Compassionate, informed advice about healthcare decision making

Archive for the ‘Death & Dying’ Category

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

Posted by

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.”

 

__________________________________________

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

Posted by

“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.

__________________________________________

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.

 

My 2021 books on a Civil War that will not go away

Posted by

Sometimes a wound is so deep and unhealed that I can’t stop myself from trying to understand what it all means. One only has to look at the images of the Confederate flag being carried into the U.S. Capitol last January 6th to know this war has not gone away.

“This war” is, of course, the American Civil War. In 2021, I again read books looking at “this mighty scourge,” as Lincoln called it in his second inaugural. I recorded a brief video at William Faulkner’s home. I quoted him, “For every Southern boy fourteen years old, not once but whenever he wants it, there is the instant when it’s still not yet two o’clock on that July afternoon in 1863” (Intruder in the Dust, 1948). I was that lad growing up in the Deep South. I knew Pickett’s charge on the third day at Gettysburg was the “high water mark” of the Confederate nation.

I started my review of my 2021 reading with spiritual books and then books on science. Here are my Civil War reads:

Grant (2017) By Ron Chernow

I listened to all 48 hours of this 900+ page book. It was worth every minute. Grant overcame so many setbacks to succeed as a general and President. Most significantly, according to Chernow, was his conquering his struggles with alcohol, a fact he does not mention in his own memoir. Had the Civil War never happened, history might not have known the name of U.S. Grant. It was his strategy to cut off the Southern states from beyond the Mississippi River with the fall of Vicksburg (July 1863), send Sherman through Georgia (1864), and capture Lee’s Army of Northern Virginia at Appomattox. There was no finer moment in his life than when he offered generous terms of surrender to Lee. He hoped to begin the healing of a fractured nation. Sadly, as President, he had to fight the South again as it rose in the K.K.K. We are fortunate, as a nation, that Grant and Lincoln rose to the top when we needed them.

Robert E. Lee and Me: A Southerner’s Reckoning with the Myth of the Lost Cause (2021) By Ty Seidule

Author Ty Seidule was born on July 3rd into a family culture steeped in the myth of righteous cause for which we Southerners fought. When people said, “too bad you weren’t born on the 4th,” he’d reply that he was glad to have been born on the day of Pickett’s charge (there it is again). Seidule rose through the ranks in the U.S. Army and taught at West Point. Through his academic research and soul-searching, he concluded that the “lost cause” myth of the South was wrong. According to Seidule, the Civil War was about slavery and the Confederate soldiers who took up arms against the U.S. government were traitors. He makes a compelling argument that we no longer need to honor these traitors with monuments or U.S. Army bases.

 

 

In the Hands of Providence: Joshua L. Chamberlain and the American Civil War (1992) By Alice Rains Trulock

Like most, I knew of Chamberlain for only a few hours of his life on July 2, 1863, at Gettysburg. He commanded the 20th Maine at the extreme end of the Union line on Little Round Top. His troops were under repeated assault and running out of ammunition. Had he failed in defending his position, the entire U.S. Army on the field could have been destroyed in a flanking maneuver by the advancing Confederates. He ordered his men to fix bayonets, and they charged downhill, capturing more than 100 Southerners and saving the day. Many books and movies have captured this one moment. He was a college professor before the war. He became a college president and served four years as governor after returning to Maine. One other moving scene in Chamberlain’s military career was the last day of the war. He was the commander in charge of the ceremony at Appomattox, where the defeated rebels would surrender their arms. In the spirit that Grant set in the terms of surrender, Chamberlain ordered his men to salute their defeated foes, now countrymen once again.

Baptized in Blood: The Religion of the Lost Cause, 1865-1920 (1980, 2009) By Charles Reagan Wilson

With all believing God is on their side in a war, it is especially hard for the losers to explain what happened. This presented an exceptional problem for the dominant version of Christianity in the South (evangelical Protestant). In their view, the Yankees were more secular, more liberal, more urban, and less devoted Christians. This book by Charles Wilson, a former professor at the University of Mississippi and fellow church member with me in Oxford, explains the mental and theological gymnastics my Southern ancestors went through to explain how God was on their side. God sided with the South because their cause was righteous, but the North’s industrial strength was too much even for God. Dr. Wilson recently gave three lectures on this topic at St. Peter’s Episcopal Church in Oxford, and they are on YouTube. If there is any doubt that Southerners saw their cause as God’s cause, you need to look no further than two blocks from where Dr. Wilson lectured at St. Peter’s. On the Confederate monument (1907) on the Square is the inscription “They gave their lives for a just and holy cause.”

