Compassionate, informed advice about healthcare decision making

Archive for September, 2023

A Pacemaker for a 93-Year-Old with Dementia — I Have Some Questions

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Credit: Boston Scientific

More than 200,000 pacemakers are implanted each year in the U.S. 70% go to patients over age 65, many of whom see improved quality of life and probably have their lives extended.

Recently, someone contacted me because she has a friend “who is struggling with the decision for her 93-year-old mother who has dementia regarding the insertion of a pacemaker.”

I am not a doctor and do not like to give medical advice, but I do have some questions for the family to ponder as they make this decision.


  • Did the patient ever indicate her feelings about life-prolonging medical procedures in the condition she now finds herself?
  • How did the patient feel about her dementia?
  • Is she happy with the state she finds herself in?
  • What would you want if you were her?
  • What would the patient think about living longer, knowing she will lose more of her mind and become more and more feeble?
  • Has the family considered enrolling the patient in hospice and focusing on the comfort of the patient?
  • Would the patient rather die than continue to decline into more memory loss?

Care of dementia patients at the end of life is personal for me

Hank and his mother at her memory care facility

I blogged previously about my parents’ deaths in “How Did Your Mom Feel About Her Dementia?” and “A Tale of Two Docs.”

Both of my parents died with dementia. We were always looking for procedures we could NOT do to allow a peaceful and sooner death. For example, we decided if either came down with pneumonia, we would not seek a cure but would keep them comfortable. My brother, sister, and I felt we handled their ends how THEY would have wanted.

Hank with his nursing home resident father

After a year and a half in a memory care unit, my mother fell and fractured her pelvis. This is a known death sentence for a dementia patient. We didn’t even have her sent to the emergency room. The hospice doc ordered pain medication, and I flew from Virginia to Colorado to be with her.

After more than four years in a nursing home, declining from Parkinson’s and strokes, my father could no longer be hand-fed. There was NO discussion about a feeding tube. I flew to Tampa to be with him, where he died six days after his last intake of food or water.

Sometimes, questions are better than answers.


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 or on Amazon.

A Cave, A Deathbed, and “How You Made Them Feel”

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“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” —Maya Angelou

1975 – Vineville Baptist, Macon, GA, youth group on retreat at Toccoa, GA. Photo by Hank Dunn

My theory about what matters most in the ministry is based directly on Angelou’s quote: It wasn’t so much what I said or did during my 50 years in the ministry. It was more about that certain “something” that made the people I worked with feel a particular way.

I was a youth minister for the first five years after seminary. I loved the work and loved “my kids.” We keep in touch in a Facebook group. I asked the group about our ministry and the Angelou quote.

Interestingly, a few noted specific things I said or some teaching from the books we read. Okay, so maybe people DO remember the things you say. One fellow, who eventually became a teacher and hospice chaplain, commented, “I don’t see it as an either/or but a combination.”

1977 – High school student on a backpacking trip into the Shining Rock Wilderness, NC. Photo by Hank Dunn

Others confirmed my theory that how people felt was most important. Another one of my kids (who also went into the ministry and travels the world training substance abuse counselors) commented:

“Absolutely. Experiences of pleasure, pain, joy, and shame have the biggest impact on the wiring of our brains and, therefore, how our souls interpret and interact with the world. Hank, you created a safe space where we could experience the joy of God and His love for us in nature, community, and individually.”

Sitting alone in a dark cave

I would sometimes take the teenagers into the wilderness as a place of ministry. We rafted on the Chattooga River, where the movie Deliverance was shot. We backpacked all over the north Georgia and western North Carolina mountains. We paddled and camped for three days in the Okefenokee Swamp. And, my favorite, we explored caves.

Part of every caving experience always included time for silent introspection. I would separate the kids along a passageway, take their lights, and have them sit alone in the darkness for 30 minutes. Recently, a participant on one of those trips shared with me the journal he kept at the time. The now-retired pharmacist wrote in 1975:

“I was really nervous before entering the cave. I never really liked the idea from the start. But when all lights were put out, I felt one of the greatest feelings of inner peacefulness and calm.”

1977 – “The Squeeze” in Johnson Crook Cave, AL. Photo by Hank Dunn

Here’s part of a report I wrote about another caving trip with junior high kids, also in 1975:

“There was one girl who was very much afraid to sit alone. I sat her down at the end of the line, where I would be close to her. After approximately five minutes in the dark, she began crying and eventually called me. I went to her, comforted her, told her I was near, and asked her to continue to sit, think, and pray as she remained in her place. She calmed down and completed the half-hour in darkness. She later revealed that it was not so much that she was afraid of the darkness but afraid to face up some of the own things in her life.”

“…people will never forget how you made them feel.”

A deathbed and the gift of presence

1990 – Fairfax Nursing Center. Photo by Hank Dunn

Fast forward 25 years, when I was a hospice chaplain. I was called to the home of a woman dying of cancer. I had made several attempts to schedule a time to see her and her family, but they were always busy and put off letting me in. Now, she was in her last hours. It was time to let the chaplain in.

