Compassionate, informed advice about healthcare decision making

Archive for the ‘Emotional & Spiritual Issues’ Category

Cancer and Things Done and Things Left Undone

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Since my bladder cancer diagnosis in May, I have found myself clearing my calendar to allow the next steps in my care to unfold. I am trying to prioritize what I need to do and what can be left undone.

Photo by National Cancer Institute on Unsplash

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

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

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

Things Left Undone

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

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

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

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

Things Done

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

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

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

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

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

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

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

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

This blog is DONE.

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

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Book Review: Nothing to Fear: Demystifying Death to Live More Fully by @hospicenursejulie

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Perhaps Hospice Nurse Julie’s book should come with a TRIGGER WARNING: Do not read this book if you do not like the words “Clean, Safe, and Comfortable.” More on that in a minute.

Nothing to Fear: Demystifying Death to Live More by Julie McFadden, RN, is the latest in a long line of books showing the way to a more peaceful and more meaningful dying experience. Why another death and dying book? Why not? Sitting at #8 on the New York Times “Advice” best-seller list, Nothing to Fear is full of advice about navigating the last six months of life under hospice care.

McFadden is better known as @hospicenursejulie to her followers on Instagram (357K), YouTube (432K) and TikTok (1.5M). An influencer with numbers like that has a ready-made public to drive her book sales. It works the other way too. In a way, her fans helped write the book. She often refers to questions she received from followers or experiences they shared with her. Here’s an example:

“Some people ask me, ‘Why is it so important for people to know that they’re going to die?’ It’s a great question. When people choose to learn about their particular illness and what their death might look like, their fears often are eased as they acknowledge what’s happening. The people who are willing to discuss end-of-life issues and to accept that they’re going to die seem to carry about them a certain type of freedom, and they truly live their last days well. Their fear tends to decrease, and they tend to be freer and more full of life, even though they’re dying.”

I listened to McFadden read the text on Audible my first time through. She comes across as the same nurse Julie we know on social media. I don’t think any actress could have captured the conviction, empathy, and compassion we hear in Julie’s own voice. Typical of me, I liked this book so much I bought it a second time in print form. There were too many quotes I JUST HAD to have.

A Very Practical Book

At bottom, Nothing to Fear is a very practical book — a sort of “how to” guide to a peaceful death on hospice. It is user-friendly with lots of lists with numbers or bullets. Here’s one of my favorites from the “Grief” chapter:

THINGS NOT TO SAY WHEN SOMEONE IS GRIEVING

  • “At least she had a long life.”
  • “God needed her in heaven more than we needed her here.”
  • “Everything works together for good for those who love God.”
  • “He’s in a better place.”
  • “There’s a reason for everything.”

Three Themes Stand Out

  1. @hospicenursejulie

    Is the patient “clean, safe, and comfortable”? The answers to this question are always on minds of those on the hospice team. Julie reminds family members to strive to always make sure the patient is clean, safe, and comfortable.

  2. Dying peacefully can be like the process of childbirth. Nurse Julie is not the first to make this comparison. The hospice movement grew out of the same mindset as the “natural childbirth” revolution in the 1960s. Probably the first book to start us thinking about death positively, Elisabeth Kübler-Ross’s On Death and Dying, came out in 1969. Just like a baby “knows” how to be born, the dying body knows how to die. “Listen to the body” we read often in these pages. Again, from nurse Julie:

 

“After years as a hospice nurse, I can share this strange but true fact: our bodies are biologically built to die.

  1. We need to talk about death and dying for a peaceful death to occur. The quote above about why it is important for people to know they are going to die comes from the chapter titled, “Death Is Not a Dirty Word.” In another chapter titled “Advice for the Dying” we find:

 

“When you look death in the face, it loses its power to bully you. If your death has not yet been part of the conversation in your family or in your home, then your loved ones may not know it’s okay to talk about it with you. Bring it up first, so they know you’re okay with it, and when you do, don’t sanitize it. Use all the d-words: dying, death, dead, died.”

