Photo by Tim Mossholder on Unspalash

#5 Hang out with OLD, SICK, and/or DYING people.

                  Volunteer with a hospice or nursing home. Better yet, visit seriously ill relatives. You will learn a few things about the end of life, and it will mean a lot to someone else.

#4 PUT IT IN WRITING, resolve to do those advance directives you’ve been putting off.

                  Go to caringinfo.org to download an advance directive for your state. The MOST IMPORTANT piece of paper is the “healthcare durable power of attorney.”

#3 Consider a “DEMENTIA advance directive” addendum.

                  I did this in 2024. For me, it was a Voluntary Stopping Eating and Drinking or VSED addendum to my already existing advance directive. My instructions are that hand feeding be withheld if I progress into severe advanced dementia.

#2 TALK to your family about your end-of-life values.

                  For example, tell your family if it is more important to you to be kept alive on machines no matter the quality of life or, conversely, if you would rather not have your life prolonged artificially if you have a serious illness with little chance of recovery.

#1 Assume a NONJUDGEMENTAL stance

                  This is for all areas of life but in the area of end-of-life decisions, if you have been putting off completing an advance directive, don’t feel guilty that you delayed. Just do it without judgement. Or, if have regrets about a decision you made on behalf of someone you love, be gentle on yourself. WE ALL ARE DOING THE BEST WE CAN. This is a mindfulness practice for all of life — being nonjudgemental about events, people, and the things people do.

HAPPY NEW YEAR!

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Top Five New Year’s RESOLUTIONS To Prepare for the END OF YOUR LIFE first appeared on Hank Dunn.

Why wouldn’t you want to know your prognosis if you had an aggressive disease? Wouldn’t it help in choosing treatment options and planning for the future?

These questions came to mind as I read recent stories about 72-year-old pop singer Michael Bolton’s life with a glioblastoma. Although this type of brain cancer is often fatal, Bolton has told his physicians that he does NOT want to know his prognosis.

From a recent article in People magazine:

“Today Bolton is in what his doctors call a ‘survivorship stage.’ He has purposely not been given a prognosis—and his family is choosing to remain hopeful in the face of daunting statistics. The five-year survival rate for glioblastoma patients is just 6.9 percent, and the average length of survival is eight months, per the Glioblastoma Foundation. Still, ‘our doctor told us that he has patients with glio that he has had for 10 years.’ [Bolton’s daughter] Holly says, ‘In my mind that’s my dad.’”

Could this be DENIAL?

In some cases, not wanting to know a prognosis (or flat-out refusing to accept a fatal diagnosis) could be a form of denial.

Once, on my first meeting with a new hospice patient with metastatic cancer, the husband told me, “God has told me my wife is not going to die, so I don’t want any talk about ‘death’ or ‘dying.’ Only positive thoughts.”

I said to him, “I will honor that, but I do have two concerns. I have had some families say to me, ‘We are hopeful and don’t want any opioids because we are afraid of addiction and hastening death.’ So, one concern is about adequate pain control. The other concern is that if you don’t allow death as a possibility you may miss some very important conversations.”

Both the patient and her husband assured me that she would get whatever pain medications she needed and that they have talked about those important things. I believed them on both counts.

Initially, I had the same concerns reading this story. There is no indication that Bolton is not getting the pain meds he may need. But, in choosing not to know his prognosis, is he living in denial of the gravity of his situation? Reading further, I think not.

Bolton said, “It’s a reality of mortality. Suddenly, a new light has gone on that raises questions, including ‘Am I doing the best that I can do with my time?’” This sounds like a man getting ready to die while enjoying what time he might have left (but also not wanting to talk about the amount of time he has left).

The difficulty of making “how-much-time” predictions

I can understand that a person may not want to know their prognosis because predicting how much time a patient has is so difficult. A Facebook friend recently posted, “One year ago (May 23), I was told I had 6 months to live. I’m still here.”

My “real” friend, Tom, was diagnosed with stage 3 esophageal cancer in 2009. He was 51. He did want to know his prognosis and was told the 5-year survival rate was 15-20%. He called me at the time and asked if I would be a pallbearer. “Of course,” I said. He’s still here.