When I arrived, a family friend sat with me in the living room and explained what was happening. We then went into the bedroom where the woman lay dying. Her husband sat beside her, and a nurse was not far away. I said very few words. There was little to say. I asked the husband if I could offer a prayer. He said, “Please do.” I finished my prayer, and he asked, “Can we say the Lord’s Prayer?” “Of course,” I replied, and we all prayed.

I left the bedside, and the friend followed me to the living room. I stopped to say goodbye, and this woman threw her arms around me, hugged my neck, and said, “You are so wonderful. That is just what we needed.” My first thought was, “Boy, is this job easy.” Anyone who could recite the Lord’s Prayer could have done what I did in that room. But then, I was so grateful to be invited into this moment in this family’s life.

I think Maya Angelou and I are on to something. People always remember how you made them feel.


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 or on Amazon.

“Grace” From Prehistory to Today

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“All human nature vigorously resists grace because grace changes us, and the change is painful.” Flannery O’Connor

“Grace is always available to us, only we are not always ready to receive it.” Kabir Helminski, The Knowing Heart: A Sufi Path of Transformation

Photo by NEOM on Unsplash

“Grace” found in the wilderness

How did early humans sense the world they inhabited?

I have spent hundreds of nights sleeping in the wilderness. I have bedded down in caves, on mountaintops, on beaches, in the woods, on platforms in swamps, on riverbanks, and on prairie grasslands where the buffalo roam. I have had to narrow down my equipment to essentials I can carry on my back or in my kayak. I have had a few near misses with disaster that left me grateful just to be alive. But more often, I am incredibly moved by the beauty surrounding me — or rather, the beauty that I am immersed in.

1999— Hank on Mr. Democrat, Colorado

In 1999, at 9 AM on a September morning, after hours of climbing, I had reached the summit of the 14,148-foot Mt. Democrat in Colorado. I was alone. I wrote the following about this moment:

“I stood alone, drinking in the vastness of the alpine scene before me. I stood alone and thought there is nothing in my life that challenges me so physically — pushes my endurance and determination. I stood alone, knowing I receive more nourishment for my soul in the out-of-doors than any other place I could stand. I stood alone and felt a joy come up from inside of me. And the words that came out were, ‘Thank you, Jesus. Thank you, Jesus, for my life. Thank you for this wonderful world. This wonderful world.’”

To sum up these thoughts, I was overwhelmed by GRACE.

Did early humans have a similar sense of wonder and gratitude?

1976— Sleeping in a cave, Alabama

I may spend an inordinate amount of time contemplating the early hominids’ transition from lower animals into modern humans or homo sapiens. I even made a two-minute video while kayaking on a lake, pondering whether ancient humans thought the universe was to be feared or grace-filled.

I say “inordinate” because it is what it is. Or rather, we are what we are — thinking beings who walk upright, possess an opposable thumb, know we will die, etc. Why waste intellectual energy on something that happened hundreds of thousands or millions of years ago?

Yet I can’t help imagining our early ancestors had a sense of gratitude. I can imagine they were taken by the beauty of the natural world, not unlike how a beautiful sunset moves us today. I can imagine them being grateful for the bounty of the earth that sustained them, whether it was for the fruits and nuts hanging on trees or the small game near their dwellings.

Did they experience the world as I did on Mt. Democrat? Did they marvel at the gift of a newborn baby? What did they feel when a tree fell to the ground, just missing where they stood? Were they grateful to be alive, thankful they were granted grace?

But, perhaps, early human creative minds didn’t stop at just feeling grateful. Maybe we asked questions. Why was I not killed? How did I receive bounty from the earth? One possibility we came up with was there must be Someone responsible for our good fortune — Someone GREATER than us but sort of like us.

Why are we alive in the first place? How are we surviving so much that could kill us? “God” was our answer.

God or no God, grace abounds

Try this thought experiment: Suspend your traditional religious beliefs for a few moments and contemplate what drove our species to start thinking about God. Without the religious explanation, we might conclude that our ancestors did not believe in God. Heck, at one point, they did not even know they existed in the sense that humans are now self-aware.

Believers will say, “Those early humans were just becoming aware of the God who started it all ‘In the beginning.’” That may well be. But God or no God, grace abounds — then and now.

“Amazing Grace” sung by all

2023— Sipsey Wilderness, Alabama

A curious phenomenon in our time is the popularity of the hymn “Amazing Grace.” Secular nonbelievers and devout Christians can sing the words and be moved. Written in 1779 by John Newton, a former captain of slave ships who would become an abolitionist, the song speaks of “grace that saved.”

Interestingly, “God” or the “Lord” is not mentioned until the fourth verse. It is grace that saves, as we see in the second verse of the hymn:

Thro’ many dangers, toils, and snares, I have already come;

‘Tis grace hath brought me safe thus far, And grace will lead me home.

No wonder the song has such widespread appeal. Grace is universal. Some say that grace comes from God. For others, grace comes from simply being part of this wonderful world. Grace is present either way. My theory, in summary, is that humans started considering the existence of GOD to explain the GRACE of life itself.

(Cover Photo by NEOM on Unsplash)


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 or on Amazon.

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