Spirituality in Nothing to Fear

As a hospice chaplain, I am always on the lookout for how an author handles things spiritual. Nurse Julie seems to be so typical of the scores of hospice nurses I have worked with. It varies widely, but 25% to 75% of hospice patients decline visits from the hospice chaplain. Therefore, often patients and their families get spiritual support from the nurse.

Throughout Nothing to Fear we see nurse Julie addressing spiritual concerns of her patients and their families. She devotes a whole chapter, “Deathbed Phenomena,” to stories about patients having visions of long dead relatives. Here’s her understanding of these experiences returning to her theme of the metaphor of birth:

“As much as we’d like to, we simply don’t understand everything about these encounters. They’re mysteries. For my part, I can say that my own few experiences have given me nothing but confidence that a better world awaits us. I do believe that there’s an afterlife because of experiences like these.… In many ways, it feels a lot like the wonder of birth. When I get to see a baby being born, I weep from joy. I look at that baby and wonder, ‘Where did you come from?’ When someone dies, I have that same feeling I get when babies are born. It’s a feeling of home. Of comfort.”

In the chapter titled “What the Dying Process Looks Like,” Julie encourages families to pause just after their person dies and allow this “sacred” moment to sink in. In a section headed, “Death Is Not an Emergency,” we find this:

“Whether you’re with your loved one when they die or you discover that they have died after the fact, there is nothing you have to do immediately. Simply notice that what has happened is sacred. Death is a natural part of life, and you have, in whatever way, participated in your loved one’s journey toward this sacred moment.”

This Book Is Just That Good

I place Nothing to Fear up there with Dr. Ira Byock’s Dying Well (1998), Dr. Atul Gawande’s Being Mortal (2017), and Katy Butler’s The Art of Dying Well (2020). This book is just that good. Nurse Julie combines the powerful bedside stories of Ira Byock and the boatloads of practical advice of Katy Butler.

Even with all these wonderful books, we still see a lot of unnecessary suffering at the end of life. Hopefully by exposing the TikTok generation to a more peaceful way of dying, Nurse Julie can help relieve more of that suffering.

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Ambivalent? Please, Make Up Your Mind! Or Not!

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The old man had come to our nursing home from the hospital in declining health with late-stage dementia. Almost immediately upon arrival, he had a medical crisis. Because he was a “full code” (everything should be done to save his life in a medical emergency), the nursing staff called 911, and he was off to the hospital again. I rode with him in the ambulance.

While waiting for the daughter’s arrival, the ER doc asked me, “What is his code status?” I told him.

Part of my role as the nursing home chaplain was to talk to all new patients and/or their families about advance directives and the possibility of a “No CPR” order. This resident was so new to us that I had no time to contact the daughter, the decision-maker in this case.

Explaining the need for a “No CPR” order

Photo by Kier in Sight Archives on Unsplash

The daughter arrived at the ER and went directly to her father’s side. He was responsive and not actively dying (though he would indeed die within a week). With her permission, I offered a prayer. I then asked her to come into the hallway so we could talk.

She was still dressed in business attire, having rushed over from a corporate or government office in the D.C. metro area. She seemed well-informed, intelligent, caring and involved. An ideal audience for my “No CPR” discussion.

I explained CPR and its lack of success in saving patients in her father’s condition. She seemed to understand and said she wanted her dad to be comfortable, knowing the end was near. I told her she would need to request a “No CPR” order from the physician.

Surprise indecision

Photo by SHVETS production

A few days later, the man returned to the nursing home. To my surprise, he was still a “full code.” I thought, “Didn’t she listen to me? She seemed to want comfort only and no CPR.” I called her and went through my standard spiel about the lack of benefits of CPR.

The daughter stopped me mid-spiel. She said, “I know CPR will not save my father’s life. I want him to die peacefully. But it is just so hard letting go.”

I wrote her off as “ambivalent.” I didn’t think she could make up her mind. Turns out, it was the emotional act of calling the doctor to request a “No CPR” order that symbolized her holding on — not letting go. She was trapped in ambivalence; she didn’t want her father to die…but she wanted him to have a peaceful death.

