Death & Dying | Hank Dunn

Compassionate, informed advice about healthcare decision making

Archive for the ‘Death & Dying’ Category

Randomness, Death, and Mystery… It’s Okay

Posted March 30, 2021 by [email protected]

Do you ever do this while reading random obituaries?

I see some person, about my age, who died of cancer. I read on and see it was lung cancer. I’m relieved. Obviously, they smoked. I don’t smoke. I won’t die.

Then, I read, a healthy person about my age dies suddenly from an undiagnosed brain aneurysm. No warning. They just drop dead. A random chance occurrence like a victim of a mass shooting at a grocery store.

We humans look for patterns — for reasons “why.” Some find comfort in the idea (*SPOILER ALERT* — not me) that God is in control of everything and sends some people a quick, unexplained death.

There are no accidents… or not?

I conducted a graveside funeral service years ago as a hospice chaplain. A woman came up to me after the service and told me her story. “A couple of years ago, my eight-year-old son was playing on the swing set in our backyard,” she started. “He jumped off the swing, fell on his head, broke his neck and died instantly. In my grief someone sent me a card that said, ‘With God there are no accidents.’”

I thought (but didn’t say), What a horrible thing to tell a grieving mother. God killed your son. Before I responded, I studied her face to see if I could catch some glimpse of how she received this message. I didn’t have to guess. She told me, “Those words have been so helpful to me.”

I was almost speechless. This woman is a complete stranger and I have no pastoral relationship with her. I would never want to take away a word that was helpful to her. I must have said something like, “I am so thankful that was helpful to you. It must have been a horrible time.”

What do I know? The card may be right.

Everything happens for a reason?

Contrast this with best-selling author Kate Bowler and her book Everything Happens for A Reason: And Other Lies I’ve Loved. The book jacket describes her situation:

“At thirty-five, everything in her life seems to point toward ‘blessing.’ She is thriving in her job, married to her high school sweetheart, and loves life with her newborn son. Then she is diagnosed with stage IV colon cancer.”

Bowler is an academic who has studied the “prosperity gospel.” That would be the megachurch televangelists who teach that if you just believe hard enough (and make a contribution) only good things will come your way. In her research, she saw the downside of this belief is that when you’re thrown life’s random tragedies you are left feeling like a loser.

Do yourself a favor and watch her TED talk on YouTube. Over six million people have viewed this 15-minutes of wisdom. She has learned to live with mystery… with randomness… with not having a “reason.” And it is okay.

Don’t Say of Me, “He fought to the bitter end!”

Posted March 16, 2021 by [email protected]

“Dad was a fighter. We never gave up on him!” they said to each other.

For me, it was one of the saddest scenes I had witnessed since I started working as a chaplain in 1983.

I must emphasize that my interpretation of this scene as being sad is my opinion. This entry is about how I want to be treated in the end…or not treated as the case may be.

Others do want to “fight to the very end” and I can support that. But this case seemed beyond all reason. You can decide for yourself.

On this particular day, I was in the emergency department waiting room with the family of one our nursing home residents who had been rushed to the hospital. The patient was riddled with cancer, literally. He had tumors breaking his skin in multiple places. His body was wasted.

Earlier at the nursing home, I sat with the wife outside the patient’s room while the paramedics were beating on the man’s chest. One EMT compassionately knelt by this woman to tell her that they did not have a pulse on her husband, but they were going to continue CPR and take him to the hospital. He said he was not hopeful that they could save the man’s life. He did an admirable job of breaking bad news.

When the ER doc came out to tell the family that they were unable to revive him they said to each other, “Dad was a fighter. We never gave up on him!”

Fighting battles

This story has so many things to unpack. Ethics. Compassion. Autonomy. “First, do no harm.” Surrogate decision-making. Moral distress of the professionals. Not to mention the patient’s adult children were not speaking to his wife, their stepmother. But I’ll focus now on the language of fighting to the bitter end.

“Keeping Away Death,” sculpture by Julian Hoke Harris, located near Grady Hospital in Atlanta.

