Compassionate, informed advice about healthcare decision making

Archive for February, 2022

Curious After Seven Decades Above Ground

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

My birthday passed last week. Number 74. Now, a bitter-sweet day.

Bitter-sweet because I miss my younger brother, Dennis. He died on my birthday five years ago. When his wife called my sister to tell her Dennis had died, she said, “Don’t tell Hank. It will ruin his birthday.” She was right. My sister immediately called me, and it ruined my birthday.

The day now brings the appropriate mix of gratitude for another year of life and grief that my brother is no longer here to call me with birthday wishes. Bitter-sweet.

I find I’m getting more curious about myself as I settle into over seven decades above ground.  What am I curious about? About me. My thinking. My spiritual beliefs. I’m curious how can I still find new ways of thinking about and experiencing things spiritual. Curious how I find new ways of verbalizing these experiences.

An old man listening to books

Hank’s 74-year-old self

Last week, I told the story of an old man at the nursing home where I was the chaplain. I was in my 30s and he was in his 90s. The story was about his loveless marriage (according to his wife), but I mentioned that he listened to recorded books.

Every day, he’d be bent over in his wheelchair, leaning down, straining to hear history books being read on a record player. As a young man, I thought, “What is he doing? What is this 90-year-old man going to do with this new knowledge?” He talked very little. He was years past teaching children, or anyone for that matter. He just sat in his room and listened as the day crept slowly by. Now, I think, “I am the old man!”

You start dying slowly

Late last year I was introduced to the poem “You Start Dying Slowly” by Martha Medeiros. In Portuguese it is A Morte Devagar — “A slow death”. This poem meant so much to me that I printed it out and glued it to the inside of the journal I just started in November.

Here are a few lines:

You start dying slowly…
If you do not risk what is safe for the uncertain,
If you do not go after a dream,
If you do not allow yourself,
At least once in your lifetime,
To run away from sensible advice…

Referring to the poem, I wrote in the journal on November 21, 2021, “I am profoundly moved by this piece. I still marvel that, at my age, I am still wanting to make something of my life. I still struggle with taking risks.” Weeks later, on January 4th I wrote, “‘Who are you God and who am I?’ St. Francis said and I BOTH say. I am almost 74 and have not settled this.”

My 24-year-old self meets my 74-year-old self — it is not pretty

Hank’s 24-year-old self

Fifty years ago, if my 24-year-old self met my now 74-year-old self, he would have called me a heretic. I was so certain about things at 24. Now, being “right” is less important. Rather, following the teaching of Jesus, right action is more important that right theology.

Now, questions are more important than answers. Curiosity feels better than certainty. I am the old man listening to books. I listen not to know more but to be comfortable with not knowing. The mystics are my favorite guides. Thomas Merton summed up, for me, the mystery of knowing and not knowing God:

 

Thomas Merton

“Your brightness is my darkness. I know nothing of You and, by myself, I cannot even imagine how to go about knowing You. If I imagine You, I am mistaken. If I understand You, I am deluded. If I am conscious and certain I know You, I am crazy. The darkness is enough.”

 

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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.

Valentine’s Special: “I don’t think I ever loved him.”

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With Valentine’s Day just passing, a comment came back to me out of my lifetime of conversations. Thirty years ago, I was visiting a nursing home resident’s wife as we prepared for his funeral. The old lady summed up their 60-plus-year marriage with the words, “I don’t think I ever loved him.”

How sad is that?

As a nursing home chaplain, I did not get to know patients and their spouses in their best days. They came to us a shell of their former selves.

He seemed to be a quiet introvert. He spent most of each day in his wheelchair, listening to recorded history books. She was friendly and faithful with her daily visits. She seemed happy.

A steady job and homemaking skills

They lived in Chicago, during The Depression. They attended the same church, a good place to meet like-minded people. He was 28 and she was 18 on their wedding day. He had a good job as a schoolteacher. She lived at home with her parents.

This was a different time when women mostly thought about finding a man to provide for them. Men were looking for a woman to bear their children and make the home. Evidently, at least for this couple, love was farther down the list of desired qualities in a long-lasting marriage. And yet they stayed together for 60 years.

Leaving a loveless marriage

Nowadays people handle loveless marriages differently. My friend’s husband left her for another woman after 30 years of marriage. A couple of months after he moved out, he told my friend, “I feel for her what I always wanted to feel for you.” She thinks he never loved her.

After a several years of being single, my friend married again. This time it was to a man who truly loved her. She had made a list of qualities she wanted to look for in a husband. She told me, “I made this list, and, for some reason, I did not have on the list ‘someone who loves me.’ Turns out, that was the most important quality. You would think I would have thought about love first.”

Perhaps a third way — falling in love with your spouse

Which is the better way? Staying in a loveless marriage or leaving it to find your true love? Or is there a third way? Falling in love with your spouse. It would have taken work and probably therapy. There must have been some small spark of love at the start. Perhaps that was an ember that could have been rekindled.

The old lady was of a different generation, so she had little awareness that she could have asked for more out of her marriage. My friend’s ex was of the mindset to take care of himself first, even if that meant finding love outside of the marriage.

Perhaps they both missed what could have been.

Happy Valentine’s Day!

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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.

Can a POW have a “Good Death” Hundreds of Miles from Home?