Fighting to defend slavery was “A JUST AND HOLY CAUSE.” Monument on the Square, Oxford, Mississippi

__________________________________________

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.

 

Me: “I’m the chaplain.” Patient: “Oh God NO!”

Posted by

I started our first meeting as I have hundreds of times before and since, “I’m Hank. I’m the chaplain.”

The response from our new hospice patient took me aback, “Oh God, NO!”

One of the great things about being a chaplain is that, generally, people are glad to see you.

…Let me restate that: People are not glad that they are in hospice and need to see a chaplain. People who are seriously ill and dying are usually pleased to see the chaplain. My standard greeting on a first meeting is, “I am glad to meet you but sorry for what has brought us together.”

An invitation to revisit my experience as chaplain

 A recent “GeriPal Podcast” has caused me to reflect on my years as a healthcare chaplain. That’s “GeriPal,” as in geriatrics and palliative care. “Spiritual Care in Palliative Care” is discussed by three chaplain educators and trainers and the two physician hosts.

Years ago, by chance, I became part of an experiment to find out how people actually felt about the prospect of seeing a hospice chaplain. I was the only chaplain working out of the Loudoun/Western Fairfax office of the Hospice of Northern Virginia.

When a new patient came into our service, the admitting nurse would ask the patient or family, “Would you like to see the chaplain?” About 30% said, “Yes.” Even at that low rate, my caseload was getting too much for me to cover adequately.

Then, something very fortuitous happened. We merged with another hospice, and suddenly, we had another chaplain to cover the whole eastern half of the region.

Now, we were looking to find a way to increase the caseload to fill this new abundance of chaplain hours. We changed from a question (“Would you like to see the chaplain?”) to a simple statement from the admitting nurse — “The chaplain will be calling to set up an appointment in a few days.” Bingo! We went from seeing 30% of the patients to seeing more than 75% overnight.

Why would so many people go from saying “No” to a question to so willingly accepting a call from a chaplain?

There are all kinds of reasons people said “No” to the question. Perhaps saying “Yes” implied, “I am not spiritual enough and need help.” Or people think of chaplains as “religious” and “I am not religious.” Or maybe accepting a visit from the hospice chaplain means, “I don’t think my pastor is good enough.”

Or, maybe it’s the reason the man who said, “Oh God NO!” had when I introduced myself. I asked him, “Why did you respond like that?” He immediately said, “I don’t want to die.”

Oh my goodness. He was equating meeting the chaplain as meaning he is going to die. In his mind, you only see the chaplain when you are dying. In truth, to be admitted to hospice, he had to acknowledge that his physician was estimating that he had only six months to live. Perhaps, he had seen too many movies with a chaplain escorting a prisoner to the gas chamber or a chaplain comforting a dying soldier.

I used that first visit to assure the man he didn’t have to die just yet. I told him people flunk out of hospice all the time by their condition improving. In my mind, I could explore his fear of death in a future visit. But it was not to be.

He had another stroke and never spoke another word. His pastor and I could provide general words of comfort and encouragement in the face of the fear of death, but we had no idea what he was thinking.

So, people refuse to see the chaplain because seeing the chaplain means, “I am dying.” The ill-founded logic goes, “Asking to see the chaplain means I am dying. I don’t want to die. Therefore, I will refuse the chaplain visits and will not die.”

I wish it were that simple.

__________________________________________

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.

Our Struggle with Dying Starts When We’re Toddlers

Posted by

[Adapted from a chapter in Light in the Shadows by Hank.]

“This is where our struggle with dying starts,” was my first thought.

“Putting It Together”, J.D. Hillberry www.jdhillberry.com

Many summers ago, I was wandering through an arts festival in Crested Butte, Colorado, when I came across the works of an artist who made pencil drawings. I was fascinated by a sketch he had made of his two-year-old son, depicting him as an unfinished jigsaw puzzle.

The child is looking down at his hand, which appears to be emerging from the flat surface of the paper. There is a puzzle piece in his grasp. He is searching for the place where that piece of himself fits. The artist titled the picture “Putting It Together.”