We see it often in obituaries, “John died after a long battle with cancer.”

I’m sorry. In my view, this language makes John a loser. What a horrible thing to say about him. Everybody dies. In framing death as a battle lost, we ALL will be losers when it comes to the last act of our lives.

What does this say to the millions of us who read these words and feel ashamed when we have a disease which we know will kill us? We can only conclude, “It’s my fault I am dying.”

Did I allow too much stress to cause me to get sick? Did I not try hard enough? Did I lack faith?

Let me be clear. At this point in my life, if I get a fairly treatable cancer with a good prognosis, I will “fight” it, if you must use that language. I just do not like the battle metaphor when your enemy is death. Death is part of life not its enemy.

“He died peacefully…”

What got me thinking about this is a book I listened to recently as I drove from Oxford, Mississippi to Northern Virginia. Actually, it was two short books in one audio program — Susan Sontag’s Illness as Metaphor (1978) and AIDS and its Metaphors (1988).

What Sontag only barely mentioned in the more recent book was that she was being successfully treated for breast cancer when writing the earlier one and later “fought” and “defeated” uterine cancer. She finally died fighting a rare and very aggressive form of leukemia in 2004. And fight she did.

Her son, David Rieff, wrote a very moving memoir (Swimming in a Sea of Death) about what it is like for a family member to try to support a patient who was dragging herself through a painful dying in the false hope she would be cured.

If you must mention a cause of death in my obituary say, “He died peacefully while living with cancer” or “He died peacefully after months with palliative care and hospice.” Or, better still, “He didn’t give up, he let go and just let things be.”

Never Let a Good Plague Go to Waste

Posted September 11, 2020 by kbrachle

“Come to terms with death. Thereafter, anything is possible.” —Albert Camus

First, I did. Then, I didn’t. Now I am back thinking about dying. Blame it on COVID…and my men’s group.

In a bygone era — say February or March — the word was people like me, 72 with asthma, were dying in greater numbers than others. Yet, some were going on ventilators and surviving. I told my wife at the time, “If I get COVID, try me on a ventilator for a while.” Then I updated my end-of-life paperwork and wrote a letter to my family about the disposition of my journals. Life got back to normal.… or what now passes for normal.

The news and I have shifted. Though you still hear stories of old people getting off vents and surviving, many do not. Some get off and face years of disability. There actually is some good news in the news, too. Docs are finding less aggressive ways to treat respiratory failure with some success. My new instructions — “No CPR and no vent for me.”

So, I am back to thinking about dying.

It really could happen in short order if I get COVID. And the men’s group? I have been in this group for 28 years. We meet every Thursday at 6AM Eastern time. We have decided to let each guy take a week and retell his life story. Revisiting my story has encouraged me to think like a hospice patient.

I’m going big this time thinking about dying — I’m in life review. Where have I been? What has been the meaning of my life? What is the purpose of human life? What are my regrets? I ask myself the question I have posed as a hospice chaplain to many dying souls: “If you were to die today is there anything that would be left undone?”

In 1585, Michel de Montaigne took his family and fled Bordeaux, France, where he was mayor, to avoid the bubonic plague. (How many mayors around the world today would like a vacation in the country right now?) His term in office was about to end and he had one last official duty in town, attending the transition ceremony. A recent piece in the New York Times continued, “He rode his horse to the city’s edge and wrote to the municipal council to ask whether his life was worth a transition ceremony. He did not seem to receive a reply and returned to his chateau. By the time the plague subsided, more than 14,000 people — about a third of the city’s population — had died horrible deaths. As for the former mayor, he returned to a far more pressing task: the writing of essays.”

