Compassionate, informed advice about healthcare decision making

Archive for the ‘Emotional & Spiritual Issues’ Category

Randomness, Death, and Mystery… It’s Okay

Posted by

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.

“Find in Yourself What You Criticize in Another”

Posted by

Picture yourself at a restaurant with family and friends. The server places plates of delicious-looking food in front of everyone. Then one of your table companions says, “WAIT, WAIT, NOBODY EAT. I HAVE TO TAKE PICTURES.”

Then she takes out her phone, photographs each plate, and posts them to Instagram and/or Facebook.

When this happens to me, I think, “Oh my god! Can we just eat? Who cares what we are eating??”

The curse of social media: Every event is a photo op

Three years ago, we were living in Florida and my daughter was home on break. Out of the blue she says, “Hey. Let’s go for a walk on the beach.” I was so flattered that my college-aged kid would want to spend time with me. And as a bonus, I could get in a little cardio.

So, we drive over to Jupiter Island, park the car in the parking lot, and start walking north away from the crowds. After about a hundred yards she hands me her phone and asks, “Would you take my picture?”

Sure. No problem.

After about ten shots I hand her the phone. She looks at the photos and says, “Take some with more beach in the background.”

I do. Hand her the phone. She looks at them and says, “Maybe you should stand farther back.”

I do. My cardio op has now become my daughter’s photo op.

Photo ops in the swamp

In December, I posted a blog about my love of paddling in swamps. I really do love swamps. I was disappointed in my last trip to the Chakchiuma Swamp in nearby Grenada, Mississippi. This was back in the fall and we had gone through a dry spell. I could only access a small portion of the swamp for lack of water.

For a couple of months, I have been looking for several days of rain followed by a sunny morning. Last Wednesday was the day even though it was to be 32 degrees at my preferred launch time of sunrise.

It was all I had hoped for. Still water. The rising sun struggling to penetrate the fog. Quiet.

I had been thinking of a video I could make while paddling in this idyllic setting. I have been trying to increase my own social media presence by posting short videos on YouTube and Facebook. My plan was to condense that blog post by recording myself sharing my thoughts while paddling. So, I set up my tripod and mounted my phone.

I shot a video. And another. And another. And many more takes saying pretty much the same thing each time. Most were two minutes, but I shot five that were less than a minute so I could post one on Instagram. I shot seventeen videos in one hour and twenty-five minutes. I added up the times of each video and it came to a total twenty-seven minutes.

My many selves

Almost fifty years ago I was encouraged by an exercise in a book to discover my dark side, to look at my life and “Find in yourself what you criticize in another.”*

Bingo! I turned a wonderful time in the swamp into a photo op.

*From Our Many Selves: A Handbook of Self-Discovery by Elizabeth O’Connor, 1971. I wrote a previous blog about Elizabeth and the influence she had on my life.

My Birthday, Life Expectancy, and Regret Lists

Posted by

“The death of one man is a tragedy. The death of millions is a statistic.” ―Joseph Stalin

NEWS ITEM: “Life expectancy in the United States fell by a full year during the first half of 2020 [to 77.8 years], a staggering decline that reflects the toll of the COVID-19 pandemic as well as a rise in deaths from drug overdoses, heart attacks and diseases that accompanied the outbreak…” Washington Post, February 17, 2021

“The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labor and sorrow; for it is soon cut off, and we fly away.” ―Psalm 90:10

NEWS ITEM: Last week, Hank Dunn celebrated his birthday on Zoom with his family in Colorado, Virginia, North Carolina, and Mississippi. His age is north of the biblical “threescore and ten” and south of “fourscore.”

I tend to take life expectancy tables personally.

Here’s a sobering statistic — of every 100,000 people born in my birth year, only 73,246 are still living. CDC report “United States Life Tables.”

But wait…there’s more! Of those my age, our life expectancy is now about 14 years. That means in 14 years half of those my age who were alive in 2021 will be dead. So, it’s 50-50 I will make it to 2035.

Me with my sister, Janice, and my brother Dennis, 2017. Two weeks after this photo was taken, Dennis died on my birthday.

And looking at the stats closer to home is just as sobering. Of the six people in my family of origin (me, my parents, two brothers, and a sister) only two of us are still living. I hate to agree with Stalin. But the fact that 26,754 out of 100,000 people in my cohort are now dead is a statistic to me. But when my 64-year-old brother, Dennis, died on my birthday in 2017 — that was a tragedy.