On the other side of this are the patients who enroll in hospice and die just days after admission. Sometimes, the problem is that the doctor waits until the last minute to tell patients the truth, “You are dying.” Then, some patients and families have been told the truth but want to be hopeful and choose not to go on hospice.

Physicians are now encouraged to ask themselves the “surprise question:” Would you be surprised if you heard that this patient had died in the next six months? If the answer is “No. I would not be surprised,” then it is time to make that hospice referral.

@hospicenursepenny’s thoughts on the importance of talking about it

Penny Hawking Smith, R.N. has a great chapter on this topic, “The Need to Know,” in her book Influencing Death. This is what she has to say about getting the “bad news” out there:

“Truthfully, a dying person’s prognosis is often the elephant in the room.… Families don’t want to bring it up to the dying person because there’s a common fear it will take away their person’s hope, making them die faster; I’m here to call bull**** on that. On the other hand, the dying person sometimes doesn’t want to bring it up to their family and bum them out, which, of course, it will. My advice? You’re dying, so they’re going to be bummed either way. At least getting the subject on the table will allow for meaningful conversations that might not happen otherwise.”

Having “hope” while preparing to die

Michael Bolton may indeed have a prognosis longer than six months. I wish this for him and his family. They say they want to remain “hopeful” and not know the prognosis. I say there are other things to hope for besides not dying. Hope that pain is under control. Hope that he can feel comfortable enough to enjoy his family. Hope that, when the time comes, he will enter hospice in a timely manner.

Meanwhile — he’s still here.

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Michael Bolton DOESN’T Want to Know His Prognosis first appeared on Hank Dunn.

I discussed VSED in a previous blog post here.

Here is the link to the podcast on Jill’s website.

Here is the link to Apple Podcasts

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post New Podcast with Hank — “Seeing Death Clearly” on nutrition and hydration first appeared on Hank Dunn.

I had a great conversation with Hospice Nurse Penny and Halley Hospice Social Worker  on their great podcast “Death Happens.” You can find it wherever you get your podcasts.

Here is the link to the podcast  on YouTube:

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Hank on “Death Happens” podcast first appeared on Hank Dunn.

Hand feeding on the memory care unit

It was lunchtime on the memory care unit of the nursing home where I was chaplain. I was always looking for ways to minister to these poor souls who were losing their minds. What might work for more oriented patients, like a Bible study, was no good here.

Over my years there, I learned to feed the dementia residents who couldn’t or wouldn’t feed themselves. After all, Jesus did say, “I was hungry, and you gave me food; I was thirsty, and you gave me something to drink.” Although I did prefer patients who were not prone to choke or spit their food at me.

Voluntarily Stopping Eating and Drinking

The beginning of Hank’s “Dementia” addendum to his Advance Directive.

I previously wrote about hastening death by voluntarily stopping eating and drinking (VSED), titled She Fasted to Hasten Death. It was the story of a patient with decisional capacity who chose to end her life sooner rather than live with what she felt were too great of burdens.

But what of advanced dementia patients, who all need help with feeding and can no longer “choose” to hasten their death? I wrote another blog, VSED by Advance Directive — an Alternative to Prolonged Dying, about how to write an advanced directive (AD) indicating to your caregivers to stop hand feeding when you get to the last stages of the disease. I personally have such an advance directive.

Problems with VSED by Advance Directive

It sounds so simple: I want a peaceful death not dragged out over multiple years. So, I wrote instructions to stop hand feeding if I decline to the last stages of dementia. But there could be problems following my instructions:

1. State regulations require addressing weight loss. If I am in a facility and am losing weight because hand feeding has been stopped, the administration might worry state regulators would not look too kindly at that.
2. Caregivers might refuse to carry out my wishes. My family or professional caregivers might feel uneasy withholding feeding when I still open my mouth to eat and drink.
3. Honoring wishes. I wrote the advance directive when I was healthy and of sound mind. I know when I get to end-stage dementia, I will not remember my desire to hasten my death. So, demented Hank is still willing to eat and drink. Who do you honor? Competent previous Hank or demented current Hank?

Minimal Comfort Feeding

Screenshot

A recent article in the Journal of Pain and Symptom Management reports on “minimal comfort feeding” as an alternative to VSED by AD. Titled “‘Mr. Smith Has No Mealtimes’: Minimal Comfort Feeding for Patients with Advanced Dementia,” The article is available for free.

