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Archive for the ‘Emotional & Spiritual Issues’ Category

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

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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”

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“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”

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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)

Never Let a Good Plague Go to Waste

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“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 16th 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

“Giving Up, Letting Go, and Letting Be” — A Poem

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Giving Up, Letting Go, and Letting Be, By Hank Dunn

— Giving up implies a struggle…

Letting go implies a partnership…

Letting be implies, in reality, there is nothing that separates.

— Giving up says there is something to lose…

Letting go says there is something to gain…

Letting be says it doesn’t matter.

— Giving up dreads the future…

Letting go looks forward to the future…

Letting be accepts the present as the only moment I ever have.

— Giving up lives out of fear…

Letting go lives out of grace and trust…

Letting be just lives.

— Giving up is defeat at the hands of suffering…

Letting go is victory over suffering…

Letting be knows suffering is often in my own mind in the first place.

— Giving up is unwillingly yielding control to forces beyond myself…

Letting go is choosing to yield to forces beyond myself…

Letting be acknowledges that control and choices can be illusions.

— Giving up believes that God is to be feared…

Letting go trusts in God to care for me…

Letting be never asks the question.

 

This poem can be found in both Hard Choices for Loving People and Light in the Shadows.

Photo by JOHN TOWNER on Unsplash

Life and Death as Metaphor – Part 2

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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

“Do Nothing” and “Last Minute Care”…Oh my!

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There is a lot of misinformation out there about palliative care and hospice. I just read an interesting blog post. In it, Dr. Cynthia X. Pan describes how she entered “palliative care” in Google Translate and got Chinese characters back. She then translated those characters back into English, and it came back: “do nothing care.”

Wait… there’s more. She did the same thing with “hospice” and it came back as “last minute care.”

This not just a problem with Google Translate or the Chinese language. A lot of people think this about these very appropriate and helpful medical care approaches. I remember back in my nursing home chaplain days when I was just getting my start talking to patients and families about “No CPR” orders I learned an early lesson.

Families and patients hear, “No Care” when you say “No CPR.” They might say, “You mean when mom is dying you are going to just do NOTHING!”

We do lots for dying patients

So, I started leading the conversation with “We do lots for dying patients. We keep them clean and dry. If they are having a hard time breathing, we clear their airway and give them oxygen. We give them pain medications. You can be here to comfort your mom, even get up in bed with her. We just are not going to beat on her chest when her heart stops. That is what the ‘No CPR’ order is about.”

But like Google translator many people hear, “palliative care” and think “do nothing care.” Palliative care is very aggressive keeping a patient comfortable and meeting social and spiritual needs.

Likewise, so many people think hospice is for the last day or two of life, even though Medicare offers to cover a patient for six months (or more). Late referrals are a real problem in hospice. We do our best work if we have, at least, weeks if not months to care for a patient. More time means better pain control, getting the most appropriate equipment into the home, more time for social and spiritual support.

So help me get the word out there. Palliative care is LOTS of care and hospice care is MONTHS of care.

Update: Google Translate seems to have fixed both translations. Progress!

Life and Death as Metaphor

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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

Letting Go of Distractions for Lent

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  • “There are too many mediocre books which exist just to entertain your mind. Therefore, read only those books which are accepted without doubt as good.”  —Seneca, d. 65
  • “Life seems but a quick succession of busy nothings.”  —Jane Austen, d. 1817
  • “The difference between real material poison and intellectual poison is that most material poison is disgusting to the taste, but intellectual poison, which takes the form of cheap newspapers or bad books, can unfortunately sometimes be attractive.”  —Leo Tolstoy, d. 1910

It has been long recognized that occupying our minds with things trivial crowds out what is most important. People who lived centuries ago thought there were too many unimportant distractions. Imagine that. Seneca, Austen, and Tolstoy didn’t even have to contend with smart phones or Netflix.

The phone itself was a major source of the unimportant

As Ash Wednesday and Lent approached this year, I read a newspaper article (on my phone) with suggestions about reducing unimportant distractions. What especially caught my notice was how the phone itself was a major source of the unimportant.

I charge my phone on my nightstand, and I am my own worst enemy at night. I go to bed reading articles or checking social media. If I wake in the middle of the night and cannot get back to sleep, I read the news on my phone. I tend to be a politics and news junkie so I just HAVE to read the latest. So, I often find myself reading a political article in the middle of the night that leaves me mad or sad or both.

I decided it was time to remove the distraction. Wanting to get “spiritual credit” for this completely sensible mental health move, I gave up the phone by my bed at night for Lent. The simple solution was to put the phone across the room at night. It was actually easier than I thought it would be.

I’m back to keeping printed books on my nightstand to read. If I can’t sleep, I meditate or pray. What a novel approach.

Photo by William Hook on Unsplash

 

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.

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:

  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.

Photo by Greg Rakozy on Unsplash

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