Frustration with ambivalent patients/families among providers

This story about this patient and his daughter came to mind as I listened to a recent GeriPal podcast, “Ambivalence in Decision-Making.” The two physician hosts discuss the topic with three bioethicists and a doctor. You can listen to the podcast, watch it on YouTube, or read a transcript. Dr. Josh Briscoe discusses this thoroughly in a substack post, “Ambivalence in Clinical Decision-Making: Or, Having Your Cake and Eating it Too.”

Healthcare providers — doctors, nurses, social workers, and chaplains — see this all the time. We can feel frustrated that people can’t make up their minds. Did I not explain it well enough? Do they need more information?

One of the guests on the podcast note, “Ambivalence should be a flag that something’s going on here, something’s important, and we should slow down and pay attention to that.”

They then go on to reframe this indecision as a good thing, saying that ambivalent decision makers “are really sitting with their options and sitting in that tension. And that for us, felt almost like [it was] a good thing. Look how seriously someone’s taking this decision, right? They really want to make sure they get it right and that it’s a choice they can live with.”

At the end of my story, the daughter did request the “No CPR” order. Her dad died a few days later, peacefully.

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Toby Keith Quit Chemo

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“I quit chemo…and it probably did more damage to me than the cancer did….” This was Toby Keith’s feelings about chemotherapy, according to his friend Brett Favre.

So, is the takeaway to never do chemo? Absolutely NOT.

Photo by Hiroshi Tsubono on Unsplash

Country singer Toby Keith was diagnosed with stomach cancer in 2021. About six months later, he announced to his fans on social media that he was receiving chemotherapy, radiation, and surgery.

“So far, so good,” Mr. Keith wrote in a June 2022 statement on multiple social media platforms. “I need time to breathe, recover, and relax. I am looking forward to spending this time with my family. But I will see the fans sooner than later. I can’t wait.”

Keith’s last concert in Las Vegas, (TobyKeith.com)

Indeed, he got back out there and played a series of shows in Las Vegas less than two months prior to his death a few weeks ago. In an interview right before he died, he said, “Cancer is a roller coaster. You just sit here and wait on it to go away — it may not ever go away.”

“[Keith] handled it with grace and faith and family and stood up to the cancer as good as you can,” said the former Green Bay Packers quarterback. “[But] I think in the end he was just tired,” Favre added.

We can hardly base treatment decisions on one man’s experience. Mr. Keith, diagnosed at age 60, made his decision based on the type of cancer he had and his own unique goals of care at that stage in the disease.

I am guessing if, during that last phone call, Favre asked, “Do you regret getting the chemo?” Keith might have responded, “Not at all.” Perhaps it bought him some time. Maybe, earlier in the treatment, he did not think it was causing “more damage… than the cancer.”

In my years as a hospice chaplain, I got to see patients after they had stopped treatments that were meant to cure the disease. Heck, you can’t get into hospice unless you stop curative treatments. Many expressed similar sentiments as Toby Keith. In medical-speak, “the burdens outweighed the benefits.” There, perhaps, was a time when the benefits were greater, but no more.

Or, to paraphrase Ecclesiastes in the Hebrew Bible, “There is a time for chemo and a time for no chemo.”

Let go and let be.

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

“God’s Child” Holding Still in Jail

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“Before every person there marches an angel proclaiming, ‘Behold, the image of God.’” —Jewish Proverb

It’s Wednesday. Any Wednesday. 2:00 PM.

Photo by RDNE Stock project:

I am sitting in silence with inmates at the Lafayette County Detention Center in Oxford, Mississippi. The local pronunciation of the name is “la-FAY-et.” The men are here awaiting trial, sentencing, or their “more permanent home” in the Mississippi or federal prison systems.

You can stand at the front door of my church, St. Peter’s Episcopal, and see the jail less than a half-block away. Some men in the church have been coming here for years, doing various outreach like starting a library or bringing Christmas cards for the inmates to send to friends and families.