He is now regarded as the originator of the modern form of literature we call “the essay.” Like any philosopher worth his salt, Montaigne contemplated death. Early on in my work with the dying, I kept finding him quoted in the literature on death and dying. He titled one piece, “To philosophize it to learn how to die.” Here’s an excerpt:

Knowing how to die gives us freedom

“To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness; let us frequent it, let us get used to it; let us have nothing more often in mind than death. At every instant let us evoke it in our imagination under all its aspects.… To practice death is to practice freedom. A man who has learned how to die has unlearned how to be a slave. Knowing how to die gives us freedom from subjection and constraint. Life has no evil for him who has thoroughly understood that loss of life is not an evil.” Michel de Montaigne, c. 1533-1595

Even before the plague, like anyone in the 16^th century, he was quite familiar with death. Besides disease taking lives, Protestants and Catholics were killing each other periodically. It is curious to me that he even felt the need to encourage his readers to contemplate death. How could you NOT in a world surrounded by death? The human capacity to ignore or put off contemplation of death is huge.

I am convinced that I will never fully face my own death until I have a terminal diagnosis. Not only being given the diagnosis, but also having the felt sense in my body that I am checking out. But still, I am trying. COVID has helped move the process forward. I could die. I must be ready. I have decided not to let a good plague go to waste.

Photo by Veit Hammer on Unsplash

Life and Death as Metaphor – Part 2

Posted July 8, 2019 by kbrachle

I continue to gather these quotes on life and death as metaphor. Most were found on the WeCroak app:

“Our life is a faint tracing on the surface of mystery.” —Annie Dillard
“For life and death are one, even as the river and the sea are one.” —Kahlil Gibran
“Not success. Not growth. Not happiness. The cradle of your love of life … is death.” —Stephen Jenkinson
“Life is a spark between two identical voids, the darkness before birth and the one after death.” —Irvin D. Yalom
“Life is a succession of misunderstandings, leading us on to the final truth, the only truth.” —Roberto Bolano
“We only get to be in our bodies for a limited time, why not celebrate the journey instead of merely riding it out until it’s over?” —Jen Sincero
“Yet, in a bizarre, backwards way, death is the light by which the shadow of all of life’s meaning is measured. Without death, everything would feel inconsequential, all experience arbitrary, all metrics and values suddenly zero.” —Mark Manson
“Death is our friend precisely because it brings us into absolute and passionate presence with all that is here, that is natural, that is love.” —Rainer Maria Rilke
“Life’s but a walking shadow, a poor player, that struts and frets his hour upon the stage, and then is heard no more.” —Shakespeare

Life and Death as Metaphor

Posted April 23, 2019 by kbrachle

I am a collector of quotations about life and death. (BTW, I found a great source for these in an app called WeCroak.)

I was reading through my collection the other day and noticed many of the quotations contained metaphors for life and death. Here are a few of my favorites:

“Our lives are as bubbles in boiling water, which appear, rise to the surface, pop, and disappear.” —Leo Tolstoy
“No matter how much you’ve been warned, Death always comes without knocking. Why now is the cry. Why so soon? It’s the cry of a child being called home at dusk.” —Margaret Atwood
“Another way to get a sense of your life moving continuously towards death is to imagine being on a train, which is always traveling at a steady speed—it never slows down or stops, and there is no way that you can get off. This train is continuously bringing you closer and closer to its destination: the end of your life.” —Sangye Khadro
“Death is the sound of distant thunder at a picnic.” —W.H. Auden
“Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight. She helps us discover what matters most.” —Frank Ostaseski
“Dying is a wild night and a new road.” —Emily Dickinson

Photo by Paul Jarvis on Unsplash

Holding the Space for Grief

Posted March 11, 2019 by kbrachle

Caitlin Doughty has done it again! She produced another knock out book that I took way too long to read.

I blogged about her first book, Smoke Gets In Your Eyes, confessing my narrow range of interest (mostly death and dying and spirituality stuff) and my slow reading. Her “new” book came out in 2017 and I just finished it yesterday. No matter…if you haven’t read it yet, it is new to you.

From Here to Eternity: Traveling the World to Find the Good Death is a travelogue about ways people around the world honor the dead and help the bereaved carry their grief. As with her first book, this one comes with a WARNING: there are graphic descriptions of dead bodies and of what happens to these bodies after death. I personally was not offended by this and do feel the descriptions are an essential part of her narrative.

