Emotional & Spiritual Issues | Hank Dunn

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Archive for the ‘Emotional & Spiritual Issues’ Category

Milestones

Posted November 16, 2023 by [email protected]

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).

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Halloween AND The Advent of the Cowboy

Posted October 31, 2023 by [email protected]

[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

Posted October 19, 2023 by [email protected]

“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:

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

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

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Photo by Greg Rakozy on Unsplash

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

Posted September 21, 2023 by [email protected]

“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.

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“Grace” From Prehistory to Today

Posted September 15, 2023 by [email protected]

“All human nature vigorously resists grace because grace changes us, and the change is painful.” Flannery O’Connor

“Grace is always available to us, only we are not always ready to receive it.” Kabir Helminski, The Knowing Heart: A Sufi Path of Transformation

Photo by NEOM on Unsplash

“Grace” found in the wilderness

How did early humans sense the world they inhabited?

I have spent hundreds of nights sleeping in the wilderness. I have bedded down in caves, on mountaintops, on beaches, in the woods, on platforms in swamps, on riverbanks, and on prairie grasslands where the buffalo roam. I have had to narrow down my equipment to essentials I can carry on my back or in my kayak. I have had a few near misses with disaster that left me grateful just to be alive. But more often, I am incredibly moved by the beauty surrounding me — or rather, the beauty that I am immersed in.

1999— Hank on Mr. Democrat, Colorado

In 1999, at 9 AM on a September morning, after hours of climbing, I had reached the summit of the 14,148-foot Mt. Democrat in Colorado. I was alone. I wrote the following about this moment:

“I stood alone, drinking in the vastness of the alpine scene before me. I stood alone and thought there is nothing in my life that challenges me so physically — pushes my endurance and determination. I stood alone, knowing I receive more nourishment for my soul in the out-of-doors than any other place I could stand. I stood alone and felt a joy come up from inside of me. And the words that came out were, ‘Thank you, Jesus. Thank you, Jesus, for my life. Thank you for this wonderful world. This wonderful world.’”

To sum up these thoughts, I was overwhelmed by GRACE.

Did early humans have a similar sense of wonder and gratitude?

1976— Sleeping in a cave, Alabama

I may spend an inordinate amount of time contemplating the early hominids’ transition from lower animals into modern humans or homo sapiens. I even made a two-minute video while kayaking on a lake, pondering whether ancient humans thought the universe was to be feared or grace-filled.

I say “inordinate” because it is what it is. Or rather, we are what we are — thinking beings who walk upright, possess an opposable thumb, know we will die, etc. Why waste intellectual energy on something that happened hundreds of thousands or millions of years ago?

Yet I can’t help imagining our early ancestors had a sense of gratitude. I can imagine they were taken by the beauty of the natural world, not unlike how a beautiful sunset moves us today. I can imagine them being grateful for the bounty of the earth that sustained them, whether it was for the fruits and nuts hanging on trees or the small game near their dwellings.

Did they experience the world as I did on Mt. Democrat? Did they marvel at the gift of a newborn baby? What did they feel when a tree fell to the ground, just missing where they stood? Were they grateful to be alive, thankful they were granted grace?

But, perhaps, early human creative minds didn’t stop at just feeling grateful. Maybe we asked questions. Why was I not killed? How did I receive bounty from the earth? One possibility we came up with was there must be Someone responsible for our good fortune — Someone GREATER than us but sort of like us.

Why are we alive in the first place? How are we surviving so much that could kill us? “God” was our answer.

God or no God, grace abounds

Try this thought experiment: Suspend your traditional religious beliefs for a few moments and contemplate what drove our species to start thinking about God. Without the religious explanation, we might conclude that our ancestors did not believe in God. Heck, at one point, they did not even know they existed in the sense that humans are now self-aware.

Believers will say, “Those early humans were just becoming aware of the God who started it all ‘In the beginning.’” That may well be. But God or no God, grace abounds — then and now.

“Amazing Grace” sung by all

2023— Sipsey Wilderness, Alabama

A curious phenomenon in our time is the popularity of the hymn “Amazing Grace.” Secular nonbelievers and devout Christians can sing the words and be moved. Written in 1779 by John Newton, a former captain of slave ships who would become an abolitionist, the song speaks of “grace that saved.”

Interestingly, “God” or the “Lord” is not mentioned until the fourth verse. It is grace that saves, as we see in the second verse of the hymn:

Thro’ many dangers, toils, and snares, I have already come;

‘Tis grace hath brought me safe thus far, And grace will lead me home.