The authors identified three possible approaches to advanced dementia regarding feeding:

1. Comfort Feeding Only. Attempt to feed the patient on a regular basis but give no more food and liquid than is comfortable. Advanced dementia patients can live for years with this approach.
2. Minimal Comfort Feeding (MCF). Provide the patient only as much food and liquid as necessary to avoid discomfort. With this approach a patient might live just weeks to a few months.
3. Stopping Eating and Drinking by Advance Directive. No food or liquid at all. The patient will live just days.

The second option would be especially appropriate for the “patient with advanced dementia who previously expressed a wish to avoid living with advanced dementia.” MCF also addresses the problems with VSED by AD I listed above. The case study patient in the journal article did not put his expressed desire to avoid prolonged hand feeding in an advanced dementia condition in an advance directive.

Withholding ALL food and fluid does have uncomfortable symptoms like a sense of thirst and hunger. MCF addresses these symptoms by only giving enough food and fluid to avoid discomfort but not so much to sustain life for what could be years with comfort feeding.

There are morally acceptable ways to avoid prolonged dying, perhaps for years, by pursuing “voluntarily stopping eating and drinking by advance directive” or by “minimal comfort feeding.”

I feel good about the prospects for my last days should it come by dementia.

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Do we honor Competent Hank or Demented Hank? first appeared on Hank Dunn.

Source: National Inst. of Health

“Dialysis May Prolong Life for Older Patients. But Not by Much,” by Paula Span unpacks the results of a recent medical research study published in the Annals of Internal Medicine. The researchers compared the length of life and quality of life of two groups of elderly patients with advanced kidney disease. One group started dialysis to manage their disease, and another group declined dialysis.

But the group that declined dialysis didn’t just DO NOTHING. Here’s how the NY Times article put it:

“The alternative to dialysis goes by various names — medical management, conservative kidney management, supportive kidney care. In this scenario, nephrologists monitor their patients’ health, educating them about behavioral approaches, prescribing anti-nausea drugs like Zofran and diuretics like Lasix to reduce fluid retention, and adjusting their doses as needed.”

I contacted my nephrologist friend, Dr. Alvin Moss, at the West Virginia University School of Medicine. He has long been an advocate for treating kidney failure in elderly patients without resorting to dialysis. He said his patients like to call this approach, “active medical care without dialysis!”

I wrote about this topic in a blog post three years ago. Also, if you want to watch a humorous spin on the very serious subject of the for-profit dialysis business go to Dialysis: Last Week Tonight with John Oliver.

Longer life with worse quality of life

It is true that those on dialysis lived longer, on average, about 25 months, where the group receiving active medical care without dialysis lived about 23 months. But the quality of life for the dialysis patients was worse.

The dialysis group spent about two weeks less at home (in a hospital or nursing home) than those getting supportive care. Almost all the dialysis patients had to travel to a center three times a week to be hooked up to a machine for several hours each visit. Yes, they lived 2 months longer, but with greater burdens.

Photo by Harry cao on Unsplash

Here is one patient’s approach to the dialysis decision from the NY Times article:

“Even before Georgia Outlaw met her new nephrologist, she had made her decision: Although her kidneys were failing, she didn’t want to begin dialysis.

“Ms. Outlaw, 77, a retired social worker and pastor in Williamston, N.C., knew many relatives and friends with advanced kidney disease. She watched them travel to dialysis centers three times a week, month after month, to spend hours having waste and excess fluids flushed from their blood.

“‘They’d come home weak and tired and go to bed,’ she said. ‘It’s a day until they feel back to normal, and then it’s time to go back to dialysis again. I didn’t want that regimen.’

“She told her doctors, ‘I’m not going to spend my days bound to some procedure that’s not going to extend my life or help me in any way.’”

Nursing home patient stopped dialysis

 What happened to the patient worried about suicide?

That patient who asked me about suicide? You guessed it. He was on dialysis and had had enough. He wanted to stop the treatment and die peacefully in the nursing home. He was also a very devout Catholic and wanted assurance that stopping dialysis was not suicide.