Doughty is a mortician, owner of a nonprofit funeral home, Undertaking L.A., and a leader in the Death Positive movement. The movement seeks to change the way we do death and dying in Western culture. We tend to hide death, remove it from view, and make it unnatural. Our hospitals and funeral homes can be the greatest obstacles to a more positive view of death.

There is no shame in a public expression of grief

One of the common characteristics of all the unusual death and funeral practices described in the book is the openness of grief—there is no shame in a public expression of grief for years after a death. Families in Indonesia may keep the mummified body of a relative in their homes for months or years. In Bolivia, human skulls are decorated and given a prominent place in dwellings. In Colorado, a whole community turns out to witness the open-air cremation of one of their own.

In the West we want people to “get over their grieving,” “to find closure,” to “move on.” The truth is, we never stop grieving. Other cultures have established rituals around death that bring grief into the light.

Hold the space is to create a ring of safety

Doughty ends her book, “No matter what it takes, the hard work begins for the West to haul our fear, shame, and grief surrounding death out into the disinfecting light of the sun.” What is needed is “holding the space” for the dying person and their family. “To hold the space is to create a ring of safety around the family and friends of the dead, providing a place where they can grieve openly and honestly, without fear of being judged.”

Photo by Kent Pilcher on Unsplash

The “Comfort” of Nothingness

Posted June 6, 2018 by kbrachle

“When I’m dead, I’m dead.… and I just sail off into nothingness, and that brings me a lot of comfort. That doesn’t bring everyone comfort but it brings me comfort.” —Caitlin Doughty, author of Smoke Get in Your Eyes, from an interview on the documentary “Into The Night: Portraits of Life and Death.”

Some people are okay with death being the end.

Their dead father sent a snowstorm

I haven’t run into too many people like that because I have spent so much of my life around folks who believe just the opposite. Many, if not most people, both religious and nonreligious, have some sense that their lives will continue in some form after death. I even had one family insist their dead father sent a snowstorm.

This family had asked me to conduct the funeral service for this man who was one of our hospice patients. I had never met the man nor his family before, since they all claimed they were not religious and did not want a visit from the chaplain. So, he dies and they have no relationship with any church but needed someone to lead the service. Happens a lot in hospice. I was glad to help out.

Through a phone conversation with family members I planned the service which was to take place at the funeral home. They described the recently departed man as very shy and private. He was also a giving and generous man who loved his family dearly.

The night before the scheduled service we had a major snowstorm. I felt I could make it to the funeral home, as did the family, so the service was held as planned. No burial was needed since the man had been cremated.

Only one person showed up for the service besides the few family members.

This lack of turnout did not bother the family in the least. They said, “It’s just like Dad. He was so private that he sent a snowstorm to keep people away.”

“Okay,” I thought.

What do I know? Maybe the recently departed do have the power to send snowstorms. My point is that the belief in living beyond the grave is pervasive whether or not it has a religious aspect to it.

Yet, in my years at the bedsides of the dying and their families, I have gathered enough evidence that some people can be okay with the idea that the last breath is the end. I have seen scores of people face their deaths peacefully even while they have no belief that they are “going to a better place” or are going to be reunited with departed family members.

Many people agree with Caitlin Doughty that death is the end. But, I did find her use of the word “comfort” something I have not heard a lot from those who accept that there is nothingness after death.

I do hear “comfort” from those expecting to see deceased relatives or to be in the presence of God. I can’t tell you the number of times I sat with a family around the bed of a dying relative and someone says, “I don’t know how people do this without faith in God?” Caitlin seems to have an answer to that question.

How is the thought of nothingness “comforting”?

Another way of asking that question is, “How is the thought of nothingness ‘comforting’?”

We know humans, at some point, became conscious beings in our prehistoric past. A major hint of this emerging consciousness is the fact that we buried our dead with tools and other items to help the departed in the next life. This becomes a sign of consciousness because we know our ancient ancestors had the brain capacity to understand that they were going to die and they had figured out a way to deal with it.

Religions grew and flourished as they offered an answer to the mystery of death. What happens to us when we die? The religious answers of life after death do offer many people great comfort.