This memory of that Colorado summer came as I am now, once again, hanging out with a toddler and his infant sibling. This is my third tour of duty caring for little humans. First, there were my children. Later, I provided daycare once a week for two of my grandchildren through their early years. Now, we occasionally watch a friend’s two sons, who are 18 months and four months old.

Toddlers and the “Denial of Death”

I was watching my two grands after reading Ernest Becker’s Pulitzer-Prize winning

Hank’s grandson learning control at the light switch

book, The Denial of Death. Now, under the influence of these two new little ones in my life, I am rereading Becker. His main thesis is that the prospect of death is THE driving force in human behavior. Both the building of our individual ego or self and our culture’s attempt to shield us from the horror of death’s finality. Here’s a sample:

“[A child] avoids [despair] by building defenses; and these defenses allow him to feel a basic sense of self-worth, of meaningfulness, of power. They allow him to feel that he controls his life and his death, that he really does live and act as a willful and free individual, that he has a unique and self-fashioned identity, that he is somebody.… We don’t want to admit that we are fundamentally dishonest about reality, that we do not really control our own lives.” (Ernest Becker, The Denial of Death. p 55.)

Play and learning to take control

The toddlers in my life have shown this behavior. I remember my grandson discovering the light switch. I would stand him on a chair, and he would play with the switch. He would flip it up and then jerk his head toward the ceiling to see the light appear. Then, down and the light goes off. His actions were affecting his environment.

Hank’s granddaughter and the “singing bowl”

Let a child play with a musical instrument. My grandchildren both loved to bang on the piano or hit my singing bowl with the mallet. Any noise accomplished their unconscious goal of finding out they could influence the world around them.

Even the delight I recently observed of our friend’s toddler playing with the garden hose in our backyard revealed a growing sense of self. He put his fingers in the nozzle and felt the water. He found he could direct the flow of water into the air or on me. He was gaining control.

Fortunately, gaining control of one’s life can be beneficial to everyone concerned. Eventually, the child learns that studying improves your grades. Exercise makes you feel better. Treating people kindly encourages them to return the kindness.

Even toward the end of life we can practice some control, choosing to seek a cure for a terminal disease or focus more on easing physical and spiritual pain.

Letting go of the illusions we created

Third tour of duty with little humans

Every child makes their own progress toward gaining a feeling of control. This positive self-image that gives us a sense of meaningfulness, safety, and stability, allows us to grow and thrive. What is truly happening is that WE are creating this ego with the material that is handed to us genetically and emotionally. If we do the job adequately, we can live a life enjoying emotional and spiritual health.

So why did the sketch of the child make me think, “This is where our struggle with dying starts”? One day, in the last phase of life, all this meticulously constructed personality we spent our whole lives creating is revealed for what it is — a mask. The root meaning of the words “person” and “personality” is from the Latin persona, a mask worn by actors in a play.

Last week I wrote about dying without illusions. Watch a toddler and see those illusions being created.

 

 

Dying Without Illusions: A Tribute to Susie De Porry

Posted by

[NOTE: Hank wrote this tribute in 1995 when he was chaplain at the Fairfax Nursing Center, Virginia.]

She died with no family around. No wealth. Few possessions. No children, grandchildren, or great-grandchildren. She was never married. No obituary in the Washington Post. Not even a death announcement. The world will not miss her. Few will grieve her passing save for her niece, brother, and sister.

And yet, she died without illusion.

She was just a lovable human being

Susie

Susie De Porry was one of the wonderful souls who had graced our lives at Fairfax Nursing Center. There was no brighter smile. There was no one more enthusiastic about rides and activities. There was no one more devout in the practice of her faith. And no one more content to sit and read for hours.

She had a special place in the hearts of those of us who cared for her. Maybe it was because she had no family living nearby. We were almost all she had. But more than that, she was just a lovable human being.

She was born in New York City in 1903. Her father died while Susie was quite young. She studied music, including some training in France. Susie delighted in telling of her time on the Continent and playing the organ at the Notre Dame Cathedral in Paris. She taught music but mostly cared for her aging mother and other elderly people. After her last client died, Susie moved directly into a home for adults in Vienna. Two years later, in 1986, she came here to the nursing home.

During her last days and hours, several of us spent some special time alone with Susie. She was barely responsive. She would hold my hand. I wasn’t sure she recognized me. Though at one moment, she looked at me and smiled. I asked how she was feeling, and she said, “I’m doing fine.” Those were the last words I heard her say.