No wonder the song has such widespread appeal. Grace is universal. Some say that grace comes from God. For others, grace comes from simply being part of this wonderful world. Grace is present either way. My theory, in summary, is that humans started considering the existence of GOD to explain the GRACE of life itself.

(Cover Photo by NEOM on Unsplash)

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A Death Expert on His Own Deathbed: “Joy and Hope and Trust”

Posted August 18, 2023 by [email protected]

Two months after he died, Ernest Becker won the 1974 Pulitzer Prize for General Nonfiction for his book The Denial of Death. I guess, since he was dead, he was not a winner, but his book was.

I’ve been thinking lately about Becker and his book and the profound influence they both have had on my life. I referenced his thoughts in a previous blog titled, “Our Struggle with Dying Starts When We’re Toddlers.”

Best-selling author, Mark Manson* includes The Denial of Death as one of “7 Books That Will Change How You See the World.” In Manson’s playful way he writes:

If This Book Could Be Summarized in An Image, That Image Would Be: The grim reaper silently laughing to himself watching you build an elaborate Lego set called “Life,” and you turning around and saying, “Stop laughing, this is important!”

The Denial of Death

I’ll get to Becker’s deathbed below but first a few quotes from his classic. Note that Becker wrote in 1973 just as we were becoming aware that we no longer refer to all humans as “man.” I know better now but I will let his original words stand.

“The main thesis of this book is…: the idea of death, the fear of it, haunts the human animal like nothing else; it is a mainspring of human activity—activity designed largely to avoid the fatality of death, to overcome it by denying in some way that it is the final destiny for man.” (p. ix)
“The irony of man’s condition is that the deepest need is to be free of the anxiety of death and annihilation; but it is life itself which awakens it, and so we must shrink from being fully alive.” (p. 66)
“In the prison of one’s character one can pretend and feel that he is somebody, that the world is manageable.” (p. 87)
“Modern man is drinking and drugging himself out of awareness, or he spends his time shopping, which is the same thing.” (p. 284)

You may argue, “I DON’T spend any of my time thinking about my certain death.” I think Becker would say, “You just proved my point.”

Psychology Today and the deathbed conversation

Soon after The Denial of Death arrived in late 1973, Sam Keen, one of the editors at the prestigious Psychology Today magazine, called Becker’s home hoping to set up an interview. Keen explained how the deathbed interview came about: “I called his home in Vancouver to see if he would be willing to tape a conversation. His wife Marie informed me that he had just been taken to the hospital and was in the terminal stage of cancer. The next day she called to say that Ernest would very much like to do the conversation if I could get there while he still had strength and clarity. So I went to Vancouver with speed and trembling, knowing that the only thing more presumptuous than intruding into the private world of the dying would be to refuse the invitation.”

Here are a few quotes from THE expert on death as he lay dying:

“Each of us constructs a personality, a style of life or, as Reich said, a character armor in a vain effort to deny the fundamental fact of our animality. We don’t want to admit that we stand alone.”

“We do anything to keep ourselves from the knowledge that there is nothing we can do.… Well, this is the control aspect of character armor which is so vital to the human being.”

“Joy and hope and trust are things one achieves after one has been through the forlornness.”

Keen noticed that Becker kept referring to “God” when divine transcendence had not previously been part of Becker’s writings. The dying man responded:

“I don’t feel more religious because I am dying. I would want to insist that my wakening to the divine had to do with the loss of character armor.”
“At the very highest point of faith there is joy because one understands that it is God’s world, and since everything is in His hands what right have we to be sad—the sin of sadness. But it is very hard to live that.”

Ernest Becker died in March 1974 at age 49. Two months later his book was awarded the Pulitzer Prize.

*Manson is author of The Subtle Art of Not Giving a F*ck, over 8 million books sold.

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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 First Stage is “Denial”

Posted August 11, 2023 by [email protected]

“Denial is a protective device, a shock absorber for the soul. It prevents us from acknowledging reality until we feel prepared to cope with that particular reality.… We do not let go of our need to deny by beating ourselves into acceptance; we let go of our need to deny by allowing ourselves to become safe and strong enough to cope with the truth.” Melody Beattie, The Language of Letting Go

“Denial is a sacred place. Denial allows us to stay in control. It is a ledge we sit on above a cliff. Sometimes we need to stay there a little longer.” Chaplain Rev. John, quoted in “Finding Faith Through Listening,” by Andrea L. Merrill, MD, JAMA Online, July 13, 2023

Denial can cut off meaningful conversations

We were told to take off our hospice name tags before entering the home because the wife didn’t want her husband to know he was dying. On my one and only visit into the home, the man appeared yellow because of the progression of liver cancer. Even his eyes were yellow, and it turned out he was within days of dying.