Passing 70 and living under the threat that I could die abruptly from COVID-19 has gotten me thinking about legacy. What do I want to leave emotionally and spiritually to my children and grandchildren? And what about all this stuff I have written — some of it quite personal and self-revealing?

“Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.” ―Samuel Johnson (d. 1784)

I have said to myself what I tell patients with a terminal diagnosis, “Keep your regret list short.” If I were to die, are there things I would have regretted leaving undone? Gathering my personal writings like a memoir has been on my list. Thinking about my own death is not depressing to me. In this moment of time, while I am healthy, I agree with Samuel Johnson — thinking about my death concentrates my mind wonderfully.

I have been organizing things I have written over the last 45 years or so, and they are legion. I have printed out almost 700 pages and gathered them in two-inch thick binders. In these pages I can trace my spiritual growth (or lack thereof) over those years. I wrote about family tragedies, joys, and hurts I sustained.

Do I expect all my children and grandchildren to read all this stuff? Hardly. I would rather make it available and they never be read than someday one of them wonder what my thoughts were about a family event and not have my spin on it.

Keep your regret list short.


Human Kindness is Overflowing

Posted by

When I saw it, I felt in my heart, “Isn’t that a wonderfully kind thing to do?”

It was our last hour at the beach, so my daughter Katie and I decided to walk down the sand one more time. Some very generous friends let us stay in their condo about a half mile from the beach at Marco Island on Florida’s Gulf Coast.

As we headed north, walking next to the water, I noticed a stick in the sand holding up some car keys. Obviously, someone had lost the keys. Also, obviously, someone else had found them and took the time to find a stick to sink into the sand so the keys would be on display for any passerby to see.

Katie and I continued our walk enjoying the birds, people, sand, and sun. She picked up a live starfish she found in a pool of water and returned it to the sea.

On our way back, heading south, we came upon the stick in the sand and the car keys were gone. When we got up next to the stick we saw, in large letters written in the sand, a very simple, “THANK YOU.”

Isn’t that a wonderfully kind thing to do? Kind of the person who found the keys and took the time to display them — and kind of the owner of the keys to write, “Thank you.”

Immediately, I thought of a line from a Randy Newman song, “I Think It’s Going to Rain Today”:

 “Human kindness is overflowing, and I think it’s going to rain today.”

I think I first heard that song sung by Judy Collins on her 1966 album, In My Life. Bette Midler also sang it on the soundtrack for the movie, Beaches.

“Wait a minute,” I thought. Sure, it was kind act…but it was a kind act that served a very first-world problem. I didn’t notice the make of the car keys, but in this part of Florida luxury cars are common. Who knows, they could have been to a Ford Pinto. (But probably not.)

Regardless, someone had the means to have a car and the leisure time to hang out at the beach. Someone else also had the leisure time to rescue the keys. And here I was, lucky enough to have the leisure time to take note of all of this.

Photo I took of a sunset on Marco Island

I couldn’t help but think of this past year and the strain the pandemic has put on our kindness to one another. The keys on the beach proved that kindness is still out there, but what about the folks who don’t have a car right now? The folks who can’t drive to get a COVID vaccine? Or those who can’t pay their bills, let alone have leisure time at the beach? What about all of the families with children struggling with school during the pandemic? Those who have lost loved ones?

The list of those who could use a little kindness is endless.

I looked up the lyrics to Newman’s song and had totally forgotten that several of his lines were a call to care for those in need. Get this:

     “Bright before me the signs implore me

     “To help the needy and show them the way

     “Human kindness is overflowing

     “And I think it’s going to rain today…”

So, yes, let’s return the keys to our first-world friends. But then let’s extend the kindness beyond.

Signs of Hope Amid COVID

Posted by

When will our lives get back to “normal?” Is there hope this will ever happen?

I had cable news on the other day and saw this in the crawl at the bottom of the screen: “For the first time, vaccinations outnumber new hospitalizations 10 to 1.”

I took that as a very hopeful sign.

Think about it. Each time a person goes into the hospital with COVID-19, ten more just got a vaccination. And right now, those getting the shots, are the ones most likely to end up in the hospital if they were to get infected — the elderly and those with pre-existing conditions.

I must say, just seeing that crawl lifted my spirits slightly.

And then, there was the day I got my first dose of the Pfizer vaccine. (Yes, I qualified.) I got in the line of cars, filled out paperwork, inched the car along until it was my turn, received my shot from a National Guard member in fatigues, and joined the wait line for observation. My fifteen minutes were up, and I was on my way home.

My spirits lifted a little more.