She is more heroic than most of us

As I sat next to her only hours before she died, I could not help but try to gain some sense out of Susie’s life and death. Susie’s story is not tragic at all. In a sense, she is more heroic than most of us. She was free from the illusions most of us work at gathering during our lifetimes. We work at accumulating financial resources, excelling in our careers, or perpetuating our lives through our children and grandchildren.

Susie De Porry had none of the above. She was just Susie. Alone she approached the ending of her mortal days. Alone and without illusion.

I will have to make a conscious decision to see myself in this light. It would be an illusion to see myself as anything but one man passing from a human race that spans millennia in length and billions of people in width. Susie taught me that this could be done and done quite serenely.

Thanks, Susie.

“God has told me my wife is not going to die!”

Posted by

“God has told me my wife is not going to die!” That’s how my new hospice patient’s husband greeted me.

The nurse warned me that this was coming. The patient had breast cancer that had metastasized to the bone — a usually fatal prognosis.

Photo by National Cancer Institute on Unsplash

He went on to say, “I don’t want any talk about death or dying, only hope and healing.” Months before, I was asked not to return to a home where I had pushed a family to discuss possible death before they were ready.

I was wrong then, and I did not want to blow it again. As a chaplain, I was a guest in their home, so I would abide by his rules. I did say that if the topic of death came up, I would pursue it but would leave it up to them to introduce it. Until then, hope and healing.

Hope and optimism are all around us

There is hope at weddings. I have led many couples to repeat the phrase, “Till death do us part.” One pair deleted this phrase from their vows. It was his third marriage and her second. Another bride asked me to remove, “for richer, for poorer.”

The couples who didn’t edit their vows were being optimistic. The truth is half of all marriages end in divorce.

There’s hope in business. Would entrepreneurs start new ventures if they were not hopeful? Sure, they have a business plan and capital. Yet, there has got to be some self-deception, a bit of hopefulness in the face of long odds.

People who study such things call this self-deception the optimism bias. “The optimism bias is defined as the difference between a person’s expectation and the outcome that follows. If expectations are better than reality, the bias is optimistic; if reality is better than expected, the bias is pessimistic.”

Diversifying hope

It turns out optimists are happier and live longer than pessimists. I wrote in a previous blog about how the self-deception of the placebo effect can take away pain. With these kinds of benefits, so what if an optimist’s expectations are better than reality?

The Journal of the American Medical Association recently published an opinion piece, “Holding Hope for Patients With Serious Illness.” It is about doctors who encounter patients or family members who are hopeful for a happy outcome in the face of a fatal illness. What do they do? They don’t take away the hope but diversify it. Here is their summary:

“How can clinicians help patients hold multiple hopes? One approach may be to ask patients what they have heard about their prognosis from their clinical team. Patients could then be asked, ‘Given what is coming, what are you hoping for?’ It is not necessary to contest the answers nor convince patients to consider other futures. Instead, the clinician could acknowledge the response and ask, ‘What else are you hoping for?’ And then again, ‘What else?’ The point is to help patients balance and diversify their hopes, providing flexible future directions and possibilities.”

“Satan is trying to get me to doubt it.”

I stumbled onto this idea of diversifying hope on my own with the husband who heard a message from God. As I arrived for one visit, he was about to leave for work. He said, “Hank. You know how I said, ‘God told me my wife is not going to die’? Well, I still believe that, but Satan is trying to get me to doubt it. Would you pray for me?” I said I would, and he left.

I turned to the wife, who had just found out the cancer had spread to her liver. “Do you have as much confidence as your husband that you will not die?” She burst into tears and said, “I am afraid if I die, my husband will be disappointed in me.” My heart sank for them both.

Photo by Gus Moretta on Unsplash

On the next visit, I sat with the two of them. I told the husband about my conversation with his sick wife. He immediately got up from his chair, took this poor woman’s hand, and said, “I would never be disappointed in you. You have done all you can to fight this.”

I told them I had two concerns about people in their situation not contemplating the possibility of death. One was some people, believing a patient is not dying, refuse narcotics for extreme pain. (This was not the case with these two.) My other concern was that they might miss some crucial conversations. Conversations about their love for one another, saying good-bye, or finding ways to live fully in the limited time she had left.

The couple assured me they had been doing that, too. They were still hoping for a cure, but they also hoped for enough time to say all that needed to be said. They hoped for freedom from pain by accepting pain medication.