Let me suggest a two ways that, perhaps, the thought of nothingness is comforting:

For Caitlin Doughty to say that knowing there is nothing after death, “brings me a lot of comfort,” first shows that she, too, has found an answer to this mystery of death and its meaning. There is comfort in settling the question in one’s own mind and heart. Mystery solved. Of course, it is different than a more traditional religious answer but having the question settled is comforting nonetheless.
The second way nothingness after death is comforting grows out of that first reason. If there is nothing after death, that means this life is all there is. And if this is all there is then that makes this life all the more meaningful. This is it. This is not preparation for another life. Therefore, we must live this life abundantly. Enjoy it to the fullest and help our fellow humans by relieving their suffering and contributing to their joy. After all, this is all there is, they say. The incredible wonder and joy of living this one life brings the comfort.

As Doughty points out, “That doesn’t bring everyone comfort but it brings me comfort.” I have to take her at her word.

Photo by Greg Rakozy on Unsplash

The Country of Sickness

Posted June 30, 2015 by kbrachle

“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.” —Flannery O’Connor, 1956.

The southern and Catholic author was diagnosed with lupus in 1951, the same disease that killed her father when she was a teenager. She died in 1964 having lived and suffered and wrote and thrived with lupus for 13 years.

Books ONLY from My Brother

Posted February 11, 2015 by kbrachle

I do not like people giving me books

I do not like people giving me books to read that I have not requested. I have like 100 books on my wish list and when family members ask me what they can give me for a gift I go to the list and send several suggestions. I think of myself as a slow reader with a somewhat narrow range of interests and don’t want people cluttering up my reading pile with books I previously had no interest in.

So I drove from Virginia to Florida for Christmas with a stop at my brother’s rural home near Tallahassee. He handed me a gift. You guessed it. A book. A book I had not requested. But he was generous and I do not give my do-not-give-me-a-book speech right after the kindness of a gift.

I just finished reading all 241 pages. That comes out to about 4 pages a day since I accepted the book. See…slow.

Turns out it has become one of my all time favorite books. Of course it is in the death and dying genre. Right in my narrow range of interest.

NOTE to family and friends: Only my brother Dennis can give me books I have not asked for.

A memoir of a young mortician

Smoke Gets in Your Eyes and Other Lessons from the Crematory is a memoir of a young mortician, Caitlin Doughty. Oh goodness, where do I start.

A full disclosure WARNING about the book. It contains very graphic detail about the condition of bodies of the deceased, their preparation, and what cremation actually looks like. This book is not for everyone. That said, I still would recommend it for everyone. Push through it and you find a wonderful story of a young woman finding a calling to help us all in the end.

Do yourself a favor and visit Doughty’s Web site “The Order of the Good Death” at http://www.orderofthegooddeath.com/. She has some great videos called, “Ask A Mortician.” She has a Facebook page https://www.facebook.com/OrderoftheGoodDeath. A Twitter feed @TheGoodDeath (https://twitter.com/TheGoodDeath) with 16,000 followers. And lots of photos on Instagram, thegooddeath (http://instagram.com/thegooddeath).

This is not your old chaplain’s verses about “letting be.” She recently posted a photo of a greeting card, “If I had a choice to have sex with any celebrity, living or dead, I would probably choose living.”

She is irreverent but dead serious. Get it?

There is a small but growing army of folks like Caitlin Doughty out there who want to bring death into our everyday lives. She advocates for families preparing bodies for burial or cremation. She is a leader in the “Death Salon” movement holding public forums to talk about death and dying. She is not religious but encourages rituals to help families and friends of the newly dead grieve and cope in healthy ways.

Yesterday, I sent her copies of my books (unsolicited of course). I started the cover letter, “I am sorry I arrived so late to your party. Only now have I found out about all the fun you are having.”

Doctors Choose LESS Treatment When Dying

Posted January 5, 2015 by kbrachle

Here is a great article from 3 years ago about physicians choosing less aggressive treatments as they are dying than does the general public.

http://www.wsj.com/articles/SB10001424052970203918304577243321242833962#

Hank

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