“Of course not,” I told him. “You will be dying from kidney failure. It will be a very natural death.” He got that peaceful death he wanted.

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Is This Suicide? first appeared on Hank Dunn.

I recently posted a video of me eating a tomato sandwich, just bread, mayonnaise, and thick, juicy, farm-fresh tomatoes. I closed the reel commenting that there is no free will in whether we like tomatoes, “Perhaps there are more things we think we are making choices about, but we really aren’t.”

NOT ONE of the many comments on the post picked up on the lack of free will. Everyone wanted to talk about their love of tomatoes and all the different ways to eat them. Our love (or dislike) of tomatoes is an easy example of how we lack free will.

A lot goes into acquiring a taste for a food: where you grew up, what your family ate in your childhood, textures you like or dislike, or how a particular food settles in your stomach. You don’t “choose” to like a tomato, you either do or don’t based on many factors outside of your control.

Judgement or pride have no place when you accept that there is no free will in a liking for tomatoes. There is no judgement by us tomato lovers toward those who dislike them. Heck, more are available for me if a certain portion of the population dislikes them. Conversely, there is no sense of pride or achievement by those of us who have attained such a refined palate to appreciate a fine tomato. We are just the lucky ones.

Free will and “choice” in end-of-life decisions

I have made a career of helping patients and families with end-of-life decisions as a healthcare chaplain and author of Hard Choices for Loving People, which has sold over 4 million copies. The first chapter on CPR discusses the “choice” a caregiver may need to make to put a frail or elderly patient through a resuscitation attempt.

I remember the scores of patients and families I helped make end-of-life decisions as a nursing home chaplain. Most often, once I explained that only about 1% of nursing home patients survive the event that led to CPR and survivors are in much worse shape than before, the families would say, “No CPR. Let her go in peace.”

But occasionally, they would say, “Life is precious no matter how poor, and a 1% chance IS a chance. We love grandma and don’t want her to die,” and then the patient remained a full code.

Did these families exercise their free will in making these choices? What if the “choice” was not consciously made by the caregiver but resulted from a series of factors and information leading up to the decision?

Determined: A Science of Life without Free Will

Last year, Robert M. Sapolsky started making the media rounds, including a New York Times interview and a guest appearance on Sam Harris’ Making Sense podcast. He has a new book, Determined: A Science of Life without Free Will. Yes, THAT free will.

Sapolsky presents a credible argument that we are not making “choices” the way we think we are, based on the science of our brains. Here’s an excerpt of his argument:

“Once you work with the notion that every aspect of behavior has deterministic, prior causes, you observe a behavior and can answer why it occurred: because of the action of neurons in this or that part of your brain in the preceding second. And in the seconds to minutes before, those neurons were activated by a thought, a memory, an emotion, or sensory stimuli.…We are nothing more or less than the cumulative biological and environmental luck, over which we had no control, that has brought us to any moment.”*(see his full 4-paragraph summary below)

What about that family who “chose” a full code for their frail, failing, nursing home patient? Maybe they watched Rescue 911 on TV, where 100% of patients getting CPR survived (see my previous blog about CPR on TV). Perhaps this previous exposure to all of the CPR successes on TV makes them say, “Yes, do everything,” without even thinking about it.

Why present a choice if there is no free will?

So why would I take the time to explain CPR and present a “choice” to use it or not, if there is no free will to make that choice? Maybe they did not know about the 1% survival rate. This new information might connect to millions of bits of data previously registered in the family’s brains, activating an assessment that Grandma would likely not survive.

I’d also have these conversations because I can’t help myself. I am compelled by forces within my brain, formed over years of experience, for which I have no control: Talking about end-of-life decisions was part of my job, family values instilled in me from my youth was to do your duty on the job, the long line of nurses in my family fostered a natural compassion for these patients and families.

I believe the scientific evidence Sapolsky presents that we have no free will is quite compelling. Most people may disagree, citing religious and spiritual arguments over whether or not we have free will.

Humor me on this one. If there is no free will, we must be less judgmental of those who “choose” a path we feel is wrong. If they’re basing that decision on information spanning generations, they couldn’t help themselves. Conversely, I can’t take credit if my actions led to more compassionate end-of-life care for a patient. I had nothing to do with all that went into their family’s “choices.”