They had already diversified their hopes.

Aging as a Spiritualizing Process — Part Two

Posted by

The aging Presbyterian minister prayed, “…God, forgive us for our anger when the nurses do not answer the call bell. And for our annoyance when the food is cold. And for…” This went on for a few minutes. OH MY.

I thought it was a good idea. I was preparing to lead the nursing home’s Sunday morning worship service. I asked one of the residents, Horace, to give the morning prayer. He had pastored for well over 50 years and even performed a wedding for a nurses’ aid while he was a resident. Always the pastor.

So, I stood next to his wheelchair and handed him the wireless microphone at the proper time. He started well enough, “Dear Lord,” followed by some nice things to say about the day and the good Lord. Then the more honest prayer kicked in.

This was not what I had planned.

Then again, I had no idea what it was like to be so dependent on others, especially when those others let you down.

Aging forces us to grow spiritually

Last week, I started exploring “aging as a spiritualizing process.” My plan this week was to unpack an article in theJournal of Religion & Aging on this very topic. I first read that article around the time of the above-mentioned “honest prayer.”

That piece, “Aging as a Spiritualizing Process,” suggests that aging forces some spiritual practices and virtues on us that we should have learned years before. Here are a few bullets from that article:

  • Doing vs. Being: When physical limitations restrict our activities, we finally learn this lesson of the importance of just “being” rather than always “doing.”
  • Contingency: Intellectually, we all know we are going to die. As we age and more of our contemporaries die, it starts to sink in that this fact of death is beyond our control. We “take nothing for granted—thankful for even the next breath.”
  • Enfleshment: Aches, pain, and disabilities bring home the most basic Hebraic biblical understanding that “We do not have a body, we are a body.”

Not Pollyanna

This is no “Pollyanna approach” to aging and disability — no unflagging optimism, no “let’s see what we can be glad about.” And that’s okay. We can also express the honesty of my friend, the praying pastor, who was having trouble with the tardiness of nurses and cold food. Elisabeth Kübler-Ross did list “anger” and “depression” as aspects of dying.

No one put this more eloquently than Flannery O’Connor, the great writer of Southern fiction, who suffered from lupus for 13 years before she died at age 39 in 1964:

“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.”

Aging as a Spiritualizing Process — Part One

Posted by

“Growing old is no good,” the 95-year-old nursing home resident told me. I asked her when it got to being “no good.” She thought for a moment and then said, “About 80.”

“What made it ‘no good’ at that time?” I wanted to know. Without hesitation she said, “When I couldn’t do things for myself anymore.”

I told her daughter of this conversation and she said, “Oh yeah, it was about that time I came into her home, and she was standing on the kitchen table changing a light bulb in the ceiling fixture.”

This resident perfectly summarized the fear of aging; the issue is really the loss of independence. Who wants that? But decline and dependence is the future for most of us, except for the few who will die suddenly while still active.

The minister’s role of “presence and witness”

That conversation, which I also recount in my book, happened over thirty years ago. The young(ish) chaplain who heard those words is now part of the “elderly class.”

So I thought of my own elderly status and that long ago conversation as I read a recent article from Kaiser Health News, “Minister for Seniors at Famed Church Confronts Ageism and the Shame It Brings.”

Rev. Lynn Casteel Harper of the Riverside Church in New York City, sees her role with congregants in their decline as one of “presence and witness.” “Sometimes if people are going through really difficult experiences, especially medically, it’s easy for the story of the illness and the suffering to take over,” Rev. Harper said. “Part of my role is to affirm the other dimensions.”

Harper is right — it’s about presence. I found it was the same in ministering to nursing home residents and hospice patients. I could not take away the pain of loss of independence. I could not lighten the heavy weight that serious illness put on my patients’ psyches. But I could be present.

It was, in a way, easy. I just had to show up.

Acceptance of death without fear — why wait?

I was drawn to another of Harper’s comments. Yes, old folks do worry about what their last days will be like — whether there will be suffering. But she “rarely encounter[ed] a fearfulness about what will happen when someone dies.”

This acceptance of death without fear is common. It may or may not have a religious element to it but, in general, those approaching death have reached a degree of serenity. Acceptance without fear.

I say this acceptance is a spiritual process whether one expresses it in religious terms or not. In a sense, aging forces this spiritual acceptance upon us all. We could do it earlier in life, and many do, but toward the end, after losing independence, we tend to accept and just let things be.