Zoom brought out his feelings like nothing else

Laura Fraser (in San Francisco) and her 92-year-old father, Dr. Charles Fraser (in Denver) pose for a portrait via Zoom (Carolyn Van Houten/The Washington Post)

Stories continue to be told about the good that has come out of the pandemic. Just the other day the Washington Post ran a great piece about how Zoom has changed a family’s life. Laura Fraser writes about her 92-year-old father, Dr. Charles Fraser, a former physician living in a retirement facility with limited visitation.

Between his flip phone and clunky old computer, Dr. Fraser did not have the capacity to participate in an online chat. So, Laura writes:

“My husband and I bought a cheap laptop, loaded it with his email account, photos, Zoom and a password written in indelible ink on the keyboard, and mailed it off. After many tries, voilà! There he was on Zoom, with his crooked nose from the time a horse kicked him, and the familiar warm brown eyes. I hadn’t been sure I would see that face again, and I teared up.

“That’s all there is to it?” Dad asked. My sisters and their kids dialed in, and Dad held a smile so long I thought his computer had frozen.”

“Before he signs off, he tells us he loves us.”

Laura’s dad had never been one to talk about his feelings, his childhood, how he felt about his children,  or even how much he missed his wife, now gone ten years. On Zoom he has opened up for the first time. She ends her hope-filled story with this:

“A few weeks ago, over Zoom, Dad was able to see his great-granddaughter for the first time. He was delighted to learn that my nephew and his wife have named her after my mother, Virginia. ‘I just can’t wait to hug her,’ he says. His mood has lifted. He laughs as little Ginny burbles and coos. He does something else that’s new for him. Before he signs off, he tells us he loves us.”

Another little sign of hope in a time that needs so much.

Coming to Terms with the Loss of Control

Posted by

  • Citibank… “Personal Loan — Take Control of Your Debt.”
  • ACP brochure from Rochester, NY… “Advance Care Planning — Know your choices, share your wishes: Maintain control…”
  • Sears MasterCard… “Take control of your finances.”
  • SunTrust Bank… “Stay in control — transfer money where you need it, when you need it.”
  • National Car Rental… “Take Control. Join the Emerald Club Today.”
  • TSA PreCheck… “Take Control of Your Travel.”
  • VW… “A new Volkswagen means a new adventure: Take Control.”

Do you see a common theme in these ads?

Advertising professionals hook us by using the word “control” all the time. They know how important it is to us. We spend our lifetimes trying to gain control. Yet, when we come to the end of our lives, we must let go of so much control. When I speak at events, I always leave this topic for last — “Coming to terms with the loss of control.”

My favorite quotes on letting go of control at the end of life

Elaine M. Prevallet, S.L., “Borne in Courage and Love: Reflections on Letting Go,” Weavings, March/April, 1997

“The idol of control holds out to us the hope that suffering and death can be eliminated. If we just get smart enough, we will gain control of pain and even of death. That false hope, in turn, has the effect of setting suffering up as an enemy to be avoided at all costs. We can choose never to suffer!”

Daniel Callahan, The Troubled Dream of Life: Living with Mortality

“Self-respect and integrity need not, and ideally ought not, to be grounded in a capacity to control our lives and mortality.… What has come to count too much is that our choices affect outcomes in the world; we are at sea when we cannot do so. Modern medicine and the modern temperament … reject solving problems of illness and death by adopting an interior stance of acceptance, choosing instead action and domination.… Our capacity to act, to do something, is cherished — something preferably affecting the outer world of nature rather than the inner world of the self.… We do ourselves a great and double harm by focusing the meaning of self-determination, and the shaping of a self, on our capacity to make external choices, to act.”

Scene from the play and movie W;t (Wit), by Margaret Edson

– VIVIAN (Terminally ill patient): I can’t figure things out. I’m in a quandary, having these … doubts.

– SUSIE (Nurse): What you’re doing is very hard.

– VIVIAN: Hard things are what I like best.

– SUSIE: It’s not the same. It’s like it’s out of control, isn’t it?

– VIVIAN (crying, in spite of herself): I’m scared.

Viktor Frankl, Man’s Search for Meaning

Frankl was a psychotherapist, author, and holocaust survivor. He discovered that, even when he had lost so much control, he still had the freedom to choose his response to his situation.

“Man can preserve a vestige of spiritual freedom, of independence of mind, even in such terrible conditions of psychic and physical stress.… Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.… In the final analysis it becomes clear that the sort of person the prisoner became was the result of an inner decision, and not the result of camp influences alone.… It is this spiritual freedom — which cannot be taken away — that makes life meaningful and purposeful.”