Weekly Centering Prayer

About four years ago, I joined the group in a weekly “centering prayer” session, a form of silent meditation. Twice a month, we bring communion. I previously wrote a blog about me offering “The Serenity Prayer” to those gathered.

Our gathering was modeled after a group at Folsom Prison in California. The Prison Contemplative Fellowshiphas a great website with resources for those who take on a project like ours. They have also posted a 22-minute documentary video about the Folsom work titled Holding Still.

“God’s Child”

Ken begins every session here in Oxford by saying, “We want you to know that we know you are here. You are not forgotten.” In my mind, I recall the words of Jesus, “I was in prison, and you visited me.”

As the men gather each week, we hand everyone a name badge. Instead of “Hello, My Name is Hank,” each one says simply, “God’s Child.” We all wear one. Incarcerated and free.

The Jewish proverb says it best: “Before every person there marches an angel proclaiming, ‘Behold, the image of God.’” It refers to the story in the Hebrew scriptures about how humans were created in the image of God. All of us. Us do-gooder Episcopalian men and those jailed men — all the same image of God.

On the weeks we bring communion, we read from the Book of Common Prayer as part of the service:

“Lord Jesus, for our sake you were condemned as a criminal: Visit our jails and prisons with your pity and judgment. Remember all prisoners and bring the guilty to repentance and amendment of life according to your will and give them hope for their future. When any are held unjustly, bring them release; forgive us, and teach us to improve our justice. Remember those who work in these institutions, keep them humane and compassionate, and save them from becoming brutal or callous. And since what we do for those in prison, O Lord, we do for you, constrain us to improve their lot. All this we ask for your mercy’s sake. Amen.”

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Long-distance Caregiving is Difficult: Listen to Podcast

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I am the guest this week on “The Clarity Podcast” with Aaron Santmyire. Aaron is a missionary in Africa and started the podcast to help other missionaries with issues related to their work overseas. We talk about the unique difficulties of long-distance caregiving for family members with a serious and terminal illness. We cover the end-of-life decisions I have written about in my book, “Hard Choices for Loving People.”

Here is the link to the podcast:

https://player.captivate.fm/episode/386e2924-4d3a-4759-af07-97c58ebb7461

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Milestones

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Let’s start with a trivia question. What do the following words or phrases have in common?:

bomb, chronic disease, demonic, homework, influencer, milestone, remix, Roman Catholicism, swampland, unattainable, worthwhile

Milestone: 100K on 2017 VW Passat

The answer in just a moment. I emphasized “milestone” because I hit one last week. Our 2017 VW Passat passed 100,000 miles. I go into buying a new car with the hope of getting 200,000 miles out of it. We’re halfway there.

It’s funny how we have so many “milestones” in our lives are related to automobiles. Think of getting a driver’s license (for me, at 16) or that first car (for me, a 1969 Camaro). Heck, getting the Passat in September 2017 was marked by another milestone — Hurricane Irma in Florida.

My wife and I were signing papers in the VW sales office when we noticed a long line of people holding propane tanks across the street. My wife commented, “Look at all the people getting ready to grill on Labor Day.” The salesman responded, “Are you crazy? They’re getting ready for the hurricane.”

We were new arrivals in the state and failed to make the connection with the approaching hurricane. That memory is now a milestone — or rather two milestones: our first hurricane and the purchase of our ’17 Passat.

Defining milestones

Photo by Steven Brown on Unsplash

The best I can tell, the Romans were the first to use milestones along their roads. I found a photo of a milestone after the Roman era marking the distance to “London.”

There are two definitions of “milestone,” according to Apple Dictionary:

1) A stone set up beside a road to mark the distance in miles to a particular place.

2) An action or event marking a significant change or stage in development.

Synonyms of “milestone” include climacteric, climax, corner, landmark, milepost, turning point, andwatershed.

1990 – Fairfax Nursing Center. Photo by Hank Dunn

As a hospice and nursing home chaplain, I observed many milestones in people’s lives. The most obvious milestone for the patient and their family is the event of the death itself. But there were also milestones leading up to the death.

