have a lot of peaceful deaths there.”

Now when I show this slide, I also share this physician’s feedback. I clarify that it is the death hooked up to machines with medical staff beating on our chest that many of us want to avoid.

“Fighting to the end” or a “peaceful death”

But what about the people who want to “fight to the very end”? The ones who really do NOT want a peaceful death? Perhaps, aggressive interventions and a medicalized, violent end are their true desires. Then again, many families whose loved ones died in the ICU wish it hadn’t happened that way. They regret that their mom or dad did not have a more peaceful death.

Photo by Sharon McCutcheon on Unsplash

So, here are two extremes of what death could look like: Being hooked up to machines in the ICU or choosing comfort measures only in a non-hospital setting. An article in the Journal of the American Medical Association (JAMA)Network Open and its accompanying commentary investigated this recently.

The research looked at metastatic cancer patients who died in a hospital. Some died in the ICU or had other more aggressive treatments like mechanical ventilation, CPR, or chemotherapy before they died. Others never had these interventions. There was a curious breakdown based on race.

Black, Hispanic, and Asian patients were much more likely to have aggressive interventions before death than White patients. This research could not answer why this was the case. The commentary in JAMA speculated that perhaps it could be due to the informed decisions of the minority patients or their families.

I have cared for patients and their families who did not want the death at home. They didn’t want to face the thought of living in the house where the dead had lain. Or the patient did not want to create an extra burden for the family, which can be so common in the last days. The hospital was the best place for them to reach their goals.

Either way, the hope is that people can have the death of their choosing.