In this brief blog, I cannot begin to cover what it took Sapolsky over 500 pages to say, but I added a larger excerpt of his book below.

Now I’ve got to go back to the farmer’s market because I am out of tomatoes. I can’t help myself.

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

_________________________________________

*Below is the summary of the basic thesis by Robert M. Sapolsky in his book, Determined: A Science of Life without Free Will, pages 3-4

“Once you work with the notion that every aspect of behavior has deterministic, prior causes, you observe a behavior and can answer why it occurred: as just noted, because of the action of neurons in this or that part of your brain in the preceding second. And in the seconds to minutes before, those neurons were activated by a thought, a memory, an emotion, or sensory stimuli. And in the hours to days before that behavior occurred, the hormones in your circulation shaped those thoughts, memories, and emotions and altered how sensitive your brain was to particular environmental stimuli. And in the preceding months to years, experience and environment changed how those neurons function, causing some to sprout new connections and become more excitable, and causing the opposite in others.

“And from there, we hurtle back decades in identifying antecedent causes. Explaining why that behavior occurred requires recognizing how during your adolescence a key brain region was still being constructed, shaped by socialization and acculturation. Further back, there’s childhood experience shaping the construction of your brain, with the same then applying to your fetal environment. Moving further back, we have to factor in the genes you inherited and their effects on behavior.

“But we’re not done yet. That’s because everything in your childhood, starting with how you were mothered within minutes of birth, was influenced by culture, which means as well by the centuries of ecological factors that influenced what kind of culture your ancestors invented, and by the evolutionary pressures that molded the species you belong to. Why did that behavior occur? Because of biological and environmental interactions, all the way down?

“As a central point of this book, those are all variables that you had little or no control over. You cannot decide all the sensory stimuli in your environment, your hormone levels this morning, whether something traumatic happened to you in the past, the socioeconomic status of your parents, your fetal environment, your genes, whether your ancestors were farmers or herders. Let me state this most broadly, probably at this point too broadly for most readers: we are nothing more or less than the cumulative biological and environmental luck, over which we had no control, that has brought us to any moment.”

The post Tomatoes, No Free Will, and End-of-Life Decisions first appeared on Hank Dunn.

Sundown on the Big Schloss

My bladder cancer surgery in May canceled a long-planned trip to see my adult children and my teenaged grands. I missed my grandson’s high school graduation and my youngest daughter’s engagement party. Unfortunately, those events can never be duplicated, but I hoped this trip would compensate for lost time.

In the last two weeks, I made the delayed trip to the D.C. suburbs of Virginia, my home from 1978 to 2017. Just like when I traveled the country speaking, once I had a destination, I looked into how I could spend some time in the great outdoors — preferably including wilderness travel.

“Grandpa, how did you get into hiking and backpacking?”

Hank & grands on 2016 hike

I used to take my three grands on overnight backpacking or car camping trips. They have slept with bugs, spiders, mice, snakes, and other inconveniences and even encountered a bear. They were always good sports at the time but have declined invitations to repeat any of these adventures in recent years.

So now on my trips to visit family, I try to plan a meal with just my grandkids and me to get some quality time and have an “ask-me-anything” session. This time, we went to Chili’s right after I returned from an overnight in the woods.

Out to eat with the grands.

Over hamburgers and fries, my grandson asked, “Grandpa, how did you get into hiking and backpacking?” I thought back. It was actually a chance reading of a Redbook magazine article. In 1971, while I was in seminary, I had taken their grandmother to the doctor’s office. This was back before we could occupy ourselves with phones when waiting rooms were piled with old magazines.

Hank, left, and Charles. First backpack trip, 1974

The Redbook article was about a five-day backpacking trip into the backcountry of Yellowstone National Park. The writer was in one of the most visited parks in the country, and they never encountered another human during the whole trip. I said to myself, “I want that.”

Thus, my love of wilderness camping was born in the waiting room of a doctor’s office. It took a while, but my first overnight carry-everything-on-my-back-away-from-roads-and-the-grid trip was on March 1, 1974.

My most recent trip was July 16, 2024.

“Can I do this again?”