I would hear about the milestone of someone’s diagnosis, “I will never forget sitting in the doctor’s office and hearing ‘You have cancer.’” Or the milestone of the day someone entered a nursing home. A turning point at which the patient loses their freedom, and the caregiver is freed from the burden of constant caregiving.

Use rituals instead of stones

Milestones: A new Tampa home in 1961 for the Dunn family and upon selling it in 2000

I am a fan of using rituals to mark milestones in our lives. For a chaplain, of course, that can include a prayer at the bedside after the patient takes their last breath.

When my parents sold the home they had lived in for almost 40 years, I felt it was important to mark the milestone. Mom and I picked up Dad at the nursing home and went to the house before the closing to sell it.

I pushed Dad in his wheelchair from room to room, and we recalled the people and events that took place in each. We had a prayer of thanksgiving. We wept.

So, what does “milestone” have in common with “homework,” “influencer,” “swampland,” and those other words I listed above? The first known use of each in the English language occurred in 1662. Who knew someone could be an “influencer” hundreds of years before the internet existed?

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

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

Halloween AND The Advent of the Cowboy

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[This essay first appeared in a 1992 winter issue of Fairfacts, the newsletter of the Fairfax Nursing Center in Virginia, where Hank served as chaplain.]

 

Photo by Ardian Lumi on Unsplash

I am terminally practical and CHEAP. As l thought of dressing up for the annual Halloween costume parade at the nursing center, l had hoped to find something I could wear again. Then I realized I had been getting into Country and Western dancing since last spring. Bingo! I’d dress up as a cowboy.

I already had a pair of $19 boots (well, that’s what I paid for them while I was a freshman at the University of Florida in 1967). l bought my black jeans on sale at Sears for $10. I still needed a shirt and hat. I’ll spare you the details of shopping for these items, but my whole outfit did not cost over $50 and did l look good.

I was pleasantly surprised by the effect the costume had on women. A week after I put my cowboy ensemble together, I was dancing with a young woman from my church at a country dancing spot we both frequent. She said she liked my hat, then added, “I can’t wait to tell my mother I was dancing with a Southern Baptist minister.”

I guess her mother remembered the days when Southern Baptists didn’t dance because it might lead to worse forms of evil. I’m glad those days are past. I would hate to have my spirituality put into question just because I enjoy dancing.

The costume parade

From the Fairfax Nursing Center newsletter

The day of the costume parade at the nursing center arrived. I sauntered down the halls in my boots, black hat, and black attire. (I am guessing that is what cowboys do — “saunter.”) Once again, the cowboy outfit got attention in ways my normal work clothing never did. All was going well until, halfway through the parade, one of the elderly, female residents saw me and exclaimed, “Hank? Is that you? Dressed like THAT? And you’re a minister?”

At the time, I let it pass. But as soon as I saw this dear, old friend the following Monday she called me over and said, “I’m really sorry for what I said on Friday.” I couldn’t remember until she reminded me. She added, “It’s okay for ministers to dress like that. Will you forgive me?”

I said, “Oh, that was nothing. I didn’t let it bother me. Yet, I do think it is unfair that ministers are not expected to have a little fun and dress up on Halloween, even if it is a cowboy dressed in all black.” I told her I just wanted to be a real person. Approachable and down to earth.

Here’s the Advent part

Photo by Andreas Rasmussen on Unsplash

My breaking the rules of convention of what is expected of a minister has its theological grounding in the Christmas story. In the Christian tradition, God broke many of the rules in becoming embodied in Jesus, starting in Bethlehem. A savior born to a peasant? In a stable? Welcomed by lower-class shepherds?

This child would grow up and break the sacred Sabbath laws. He would say to live you must die. To receive, you must give away. And to be welcomed into the kingdom, you must welcome those rejected by the conventional religious wisdom.

The thought that God was in Christ suddenly lifts our humanity into the very presence of the divine. Cowboy boots and all.

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together, they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

The “Comfort” of Nothingness

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“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.