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A young soldier named William Gaston Barringer turned 18 on October 5, 1862. Less than three months later, he was wounded and died as a prisoner of war 200 miles from home. Yet, there is evidence he had a good death. How could this be?

Barringer’s marker caught my eye as I wandered around St. Peter’s Cemetery in Oxford, Mississippi. The epitaph, “I was not afraid to die; my Mother taught me to pray in early life,” got me thinking about what it means to have a good death. (See my “Hank’s Deep Thoughts” video at the monument.)

Let me clarify; a “good death” does not mean that it was good that William died. Death to the young is, of course, a tragedy. And, as a POW, he likely did not die in ideal conditions.

Being a prisoner of war was not mentioned on the monument. I did an internet search and found him on a list of soldiers who died in captivity, hundreds of miles away in Murfreesboro, Tennessee.

A “good death” through the centuries

Plagues in the 1300s killed 40-60% of the European population. Such widespread death led to the release of a couple of books known as the Ars moriendi (“The Art of Dying”). These were Christian instructions on how to have a good death. There were accompanying woodcuts, like one showing demons tempting the dying man with crowns symbolizing earthly pride.

 

By the American Civil War (1861-65), the dying and their families knew what was expected. Drew Gilpin Faust identified four elements of a good death in her moving book, This Republic of Suffering: Death and The American Civil War. According to Faust, a good death in the 19th century was one where the dying person:

  1. Was conscious
  2. Was not afraid of dying
  3. Was prepared spiritually to meet their maker
  4. Left dying words for the family

 

Even the atheist Charles Darwin, who died in 1882 in England, kept to this script. He told his wife on his deathbed, “I am not the least afraid of death—Remember what a good wife you have been to me—Tell all my children to remember how good they have been to me.”

Though a reference to spiritual things was conspicuously absent, Darwin was conscious, was not afraid of dying, and left last words for his family. In my interpretation, he wanted to emphasize that even though he had no spiritual leanings, he was still “not the least afraid of death.”

Much has changed since the Civil War, including our expectations about our deaths. Today, medical literaturedescribes what many now consider a good death: being in control, being comfortable and free of pain, having a sense of closure, etc.

This sense of control has recently manifested itself through eleven U.S. jurisdictions adopting medical aid in dying. In those places, patients can ask a physician to give them medication to hasten their dying.

Back to Mr. Barringer

The words on Barringer’s marker were an assurance to his family that he died a good death: “I was not afraid to die; my Mother taught me to pray in early life.” These seem like the dying words of a conscious man.

And there it is. William was conscious, he was not afraid of dying, he was prepared spiritually (thanks to his mother), and these are the words he left for others. I can imagine his mother visiting this monument often in her grief and being consoled, “At least he had a good death.”

 

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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.

“Watching” the Super Bowl on Life Support

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“I know he would never want to be kept alive like this,” she said to me over the sound of a machine forcing air into her husband’s lungs. He lay motionless, eyes closed. He had been like this for months after arriving at the nursing home from the hospital.

She was holding out for the miracle that seemed unlikely. She was raised Catholic but converted to Judaism when they married some forty years before. One day I came into the room on my chaplain rounds, and she had both a Jewish prayer book and a Rosary in her hands. She figured it couldn’t hurt covering all the bases.

“Why is he like this?” she asked more than once, about him being in a nonresponsive state. Doctors told her he would never regain consciousness. “There must be a reason.”

When bad things happen to good people

Since she was Jewish and asked this question, I gave her a copy of Rabbi Harold Kushner’s When Bad Things Happen to Good People. After the rabbi’s three-year-old son was diagnosed with a rare disease that would take his life by his teens, he pondered the question that became his best-selling book. Rabbi Kushner believes that although God is good and loving, nature randomly metes out bad things. God does not send bad things. They “just happen.”

I dropped in again a few days later, and she thrust the book at me. “I didn’t like it,” she said. “He says some things ‘just happen’ with no reason. I can’t accept that. There has to be a reason my husband is like this.”

Withdraw life support — but first…

Just as these situations usually progress, she and her three adult sons began to ask the staff and physician about withdrawing the life support. They were told it would be quite appropriate and could be managed in a way to provide comfort.

Washington fans during the Super Bowl years

It came down to an impromptu meeting with me in the hall outside the patient’s room. “Dad would hate this,” said one of the sons. They all agreed it was time.

Then another son spoke up. “Wait a minute. We are all headed to the Super Bowl to cheer for the Redskins.” (Of course, he was referring to the Washington Football Team once known by that name.) The patient and his sons all had season tickets, a prized possession back in the day when the team won three Super Bowls in nine years.

“It would be really sad to go to the game in Minneapolis right after dad dies. Let’s do it after the game.” They all agreed.

“Watching” the Super Bowl on life support

I had heard a lot of reasons for delaying withdrawal of life support — waiting for a sibling from California to arrive at the bedside or waiting until someone gets married. Waiting for a football game was a new one for me. I could imagine the patient would have been fully behind the delay. Football means that much to some people.

I did see the compassion in this act. Perhaps having the game on in the patient’s room just might get through to this poor soul. I didn’t really believe it would, but what do I know.

The plan worked. They took the man home days after the game, where they withdrew life support, and he died peacefully.

And the Washington Football Team beat the Buffalo Bills that year, 37-24, in Super Bowl XXVI.

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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.

 

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