When I first walked into the home, I sat alone with the wife in the living room. She was very comfortable talking about her husband’s impending death. I asked her, “What is all this about not wearing our pins or talking about death? Does your husband know he is dying?” She said, “Oh, yes, he knows he is dying.” I asked, “How do you know he knows?” She responded, “Because he asked me.” I asked how she responded to him and she had told him, “Not while I’m around.”

I suggested, “What if you had said, ‘Yes, you are dying and I’m going to miss you. We have had a wonderful marriage and I love you.’” She said, “I couldn’t do that. That would be too painful.”

Living in the shadow of a life-threatening illness is difficult. Worse yet, when it becomes clear that there is going to be no recovery, we naturally resist any thought of what really lies ahead. Understandably, this wife wanted to avoid such a painful discussion. That is why we have such a strong urge to deny the reality of the incurable nature of the disease. We want to avoid the emotional pain of saying good-bye. The man died while his wife was at the grocery store—remember she said, “Not while I’m around.”

Denial is normal

Photo by Ben White on Unsplash

Denying the reality of the terminal phase of a disease is normal, expected, and perhaps even necessary. It gets us through the initial shock of such a fate. Acknowledging the truth may cause anger and depression, which are, again, normal responses.

The father of a twenty-nine-year-old son who died of leukemia told me, “I lived in denial of the certainty of my son’s death to the very end. I was completely surprised when he died. I feel so guilty about that denial.” I thought guilt was a strange feeling for such a natural response as denial, so I asked him about that. He said, “I felt guilty because if I had accepted that he was dying, there were so many other things I would have said to him, but I lost that opportunity.”

[This blog post was adapted from my Light in the Shadows: Meditations While Living with a Life-Threating Illness.]

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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.

“He coded, but God brought him back to us!”

Posted July 27, 2023 by [email protected]

Can we “know” what God wants?

His last days were filled with great suffering, played out publicly on social media and in the national news from March until his death on May 19^th. Here are the descriptions of the patient’s condition in the last weeks of life:

April 26th, GoFundMe post: “He has now lost 80 pounds and subsequently continues to struggle with extreme weakness.… He’s on strong IV antibiotics three times a day.… He has intermittently also suffered [from] kidney issues and [has] been on dialysis. In addition to this, he is having heart and lung concerns, sores from being in bed for 4 months and depression.”
April 30th, Facebook post: “He was admitted to the hospital tonight with acute kidney failure and dehydration.”
May 9th, Facebook post: “He will be having emergency surgery tomorrow. Still in ICU fighting the infection and organ failure.”

Later, his wife refused to withdraw life support, claiming on Facebook, “He’s a fighter, and his will is strong even if his body isn’t. God is our hope.”

What does God want in a VERY serious illness?

Can we know what God wants? I was drawn to this story reading the pleas for people of faith to pray for a miracle when one could read between the lines and understand that this man was dying.

Let me be clear: If I were the chaplain in this story, I would approach this patient and his family compassionately and without judgment. As their chaplain, my role would be to meet this family where they are, not where I want them to be.

But I was not their chaplain and now have the luxury of pondering this situation from afar after it ended.

Is God ONLY for saving a life?

I find many things curious about the language and theology expressed publicly.

Let’s start with an earlier GoFundMe post from March: “He coded, but God decided that it was not his time to go and brought him back to us.” Evidently, the patient’s heart failed, yet he continued to live after the intervention of CPR.

The family saw this as a sign of God’s intervention. The skeptic might say, “God did not decide the patient should not die during that code. Human intervention went against what seemed to be God’s plan.”

Who am I to say God did or did not intervene? I stopped speaking for God years ago.

I believe it is a slippery slope to claim that God is saving the life of someone in multiple system failure when the death expectancy rate for all of us is 100%.

Perhaps “God called him home?” Acceptance or crisis of faith?

There is another way people of faith might approach such circumstances. Other families I have ministered to chose to forgo heroic medical interventions. When the patient died, they said, “God called them home.”

I am guessing that this patient’s wife probably accepted “God’s timing” when her husband finally died. I hope that is true. People who feel God is in control of everything can often shift to acceptance when death eventually occurs.