Photo by Ethan Hu on Unsplash

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’?”

Photo by Ankit Sood on Unsplash

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:

  1. 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.
  2. 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.

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together, they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Photo by Greg Rakozy on Unsplash

A Cave, A Deathbed, and “How You Made Them Feel”

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“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” —Maya Angelou

1975 – Vineville Baptist, Macon, GA, youth group on retreat at Toccoa, GA. Photo by Hank Dunn

My theory about what matters most in the ministry is based directly on Angelou’s quote: It wasn’t so much what I said or did during my 50 years in the ministry. It was more about that certain “something” that made the people I worked with feel a particular way.

I was a youth minister for the first five years after seminary. I loved the work and loved “my kids.” We keep in touch in a Facebook group. I asked the group about our ministry and the Angelou quote.

Interestingly, a few noted specific things I said or some teaching from the books we read. Okay, so maybe people DO remember the things you say. One fellow, who eventually became a teacher and hospice chaplain, commented, “I don’t see it as an either/or but a combination.”

1977 – High school student on a backpacking trip into the Shining Rock Wilderness, NC. Photo by Hank Dunn

Others confirmed my theory that how people felt was most important. Another one of my kids (who also went into the ministry and travels the world training substance abuse counselors) commented:

“Absolutely. Experiences of pleasure, pain, joy, and shame have the biggest impact on the wiring of our brains and, therefore, how our souls interpret and interact with the world. Hank, you created a safe space where we could experience the joy of God and His love for us in nature, community, and individually.”

Sitting alone in a dark cave

I would sometimes take the teenagers into the wilderness as a place of ministry. We rafted on the Chattooga River, where the movie Deliverance was shot. We backpacked all over the north Georgia and western North Carolina mountains. We paddled and camped for three days in the Okefenokee Swamp. And, my favorite, we explored caves.

Part of every caving experience always included time for silent introspection. I would separate the kids along a passageway, take their lights, and have them sit alone in the darkness for 30 minutes. Recently, a participant on one of those trips shared with me the journal he kept at the time. The now-retired pharmacist wrote in 1975:

“I was really nervous before entering the cave. I never really liked the idea from the start. But when all lights were put out, I felt one of the greatest feelings of inner peacefulness and calm.”

1977 – “The Squeeze” in Johnson Crook Cave, AL. Photo by Hank Dunn

Here’s part of a report I wrote about another caving trip with junior high kids, also in 1975:

“There was one girl who was very much afraid to sit alone. I sat her down at the end of the line, where I would be close to her. After approximately five minutes in the dark, she began crying and eventually called me. I went to her, comforted her, told her I was near, and asked her to continue to sit, think, and pray as she remained in her place. She calmed down and completed the half-hour in darkness. She later revealed that it was not so much that she was afraid of the darkness but afraid to face up some of the own things in her life.”

“…people will never forget how you made them feel.”

A deathbed and the gift of presence

1990 – Fairfax Nursing Center. Photo by Hank Dunn

Fast forward 25 years, when I was a hospice chaplain. I was called to the home of a woman dying of cancer. I had made several attempts to schedule a time to see her and her family, but they were always busy and put off letting me in. Now, she was in her last hours. It was time to let the chaplain in.

When I arrived, a family friend sat with me in the living room and explained what was happening. We then went into the bedroom where the woman lay dying. Her husband sat beside her, and a nurse was not far away. I said very few words. There was little to say. I asked the husband if I could offer a prayer. He said, “Please do.” I finished my prayer, and he asked, “Can we say the Lord’s Prayer?” “Of course,” I replied, and we all prayed.

I left the bedside, and the friend followed me to the living room. I stopped to say goodbye, and this woman threw her arms around me, hugged my neck, and said, “You are so wonderful. That is just what we needed.” My first thought was, “Boy, is this job easy.” Anyone who could recite the Lord’s Prayer could have done what I did in that room. But then, I was so grateful to be invited into this moment in this family’s life.

I think Maya Angelou and I are on to something. People always remember how you made them feel.

________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together, they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

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