The Serenity Prayer

“God, grant me the
“Serenity to accept the things I cannot change, the
“Courage to change the things I can and the
“Wisdom to know the difference.”

How to Get to “It Doesn’t Matter!”

Posted by
“Pass through this brief patch of time in harmony with nature, and come to your final resting place gracefully, just as a ripened olive might drop, praising the earth that nourished it and grateful to the tree that gave it growth.” Marcus Aurelius, Meditations, 4.48.2, quoted in The Daily Stoicby Ryan Holiday, p. 26


My father, Hampton Dunn, age 33, managing editor, The Tampa Daily Times

In many ways, my father’s death wasn’t particularly remarkable. His physical and mental abilities just went downhill and after four years in a nursing home — he died.

And, in many ways, his life was not so remarkable when compared to others who grew up in the Depression and fought in World War II.

Further, in many ways, his emotional and spiritual journey in his last days, months, and years were not unlike hundreds of others I had accompanied during my time as a chaplain.

I’ve been thinking about these things as I prepare for a virtual talk I will give on February 4th on the emotional and spiritual concerns at the end of life. Last week, I listed the seven concerns I have noticed in my work and research. One of the concerns is “Gaining a sense that what is happening is okay: ‘Letting be.’”

Writing became my father’s life

Dad (right), age 49, public relations director, AAA

My father never finished college. It was 1936 in the depths of the Depression. He got his dream job as a newspaper reporter and never finished his degree. Some fifty years later he did get an honorary doctorate from his former school, the University of Tampa. Writing became his life: first at the Tampa Daily Times; then on TV in Miami; then back to Tampa as the public relations director for AAA; and finally, after retiring from his day job at age 70, he went back into TV work.

Hampton Dunn, age 73, TV personality

It was that final TV stint, doing a two-minute spot each week featuring an on-location story about Tampa history, that gave rise to my dad teaching me a lesson on how to prepare for death.

Dad developed Parkinson’s and had to give up writing, public speaking, and TV. He could no longer type or turn the page in a book to do research. He eventually needed assistance for all activities and a nursing home was the only answer.

A moment of insight… and acceptance

Me with Dad, age 82, nursing home resident

One day we picked up dad at the nursing home to go out for a drive. I was driving. My father was in the passenger seat. My mother and nephew were in the back seat. We got stuck at a traffic light in the dense suburbs of North Tampa. Across the intersection, on the far corner, stood an abandoned forest lookout tower. The forests are long gone, and the tower is now a historic site. From the back seat, Mom said, “Your father did a TV spot at this corner.”

Dad corrected her, “I did several!”

Still stuck at the light, I thought I could pass the time, so I asked, “When was that tower last used as a fire tower?”

Dad started thinking. That date was locked in his brain somewhere but the damage from Parkinson’s and strokes prevented him from finding it. Knowledge of history was so important to my father. He had written eighteen books on Florida history and now he could not remember a date.

Slowly he turned to me and with a big grin on his face he said, “It doesn’t matter!” He had gotten to the point of “gaining a sense that what is happening is okay.” Others have characterized this as “acceptance.”

My dad never looked forward to his decline, but when it came, so much else didn’t matter. It was “okay” in the sense that the vast majority of humanity follows this same path of decline toward the end and now he had accepted it, too.

“Dad…” Kids Need Friends to Stay Healthy, Too

Posted by

Ashley and her family

“Dad… the biggest combatants of dementia are exactly what we teach in our [suicide prevention program],” my daughter responded on Facebook to my last post on friends, hearing loss, and dementia.

My daughter, Ashley Dunn Harper (@Ashharper9333), is a middle school counselor and mother of three, one in middle school and two in high school. (We’ll not get into them being three of the greatest grandchildren.)

Ashley works in Loudoun County Public Schools in the D.C. suburbs of Virginia. Sadly, teen suicide is an issue the school system, counselors, teachers, and parents have had to address. LCPS has chosen the Sources of Strength model to try and get a handle on this terrible problem.

Reducing the risks of teen suicide AND Alzheimer’s

In my blog, I quoted two lists of things to do to reduce your risk of Alzheimer’s. Ashley saw those lists and immediately recognized the similarities between her work in helping teens live a healthy life and avoid suicide and my observations about mental health in the closing years of life.

The “Sources of Strength” list includes this: “Positive friends lift us up, make us laugh, are honest with us, and are there for us when we need them.” This is not unlike the lists I quoted which included “Having two or three close friends” and “Interacting with friends.”