But for some who expect a miracle, death can cause a crisis of faith. I wrote about this in a previous blog, “God has a lot of explaining to do.”

What is keeping this patient alive? The machines or God?

May 7th, Update! “The doctors are continuing to try and prepare me for the worst. And I continue to explain to them that [we] are people of faith and that our God has the final say. I am not in denial about what’s happening to him or blind to what the medical reports say…. I just know that the God I serve is greater than any infection and more powerful than any organ failure.”

There would have been a time long ago when death was not optional. Antibiotics and other medical interventions can now cure many who would have died in another time and place.

These same modern medical treatments can also prolong the dying process, sometimes at the cost of great pain and suffering for the patient.

Other hopes besides “not dying”

I try to help families see that there are other outcomes to hope for other than “not dying.” Having a peaceful death, being pain-free, or spending quality time with family. This is what I did with the man who told me, “God has told me my wife is not going to die.”

I don’t know how the end came for this man. I only saw the announcement of his death and an obituary in the New York Times, after which the Facebook and GoFundMe pages went silent.

Hopefully, all involved, living and dead, are now at peace.

[Cover photo by Richard Catabay on Unsplash]

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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.

Finding Meaning in Suffering is Difficult — But Can be Done

Posted April 7, 2023 by [email protected]

Why do terminally ill patients choose to end their lives early?

As I have done for the last 25 years, I quickly opened the most recent annual “Oregon Death with Dignity Act: 2022 Data Summary.” Yes, it has been 25 years since Oregon made “medical aid in dying” (MAID) legal. At the time, this was often referred to as “physician assisted suicide” (PAS). In Oregon, and other jurisdictions, a physician can prescribe a lethal medication for terminally ill patients who request it and who appear to be within six months of dying. There are safeguards to assure patient safety and to address other concerns.

For 25 years this list has been part of my lectures

My interest, each year, is drawn to the list of “End-of-life concerns.” I added this list to my lectures and writings as I went about the country speaking on making end-of-life decisions. These responses are the answers to the question, “Why did the patient want MAID?”

Photo by Claudia Wolff on Unsplash

Of the seven “concerns” listed, “Losing autonomy” is mentioned by 90.3% and “Less able to engage in activities making life enjoyable” is second at 90.0%. Next to last is “Inadequate pain control, or concern about it” (28%). You would think that pain would be one of the main reasons people want to end their lives sooner — to avoid pain. (See below for the whole list.)

The piece that has made it into my lectures and writings is the concern about “losing autonomy.” Understandably, people want to be in control. I am all in for controlling the things that can be controlled like physical pain. We often think about “pain and suffering” as two related issues as in, “Pain is inevitable, suffering is optional.” Suffering is the emotional and spiritual struggle that can accompany pain.

Seeking autonomy and avoiding suffering

At the risk of over simplifying, these patients are choosing an early exit to avoid suffering. Their greatest fear is losing the ability to make autonomous choices. I honestly do not know what I will do when I face my last days, so I have no judgement of these patients who hasten their deaths.

I have never lived in nor worked in a jurisdiction that allows for MAID. A few times, I ministered to a patient who was considering suicide. We asked, “What is it that makes you want to end your life?” We found that once we addressed their concern, be it pain or care of the family, the patient no longer wanted an early exit.

I write this on Good Friday, as Christians remember the sufferings of Jesus. Over the centuries Christians have found meaning in His death. Reducing pain and suffering in dying patients can be pursued while, at the same time, looking for ways to find meaning in the midst of suffering.

Here are some quotes I have gathered to share with you to make sense of suffering, and hopefully prepare both you and me for own future suffering.

“Suffering is the state of severe distress associated with events that threaten the intactness of person.” Eric Cassell, MD. The Nature of Suffering and the Goals of Medicine
“If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete.… Suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice.” Viktor E. Frankl (1905-1997) Holocaust survivor and author of Man’s Search for Meaning
“Our avoidance instinct is also due to the fact that our culture has decided that suffering has no value.” Frank Ostaseski, Buddhist teacher and founder of the Zen Hospice Project
“You must remember that no one lives a life free from pain and suffering.” Sophocles (497-406 BCE)
“Whoever got this idea that we could have pleasure without pain? It’s promoted rather widely in this world, and we buy it.” Pema Chödrön, Tibetan-Buddhist teacher and author.
Flannery O’Connor

“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.” Flannery O’Connor (1925-1964) died after living 13 years with Lupus.
“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!” Elaine M. Prevallet, S.L., Benedictine Nun
“Terry, dying doesn’t cause suffering. Resistance to dying causes suffering.” Terry Tempest Williams quoting her dying mother in the book Refuge.

