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Archive for the ‘Autonomy’ Category

I Am the Old Man at the Record Player

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TRIGGER WARNING: This blog contains ageism.

I was 40ish, he was 90ish, and for the life of me I could not understand what the old man was doing.

It was not totally out of the ordinary for men to do strange things at the nursing home where I was chaplain. One man got out on the roof from the second floor, threatening to jump to his freedom. A nurse crawled out, at great risk to herself, and talked him back in. Another wanted to marry a female resident, much to the consternation of both families. There was no wedding, but the romance continued.

What’s the point?

So, the 90ish-year-old man who gave me pause was quite innocent compared to all this. His wife of over 60 years said he was somewhat boring. She was 19 when they married, he 29. They had one son. It was during the Depression, and he had a good job. He was a schoolteacher all his working life. She confided to me as we planned his funeral, “I don’t think I ever loved him.” I found that so sad.

Photo by Jace & Afsoon on Unsplash

When I would pass the old man’s room he was often bent over a record player, listening to books on vinyl from The Library of Congress, which sends these to the blind and infirmed. I remember he liked listening to history books.

“Why?” I asked myself. “What’s the point?” (Yes, horrible ageist thoughts.) His productive working life had long since passed. He was not part of a book club. He would be dead in months or, at most, the next two years. Why was he doing this?

The future of books on vinyl

Fast forward to me at 70ish – 77, to be exact. I started listening to books on Audible or those I can download for free from our public library. A couple times a year I visit my kids and grands in D.C. All that driving time has help me “read” twelve books already this year.

Some of these books are professionally oriented to my work, like Death Is But a Dream, by Dr. Christopher Kerr and @hospicenursepenny’s Influencing Death (I actually read the paperback version so I could write this book review). I suppose there is still a purpose for some of my reading.

Most of my reading falls in the pleasure category, which includes some of my favorite authors: Recollections of My Non-Existence by Rebecca Solnit and Unsolaced: Along the Way to All That Is by Gretel Ehrlich. Then some “freebies” from the library: My Southern Journey: True Stories from the Heart of the South by Rick Bragg and a classic, Travels with Charley: In Search of America by John Steinback.

So, what is the difference between me and the old man? I am able-bodied, he was not. I can tell others about what I am reading, he kept it inside because no one seemed to care. But now I can see we’re more similar than 40ish-year-old me would like to admit.

Decades later, that old man is showing me things that are so fascinating about our human existence. We don’t need a purpose or reason to seek intellectual stimulation. For better or worse, nowadays we often to turn to social media or television to satisfy this hunger. He turned to books.

I am the old man at the record player

Photo by Alex Boyd on Unsplash

The technology has changed. There are no more record players. I listen to my books transmitted from my phone directly into my brain through a surgically implanted cochlear hearing device. At 77, I am still curious about the world and my place in it. I hope this never ends.

My ageism toward the old man bent over the record player still nags at me. I wish I had been kinder to him. I wish I had made the effort to engage him in conversation about what he was “reading.” His hearing loss made dialogue difficult. He was just curious about the world. He wanted to feed his mind.

Now, I am the old man at the record player… and I like books on history, too.

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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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Canada vs. U.S.A. at the End of Life

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Me: “Hello, this is the chaplain, Hank. I would like to come by your home for a visit Tuesday, at 10. Would that work for you?”

Patient: “Oh, hi… (pause) No, not then. How ‘bout Thursday at 10?”

Me: “Great, see you then.”

I thought of this conversation as I was digging down into a Canadian governmental report.

Why are we so different than our Canadian neighbors? We share a 5,525-mile-long border yet, in response to one question, we are miles apart. Do we really live and die that differently?

I have this nerdy side of myself. I read through medical journal articles and government reports looking for insights into all things end-of-life. The government of Canada and the State of Oregon recently released their annual reports on Medical Assistance in Dying (MAID) or, in Oregon, Death with Dignity. These are the rebranded names for what used to be called Physician Assisted Suicide.