As I mentioned, while planning this last trip, I wanted to add a night in the woods amid visits to family and friends. The Big Schloss was an ideal choice, less than a two-hour drive from Northern Virginia. “Schloss” is the German word for castle, and the rocks on the summit indeed look like a castle from below.

No tent, just a tarp, priceless

It is only a two-mile hike and 850 feet of elevation gain to the campsite near the summit. I have probably slept on this mountain thirty times since my first trip there in 1980, when I introduced my then-six-year-old son to backpacking.

While I was a hospice chaplain, I even figured out a way to hike the Big Schloss on a workday in the summer. Because of the long daylight hours, I could leave my last patient at 5 PM, arrive at the trailhead by 7, and set camp by sundown around 9. Then, I would wake at first light in the morning, pack up, drive home, shower, and be at work by 10.

I invited my future son-in-law, Will, to join me on last week’s trip. Though he never backpacked or spent much time in the woods, he said yes. So, we left the trailhead and headed up the mountain together. The first half mile is all uphill, about 600 feet. Next, an up-and-down walk along the ridge that forms the Virginia and West Virginia border. Finally, the last quarter of a mile is all uphill, about 200 feet.

The 97-degree heat, the incline, and the 35 pounds on my back all made this a brutal hike. We made it, but to be honest, it took me several hours to recover. While recovering, we set up our tarps to sleep under and cooked dinner. After dinner we had an enjoyable campfire with some “deep thoughts” conversation.

Who was I trying to convince, “Yes, I CAN do this again”? Will, who is a strong twentysomething? You, who are reading this blog? Myself? The Universe? All the above?

A surprise test

Hank & Will, on the way down from the Big Schloss

It is not just my bladder cancer but my age that thrusts this question upon me. I will NOT be able to do this forever. Stroke, heart failure, or cancer could disable or kill me. Did I just take my last backpacking trip? Perhaps.

I don’t want to make this sound morbid. Au contraire, this is a moment to be thankful for all those wilderness outings, particularly for this most recent one.

Before returning to Arlington, Will and I stopped for breakfast at a diner on Route 11 in Woodstock, Virginia. I congratulated him over coffee, eggs, sausage, biscuits, and grits. “Will, you passed the test. You can marry my daughter.”

Surprised, he said, “TEST? I didn’t know this backpacking trip was a test!”

Oh yeah. It was. For both of us.

[NOTE: I did a short video while backpacking, talking all this. CLICK HERE]

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post “Can I do this again?” — Men, Aging, and Performance first appeared on Hank Dunn.

Photo by National Cancer Institute on Unsplash

We met with the doctor last week, reviewed my current situation, and mapped out the next steps in treatment. He is still optimistic that he got all the cancer in the first surgery, even though a second surgery is required to make sure.

Along with the surgery comes weeks of recovery tethered to a catheter and its bag o’ urine. Then, there will be six weekly treatments with more scopes and tests.

In the grand scheme of things, these burdens do not seem too great when I think of patients I have cared for over the years as their hospice chaplain. I am not complaining, nor do I feel life is treating me unfairly. This is all part of life.

Things Left Undone

This newfound status as a cancer patient makes me think of some things that really can be left UNDONE.

I canceled a routine appointment with my optometrist last week. My glasses and “readers” both work fine, even though I occasionally rely on a magnifying glass. I do need to look into having cataract surgery, but that will have to be left UNDONE for now.

I’ve already had my last colonoscopy a couple of years ago. Even before my cancer, I had accepted the guidelines that there was no need to screen for something that would not kill me before my life expectancy of ten years. And… oh yeah… that was my life expectancy before my cancer diagnosis. A colonoscopy can be left UNDONE.

As an aside, I found a GeriPal podcast that discusses stopping mammography somewhere between 70 and 75 because there is no benefit for a woman who has no history of breast cancer and who is not expected to live another 10 years.

Things Done

On the other hand, after being diagnosed with bladder cancer, I started a list titled, “Hope for the best, plan for the worst.” I can still work on these items to render them things DONE.

In the immediate future, I will take a road trip to visit my three children and four grands. I have made this trek two or three times a year for several years. I love driving long distances; this one is over 3,000 miles round trip. I will listen to books and podcasts, see my people, and visit friends, some of them going back to the 1970s. I will also visit places that will bring back so many memories. I want to get this DONE.

