Emotional & Spiritual Issues | Hank Dunn

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Don’t Tell Me, “God protected you!”

Posted January 12, 2023 by [email protected]

Morning paddle the day before the disaster.

I had a nearly fatal accident last week. In the end, I just got soaked from a capsize of my kayak and lost some items. I thank God I am alive. After reading my story, some very well-meaning people may say, “God protected you!” Being a very devout man and former healthcare chaplain…that is the LAST thing I’d want to hear.

Setting the stage for disaster

Access to take-out through high water

I took advantage of a break in my schedule, and several good weather days ahead, to go camping, kayaking, and biking. I was off to a new place for me, Bogue Chitto State Park in Louisiana, not far from the Gulf Coast. The park stretches out over several miles of the Bogue Chitto River.

The river was at flood stage, and moving very fast. I scouted it out for two days and estimated that it would take me an hour to paddle from the put-in to the take-out. The only unknown was what exactly the take-out would look like.

I took two trips there to assess it, by car and by bike. I could see the river, but I couldn’t see the riverbank where I had to take out because of the high water. So, I dropped a pin on the map on my phone so I’d know when to look for it and set off to start the paddle.

Disaster strikes

Pleasant, sunny break on sandbar on Bogue Chitto River, LA

It was a sunny but cool day. I had no problem navigating the high, swift water, and even took a pleasant break on a sandbar.

As I approached the take-out and got closer to the bank, the strong current slammed me sideways into a downed tree and I flipped over and went totally under. I was in my sit-on-top kayak so there was no popping back upright. There was also no righting the kayak because I have no idea how to do an Eskimo roll. Once I came above water again, I found my boat and paddle.

The next task was to get out of the fast-moving water. Swimming with considerable effort, I found a fallen tree near the bank and was able to hold onto it. I spent several

At this place on the bank I made my self-rescue.

minutes, still in the water, just catching my breath. Was it two minutes or five minutes? Those few minutes also gave me time to think, “This is not a good situation.” When I left, I had told no one I was paddling and when to expect me back.

Again, with much effort, I swam in water that was mostly over my head, pulling my boat from tree to tree until I found solid ground. I knew I was close to the take-out, so I walked through the woods dragging my boat until I got to the road and eventually to the take-out. I had left my bike there earlier, and was able to ride the several miles back to my car.

Some things went right…

Fortunately, I did a lot of things right. I had on my life jacket, cinched up tight. It literally saved my life. I have always worn a fanny pack attached to my body for things I did not want to lose. In it was my car key.

I also had secured my phone in my life jacket. I had it out moments before to check for the take-out and set it on the floor of the kayak. Then I thought, “Maybe I ought to secure this puppy.” I am so glad I did.

Journal was baptized after the capsize.

Because of the cool temperature, I wore wet suit pants and socks. My t-shirt and turtleneck were synthetic material, which retains some warmth even when wet. I never felt cold, partly because I was working so hard.

My biggest regret, besides getting too close to that fallen tree, was I did not secure my cochlear implant processor. I lost it in the tumble. Fortunately, I had my old processor in the car as a backup. I lost my hat and a bottle of water, too.

I never had a fear that I would die. I could have, but my life jacket saved me. There was a moment when I got separated from my boat that I feared I would not be able to get back to it and be dragged down river to who knows where. Thankfully, I was able to use my paddle to pull the boat back toward me.

It’s “No problem”

Sitting at camp that night, I was glad to be alive and warm by the fire before me. I reviewed the events of the day. I thought about my friend, Wayne, who once reframed life’s challenges for me simply using the phrase, “No problem.”

For a situation in which you have no control: “No problem, there is nothing you can do about it.” For a situation in which you CAN do something about it: “No problem, take steps to figure it out.”

For me, this mishap was the latter, and I got through it with a series of “no problems.” Submerged in the water? No problem, get above water. Lost my boat? No problem, pull it back with my paddle. Need to avoid being swept downstream? No problem, swim to shore, relax, catch my breath. Got to get back to the car? No problem, get into the woods and find the road.

That’s not what I was thinking during the unfolding disaster, everything happened so fast I had no time to think of anything but the task at hand. But you know what they say about hindsight.

A real miracle

In my 45 years of paddling, I have never swamped. I always prepare for the possibility, thus the attached and secure fanny pack, the life jacket, and wet suit. But I also always thought it was a remote possibility, thus I did not secure my cochlear device. The next morning, I typed a long journal entry on my computer (my journal got soaked in the spill). Here is an excerpt:

“I have thought about what a disaster yesterday could have been. Had I been swept underwater and pinned in a sieve of the branches of the tree, I would have been dead in minutes. They might not have found my body for weeks as the flood waters receded. A similar accident took the life of a very skilled kayaker in Great Falls, Virginia in 2013. She got pinned under water and drowned.