I did notice the list for teenagers specified positive friends. My spin on this is that by the time we get to our sixties and seventies we have already dropped negative “friends” from our lives. Teens are still learning there is a difference.

The Spiritual Side of “Grey’s Anatomy”

Posted by

“Chaplain Dunn, we need you in the emergency room,” the nurse started her call to me on a Saturday morning. “An eight-day-old baby died at his mother’s breast at home and the family needs your support.” This family had no minister to call. I did what I could for them. It was a sad, sad situation. A few hours later the funeral home called, and the family asked if I could conduct a graveside service for the child.

For twenty years, for one week each quarter, I volunteered as the on-call chaplain at the Loudoun Hospital Center in Virginia. During normal business hours, there was a full-time chaplain ready to handle emergencies. I almost always got a few calls each week I was on duty. Often, it was for deaths in the ER. Sometimes, it was for stillbirths or neonatal deaths. The staff knew they needed to provide spiritual support in times of crisis. Who could they call after hours?

The mysterious absence of chaplains

As I wrote in my last blog, we have been binge-watching Grey’s Anatomy during the pandemic. In the over 300 episodes of Grey’s Anatomy I have watched, I can’t recall a time when a chaplain was on camera. Isn’t that curious? Like all medical dramas, the show is filled with crises and death. Where are the chaplains? Full disclosure here: I am a chaplain and could be protecting my turf.

One past TV medical drama, M*A*S*H (1972-83), cast a chaplain in a significant role. The Mobile Army Surgical Hospital amid the Korean War might make the presence of a chaplain seem more acceptable. After all, it was the Army in the middle of a war. The chaplain, Father Mulcahy (a Catholic priest), was one of only four characters who appeared in all eleven seasons of the hit show — along with “Hawkeye,” “Hot Lips” Houlihan, and the crossdressing Klinger.

There was one Grey’s episode when two doctors talked about needing to get a chaplain. A patient was asking for forgiveness. He was the landlord of an apartment building that had collapsed resulting in multiple injuries and some deaths. He said he was trying to save up the money to make repairs to the structural damage the building had suffered in an earthquake. Now, people had died because of his procrastination and he wanted to be forgiven.

Dr. Ben Warren said, “The chaplain is M.I.A. and I heard there was a rabbi in geriatrics.”

Dr. Leah Murphy encouraged Ben to go see the patient and act as chaplain, “All you have to do is listen and nod your head.”

Dr. Warren did see the patient and told him he was not a priest. The guilt-ridden landlord said, “I just need someone to listen.”

The spiritual side of Grey’s Anatomy

Just because the show is absent chaplains or other clergy does not mean it does not tackle some very important spiritual and religious topics. More than once did a child need life-saving medical treatment when one parent wanted to trust the doctors and the other wanted to take the child home and trust God only. Similarly, a Jehovah’s Witness patient refused to accept a blood transfusion that could have saved his life but would violate his strongly held religious belief. A new intern felt compelled to use her hijab to stop the bleeding in a patient. It was later was returned to her, cleaned, by a fellow physician who knew the spiritual importance of the head covering.

Rabbi Eli, a dying patient, comforts Dr. April Kepner

For nine seasons of Grey’s most of the “spiritual teaching,” centers around the character, Dr. April Kepner. She starts out on the show as a conservative Christian and something of a prude. Gradually, life seems to interrupt her strongly held beliefs and morals. She loses her virginity and then recommits to a chaste life in an effort to “re-virginize.” She gets married, has a child die soon after birth, gets a divorce, and has another child as a single mother. Her own painful life story and the random tragic stories of her patients causes a crisis of faith in Dr. Kepner.

The journey we’re all on

Kepner’s breakthrough to a more mature faith is helped by a dying patient, Rabbi Eli. He is dying because of a mistake made by Dr. Miranda Bailey. Kepner views Eli’s case as just more evidence that God does not care for us. She wants a guarantee that if you are faithful good things will come your way.

The rabbi will have none of the guarantee talk. He recites a long list of faithful biblical characters who were tragic victims. Eli says it’s also in “the sequel” (by which he means the New Testament). He argues that if only good things happened in these stories, the bible would not have been a best-seller.

Rabbi Eli helps Dr. Kepner through her crisis of faith

“Who are you to know why some people live and some people die?” the dying man tells Dr. Kepner. “God’s not indifferent to our pain…the world is full of brokenness and it’s our job to put it back together again.” He asks her to tell Dr. Bailey he forgives her for her mistake. He dies confusing Dr. Kepner with his wife who is out of town. Get out the tissues.