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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.

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End-of-life concerns Number (%)

Losing autonomy 2,216 (90.3)

Less able to engage in activities making life enjoyable 2,208 (90.0)

Loss of dignity 1,666 (71.7)

Burden on family, friends/caregivers 1,179 (48.0)

Losing control of bodily functions 1,077 (43.9)

Inadequate pain control, or concern about it 686 (28.0)

Financial implications of treatment 125 (5.1)

How Come so Much Aggressive End-of-Life Care?

Posted March 27, 2023 by [email protected]

Photo by Vidal Balielo Jr. via Pexels.com

The man was riddled with cancer. The paramedics continued CPR as they wheeled him out of his nursing home room. I drove his wife to the emergency room. This is what the family wanted, although I am not sure the patient would have chosen it. When the doc came to the waiting room to tell the family he died, they congratulated themselves on “trying everything.”

Sadly, aggressive care in the last days of life is all too common. Perhaps, my experience with this patient was an extreme example. Aggressive care can include an ICU stay, surgery, chemotherapy or radiotherapy. New research shows that about 60% of elderly Americans with metastatic cancer receive some sort of aggressive care in the last 30 days of life.

60% of elderly, advanced cancer patients receive aggressive life-saving attempts in the last month of life

Photo by Matej via Pexels.com

This research was recently published in JAMA Network Open and looked at the last 30 days in the lives of 146,329 people who were over 65 and had a diagnosis of metastatic cancer, in other words, very sick, frail elderly folks with an average age of 78.2 years.

I was put onto this research by a great article from Paula Span in the New York Times. She writes a regular piece called, “The New Old Age,” and this was one in her series. What is not clear from the research is “Why?” Why are so many, obviously dying old folks being dragged through more treatments which are normally reserved for those seeking cure?

Some may want this treatment, but I doubt it

Photo by Kampus Production via Pexels.com

It is true that some of these aggressive treatments can be considered palliative, for example, radiation to reduce the size of a tumor and hopefully reduce pain. It is also true, that some of this aggressive treatment is actually what the patient wanted. Perhaps, they were made fully aware of their grave condition but chose treatment that had little chance of helping them. Both of these possibilities are probably in a small minority of this aggressive care.

Spirituality raises its head again

The JAMA study concluded, “The reasons for aggressive end-of-life care are multifactorial, including family involvement, religion and spirituality, patient preferences, patient-clinician communication, and health care delivery systems.” I would add, the default mode in our healthcare system is to do stuff, when faced with a problem. That “stuff” is usually doing more of the same rather than shifting to comfort care only.

My chaplain antennae always perk up when I see “religion and spirituality” mentioned in any medical journal article. I am back to my oft-repeated premise — for patients and families, end-of-life decisions are primarily emotional and spiritual. People need to learn when it is time to let go and just let things be.

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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.

Archive for the ‘Emotional & Spiritual Issues’ Category

Defining milestones

Use rituals instead of stones

The costume parade

Here’s the Advent part

Their dead father sent a snowstorm

How is the thought of nothingness “comforting”?

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

“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

Sitting alone in a dark cave

A deathbed and the gift of presence

“All human nature vigorously resists grace because grace changes us, and the change is painful.” Flannery O’Connor

“Grace is always available to us, only we are not always ready to receive it.” Kabir Helminski, The Knowing Heart: A Sufi Path of Transformation

“Grace” found in the wilderness

Did early humans have a similar sense of wonder and gratitude?

God or no God, grace abounds

“Amazing Grace” sung by all

The Denial of Death

Psychology Today and the deathbed conversation

Denial can cut off meaningful conversations

Denial is normal

Can we “know” what God wants?

What does God want in a VERY serious illness?

Is God ONLY for saving a life?

Perhaps “God called him home?” Acceptance or crisis of faith?

What is keeping this patient alive? The machines or God?

Other hopes besides “not dying”

Why do terminally ill patients choose to end their lives early?

For 25 years this list has been part of my lectures

Seeking autonomy and avoiding suffering

60% of elderly, advanced cancer patients receive aggressive life-saving attempts in the last month of life

Some may want this treatment, but I doubt it

Spirituality raises its head again

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