If we could learn how to accept the certainty of death earlier in life, our whole life could be more peaceful. Growing old forces this spiritual practice upon us. This is just one facet of aging as a spiritualizing process.

My Life At 100

Posted by

I made it to one hundred! 100. The Big One-Oh-Oh.

This is my 100th blog post. It took a while. I started blogging in 2011 and made six blog posts that year. For the first nine years, I only published 51.

From my very first blog post, May 11, 2011: “How to start a blog about end-of-life decisions? I have been professionally dealing with these issues for 27 years.… One thing for certain . . . the fact that patients and families often struggle with decisions about medical treatment at the end of life will not go away.”

(BTW, shout out to Kelly Brachle, of Quality of Life Publishing Co., who edits my ramblings into a coherent thought. And while I am shouting out, nothing leaves our home without the approval of my wife as she stands in for the “average reader” [when I showed her this post, she reminded me she is “above average”]. More than once, her suggestions have saved me some embarrassment.)

It’s all about the stories — family, friends, wilderness

Although I often stick to the theme of making end-of-life decisions, other topics get some attention. I share my own family’s experience with death and dying, like with my mom’s decline and death in “How did your mom feel about her dementia?” Grief is a repeated theme, like my recent post on the funeral ritual for my brother 42 years after he died.

I really try to tell stories, like the post about my friend who died with dementia. I wrote about our friendship since junior high and how we fished together in the years before his death. Occasionally, I share my adventures in the wilderness, like the one about my love of swamps.

I have been writing my whole adult life – before the days of the blog. A few of those older writings made it into the collection. I reprinted a story about riding my bicycle the length of the Outer Banks from a 1993 newsletter published by the nursing home where I was chaplain. For several years following a difficult time in my life, I sent letters (essays, really) to family and friends. In a 2014 post, I shared a piece I did in 1998 about my friend, mentor, and author, Elizabeth O’Connor.

Writing and videos for short attention spans

We have become a people with short attention spans, so I try to limit each post to about 500 words. I have even ventured into producing two-minute videos on various topics. Sometimes I’ll tell the same story in both formats. I did a blog about the lesson my father taught me about letting go in the blog “How to get to ‘It doesn’t Matter!’” I then did a YouTube video about the same story.

By the way, you can subscribe to my YouTube channel and look through my “Hank’s Deep Thoughts” playlist.

I have found that writing for others helps me think things through. I can clarify thoughts in my mind when I have to explain things in a way others can understand. So even if no one else reads these, I will keep on writing these blog posts.

Oops! I just passed 500 words. Bye!

Quality of Life Publishing Logo

Quality of Life Publishing Co. is the proud publisher of Hank’s books, as well as other branded educational materials for health care & end-of-life care.

www.QOLpublishing.com

Copyright 2025, Hank Dunn. All rights reserved. Website design by Brian Joseph Studios

Volume Discounts for Branded Book Orders

Minimum quantity for branded books is 100. English and Spanish branded books are sold separately. Click here for more information or contact us with questions.

Black

  • 100 to 249 copies: $4.50 each
  • 250 to 499 copies: $3.50 each
  • 500 to 999 copies: $3.00 each
  • 1000 to 1499 copies: $2.25 each
  • 1500 to 1999 copies: $1.75 each
  • 2000 to 3999 copies: $1.60 each
  • 4000+ copies: $1.45 each

Color

  • 100 to 249 copies: $7.00 each
  • 250 to 499 copies: $4.50 each
  • 500 to 999 copies: $3.50 each
  • 1000 to 1499 copies: $2.50 each
  • 1500 to 1999 copies: $2.00 each
  • 2000 to 3999 copies: $1.85 each
  • 4000+ copies: $1.70 each


Volume Discounts for Unbranded Book Orders

Each title/language sold separately.

  • 1 to 9 copies: $8.00 each
  • 10 to 24 copies: $5.75 each
  • 25 to 49 copies: $4.50 each
  • 50 to 99 copies: $4.00 each
  • 100 to 249 copies: $3.50 each
  • 250 to 499 copies: $3.00 each
  • 500 to 999 copies: $2.50 each
  • 1000 to 1499 copies: $2.00 each
  • 1500 to 1999 copies: $1.50 each
  • 2000 to 3999 copies: $1.35 each
  • 4000+ copies: $1.20 each