Occasionally, the hectic scenes in Grey’s O.R. and E.R. shift to the quiet of the chapel. Doctors pray, light candles, or just sit silently. Here, Kepner walks in on a distraught Dr. Bailey who is lighting a candle and seeking solace.

Dr. Kepner comforts Dr. Bailey, who made the medical mistake that led to Rabbi Eli’s death

Dr. Kepner tells her, “Eli forgave you. Some things just happen, and we don’t get to know why.” She came to a point of acceptance and was able to comfort a fellow traveler in this seemingly unfair world. Is this not the journey we are all on?

Hard Choices for Loving People: “Actually, Just One Hard Choice”

Posted by

This is the seventh and last post in a series of articles about the writing and distribution of Hard Choices for Loving People.

Article featuring the 1st edition and its subtitle, “CPR, Artificial Feeding Tubes, and The Nursing Home Resident”

What is in a name? …or title? …or subtitle?

Over 30 years, Hard Choices for Loving People has been the title of the book. But the subtitle has morphed, most notably in the audience to whom the book is addressed. It began with “the nursing home resident,” then changed to “the elderly patient.” Next was “the patient with a terminal illness,” then, “the patient with a life-threatening illness,” and finally “the patient with a serious illness.”

I wanted to welcome as many people as possible into reading my book. My constant worry was that I would turn people off or scare them away or that they would think “this book is not for me.” When I had “terminal illness” in the subtitle, readers might resist facing this fact until a few days, or even hours, before death. They need to read the book long before that time. So I replaced “terminal” with “life-threatening.”

I have now settled on “serious illness” for several reasons. First, it is the language you find in medical journals. Second, there is a standard definition for what a serious illness is; essentially, an illness with a high probability that it will end in death and which causes burdens on the patient and their caregivers. Third, people know if they have a hard time getting out of a chair or are in constant pain something is “serious.”

I didn’t want to scare people off

Where did the book title come from? To tell the truth, I can’t remember exactly how I came up with the name Hard Choices for Loving People. As I said, I did not want to scare people off, so I avoided words like “preparing for death,” or “let go.” If people are struggling with accepting a terminal diagnosis, they certainly did not want to read a book to help prepare them for death.

The double entendre was intentional. These were hard choices as people are figuring out the loving thing to do. AND loving people have to make these hard choices.

I’ll close this series of articles with an excerpt from the book where I address these choices, or, rather, a single choice:

“The truth is that we will die whether we give up, let go, or let be. We are making a choice about the nature of our dying or the dying of one we love. We can choose to die in trust and grace or in fear and struggle.

“Perhaps I titled my book improperly. We are not faced with many hard choices. We are faced with one hard choice: Can we let go and live life out of grace or must we hold on out of fear? Can we just let things be? That is really what we are talking about. To withhold or withdraw artificial and mechanical devices is just returning the patient to a natural state. We are accepting what is. We have come to accept that the patient is dying and we will just let be.” (Hard Choices for Loving People, p. 73)

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.

Copyright 2021, 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.


  • 100 to 249 copies: $3.97 each
  • 250 to 499 copies: $2.81 each
  • 500 to 999 copies: $2.21 each
  • 1000 to 1499 copies: $1.66 each
  • 1500 to 1999 copies: $1.40 each
  • 2000 to 3999 copies: $1.27 each
  • 4000+ copies: $1.08 each


  • 100 to 249 copies: $6.62 each
  • 250 to 499 copies: $3.92 each
  • 500 to 999 copies: $2.76 each
  • 1000 to 1499 copies: $1.93 each
  • 1500 to 1999 copies: $1.58 each
  • 2000 to 3999 copies: $1.41 each
  • 4000+ copies: $1.14 each

Volume Discounts for Unbranded Book Orders

Discounts apply to the total books ordered of all titles. Mix and match to get quantity discounts on unbranded books.

  • 1 to 9 copies: $7.35 each
  • 10 to 24 copies: $5.13 each
  • 25 to 49 copies: $4.24 each
  • 50 to 99 copies: $3.75 each
  • 100 to 249 copies: $2.87 each
  • 250 to 499 copies: $2.37 each
  • 500 to 999 copies: $1.98 each
  • 1000 to 1499 copies: $1.54 each
  • 1500 to 1999 copies: $1.32 each
  • 2000 to 3999 copies: $1.21 each
  • 4000+ copies: $1.05 each
There are no products