One number jumped out

End-of-life concerns: U.S.A.

End-of-life concerns: CANADA

I’m reading through these reports and one number jumped out at me. Physicians who aided these terminally ill patients in hastening their deaths with medications were asked, “Why did the patient want to end their life by taking a lethal medication?”

In Oregon, the number one reason out of seven choices that patients gave was concern over “Losing Autonomy.” 93.3% of these patients listed that as one of their end-of-life concerns. In Canada, at the BOTTOM of a list of eleven possible concerns, “Loss of control / autonomy / independence” is only mentioned by 1.7% patients.

My interest was piqued by that “autonomy” difference. So, I contacted my friend, Tim Ward, who is now writing about his travels in Europe. He and his wife are taking “senior gap year” as in “senior citizen gap year” traveling. Tim is a Canadian by birth and has recently become a U.S. citizen.

He emailed back from Paris, “It might be that in Canada, autonomy is less of a value than, say, meaningful social connection” and “the rugged individualism of the West is part of eastern Oregon’s make up.”

Individualism/Autonomy vs. social connection

I think he is on to something here. For example, the social connection vs. autonomy shows up in how we provide healthcare. In the U.S. we do not provide universal healthcare, Canada does. There is no for-profit health insurance industry in Canada, yet everyone has access to healthcare. The U.S. system is built upon a for-profit system that leaves 8.6% (28 million) of our fellow citizens without health insurance. How we provide healthcare is just the most glaring example of how we value individual choices over the common good. Also, the social safety net is very weak for the poorest among us in the U.S. — as we witnessed in the pandemic.

I got curious about where in the world people are the happiest. Turns out, Canada (#15) and the U.S. (#16) show up next to each other in a recent ranking of the happiest countries. The top countries are in northern Europe.

From the Gallup World Poll report, “[Finland] and its neighbors Denmark, Norway, Sweden and Iceland all score very well on the measures the report uses to explain its findings: healthy life expectancy, GDP per capita, social support in times of trouble, low corruption and high social trust, generosity in a community where people look after each other and freedom to make key life decisions.”

Critics would say that’s true, they may be happier, but they pay very high taxes. The countries highest on the “Happiest” list are often labeled as “socialist” by those same critics. That’s a discussion for another time and place. The point here is that the autonomy cherished by U.S. citizens shows up in less “social support.”

The myth of the cowboy

Photo by Taylor Brandon on Unsplash

Tim’s other point, about “rugged individualism,” caught my eye because of another nerdy side of me — I read books about the American South and how we got the way we are down here. Currently, I am into How the South Won the Civil War: Oligarchy, Democracy, and the Continuing Fight for the Soul of America by Heather Cox Richardson.

Richardson is a historian with 1.6 million followers on Facebook. She writes on that platform often and produces long videos discussing various history-related topics. In this current book she explains the growth of the “myth of the cowboy,” the ultimate “rugged individual.” According to her, since the late 19th century, Americans have bought into this idea that anybody can attain whatever they want, that this country was built by autonomous “rugged individualists.” This is a myth because wealth actually went to a few elites from the days of the Founders to today.

Our founding documents lay out this contradiction in spades. The same property-owning White men who wrote, “All men are created equal,” enslaved Black people and did not give women or poor Whites a vote. We, as a nation, have been struggling with this contradiction ever since. Although Canadians do not have the history of slavery we do, we both share shameful treatment of indigenous peoples. Also, a discussion for another time and place. The point here is lionizing the “rugged individual” can show up as valuing autonomy at the expense of social connection.

Pastoral care at the end of life and autonomy

The phone exchange with the patient was typical of many we had over the months I was his chaplain. He ALWAYS chose another time. As a chaplain for those at the end of their lives I am always looking for ways to enhance autonomy, because I know it is so important to most of us. I gladly changed my plans. I figured this was my little way of affirming his autonomy.

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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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