What will I listen to on this trip? The Emperor of All Maladies: A Biography of Cancer by Siddartha Mukherjee. I heard of the 2015 book just this week. I probably would not have been interested in 2015 BC — Before Cancer.

I started a project before Christmas and got stuck. My wife had asked for a bound book of photos chronicling our daughter’s life. I have sorted through hundreds of pictures, but many more remain. This needs to be moved onto the DONE list.

Finally, another kernel of an idea floating in my head is a “life story” in pictures. I wrote a previous blog about the “spiritual autobiography” I gave my family on my 75^th birthday last year. So, this would expand the autobiography and incorporate photos I have going back my early days. Get ‘er DONE.

“By what we have done, and by what we have left undone”

These words are familiar to Episcopalians. We recite them every Sunday as part of our confession. It goes, “…we confess that we have sinned against thee in thought, word, and deed, by what we have done, and by what we have left undone.”

Full disclosure: I am more of an “original blessing” guy than “original sin” guy. I give little thought to sin and much appreciation for my blessings. Nonetheless, I borrowed the wording of things “done” and things “left undone” to help me incorporate my cancer diagnosis into the living of these days.

This blog is DONE.

[I explored this same content on a video I posted yesterday on YouTube.]

___________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Cancer and Things Done and Things Left Undone first appeared on Hank Dunn.

I told her my father was treated successfully for bladder cancer at about my age (76), and my brother died from it at age 64. Her first response when I told her about my brother’s early death was, “I’m so sorry.” I took it to mean she was sorry about me losing my brother. That moment of empathy has meant so much to me. She could have gotten all clinical on me, saying bladder cancer does run in families. But she first said, “I’m so sorry.”

I have entered the land of cancer patients.

Visiting my father at the nursing home three years before he died

By the time my father got bladder cancer he was already diagnosed with Parkinson’s and had had a couple of small strokes. He had mobility problems and depended on Mom for much of his daily care. His mind was still sharp, and he continued to write professionally, dictating a history column to Mom each week. He couldn’t type anymore. His cancer was removed from the bladder with surgery followed by flushing with medications. As far as we knew, he never had another problem with it.

But his other conditions forced him into a nursing home at age 81, and he finally died soon after his 85^thbirthday. He was demented, incontinent of bowel and bladder, unable to recognize family or interact meaningfully to the world around him.

At the time of his bladder cancer diagnosis, we never discussed the possibility of NOT treating it, given that it was caught early, and the treatment was not burdensome. But surviving cancer allowed his slow decline of nine years toward a merciful death. I am sure, if my father were asked, he would have absolutely wanted to treat the cancer. Even if he could have been told about what his next nine years would look like, I think he would want to be cured of cancer.

My brother, Dennis, at a horseshoeing competition

My brother’s bladder cancer was quite advanced when he was diagnosed. He did seek a cure, but the cancer continued to spread, and he was gone ten months after blood showed up in his urine. Three years ago, I wrote a previous blog where I mentioned Dennis’ death.

Dennis was a robust 63-year-old when diagnosed. He was a farrier by profession, a demanding job shoeing horses. He was constantly inhaling fumes from the forge which probably led to his death. Smoking and exposure to smoke are risk factors that can lead to bladder cancer. My dad was a heavy smoker for half of his adult life.

And me?

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

I’ve joined a group I did not choose. At this point I do not know if I will be my father or my brother. That is, a journey of 9 years from my dad’s diagnosis of cancer to his death by other killers at age 85 or a 10-month, painful journey my brother took from diagnosis to death. Of course, I won’t be Dennis in that I am already 12 years past the age he died.

I am guessing I am like other newly-diagnosed cancer patients, and I entertain the possibility that I could die sooner rather than later. Going to that place does not make me sad — at least, it doesn’t today. According to the National Vital Statistics Reports, 44% of White males born in the U.S. in my birth year, 1948, have already died. We are just two years away from it being 50%. If my end comes in two years, I would be just average.

No reason to begrudge living an “average” lifespan. As a matter of fact, I should be thankful since half my cohort will have already died.

Grateful indeed!

___________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

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The post I Have the Same Cancer That My Father Survived, But It Killed My Brother first appeared on Hank Dunn.