“So many random, chance happenings prevented the capsize from becoming a disaster. When I first started paddling years ago I asked canoe guide, Ralph Shaw, why flood waters on whitewater rivers are so dangerous. After all, when the water rises all the rapids disappear. He said it is the volume of water that is the danger. That is what toppled me yesterday. Once the massive flood caught the edge of my boat, I was at the mercy of those waters….

“…I can hear some well-meaning people saying to me, ‘God protected you.’ I don’t want to hear that. The reason being is the terrible implication for all those who do drown in similar situations. Or what about hundreds of my patients who died while I was a nursing home and hospice chaplain? Following this reasoning, God did not protect them. It is a view that God picks winners and losers.

“I CAN say, ‘I thank God I am alive.’ But not that God saved me last week. I think of Cheryl Strayed, whom I wrote about in my blog, when she just said, ‘Thank you,’ at the end of her 1,000+ mile hike on the Pacific Crest Trail. I am simply glad to be alive every day.”

**The miracle is not that I did not die last week — the real miracle it is that I am alive in the first place.**

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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.

She Fasted to Hasten Death — VSED

Posted October 27, 2022 by [email protected]

Rosemary Bowen was not terminally ill. She hastened her death by fasting. It took seven days.

Ten states and the District of Columbia allow for “medical aid in dying” (MAID). In those jurisdictions, terminally ill people with six months or less prognosis can get a prescription for a lethal medication in order to hasten their deaths. But what about patients not in one of these states or those whose life expectancy is greater than six months? VSED is an option.

Voluntarily Stopping Eating and Drinking (VSED) can be practiced by those seeking an earlier death. It’s what Rosemary did.

Rosemary Bowen, at 94, was living independently. She said she had had a wonderful life and did not look forward to a long, slow decline toward death. For years, she had been telling her children, “That her life would not be worth living if she had to depend on caretakers to feed her, dress her, and take her to the toilet.” Then, it happened. She fractured her back and went to rehab but was unable to live independently. That was enough for her.

Rosemary asked her daughter to video her so she could show others how to take control of their dying with VSED. The 16-minute video is available on YouTube.

VSED is a legal and, in my view, a morally acceptable way to end one’s life. It is based on several established principles in medical ethics. Affirming “autonomy” we allow patients to make decisions to reject any medical treatment — even treatments that could potentially save one’s life. Also, medically-supplied nutrition and hydration (for example, by a feeding tube) have long been understood to be a treatment that could be refused.

What Rosemary did was take these one step further as she choose to refuse food and water. She did this basing her decision on her own values:

She valued independence above all else. Being dependent on others was an unacceptable quality of life.
She did not want to be a burden on her family.
She did not want to go the route of many of her friends who spent years declining in assisted living or nursing homes, facing one medical setback after another.

The importance of medical support during the process

Do not try this without medical support. Rosemary was able to get a hospice to care for her in her last days. Palliative care is also available to ease burdensome symptoms like pain and thirst. See “VSED Resources Northwest” for help with choosing this option.

“I am leaving life with great joy,” she says in the video. “I can’t tell you how content I am. I recommend it highly to do it this way.… The price of staying alive is having to live without quality and joy.… I feel so privileged to be exiting life like this and think of all the people who are wringing their hands and saying if only God would take you and all they need to do is give God a little help by holding back eating and drinking.”

At one point in the video, she is on the phone saying goodbye to friend. As she signs off, she says, “I’ll see you in heaven.”

Indeed.

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“How effective is chemotherapy?” — That is the Question

Posted September 1, 2022 by [email protected]

Would you spend $100,000 on a cancer treatment with many painful side effects that might help you survive 6.24 months as opposed to 5.91? That is 10 days longer in greater pain and suffering?

What if the doctor told you just that “this treatment will help you survive longer”? This is a true statement even though you might only survive 5.6% longer. That IS longer.

I have just discovered two great videos with Dr. Michael Greger discussing this very topic. Each video is less than seven minutes and worth every minute of your time. One is called “How Effective is Chemotherapy?” and the other is “How Much Does Chemotherapy Improve Survival?”

Let me be clear. I have no idea what I would do if I had a cancer diagnosis. I have close friends and family members who had advanced cancers and have been treated very successfully and are living active lives years after their treatments.

On the other hand, I have had patients, and, again, close friends and family members who received brutal chemotherapies and died. Many of those seemed to have received no benefit from their treatments and suffered great burdens. Many patients go bankrupt in order to pay for treatments.

Dr. Greger, in the first video says, “A large proportion of cancer patients reported their willingness to declare bankruptcy or sell their homes to pay for treatment. I mean, look, aren’t the high prices justified if new and innovative treatments offer significant benefits to patients? But you may be shocked to find out that many FDA-approved cancer drugs might lack clinical benefit.”

In his second video he referred to a study reported in the Journal of the National Cancer Institute. “In fact, the most expensive drug they looked at, the one costing $169,836 a year, did not improve overall survival at all, and actually worsened quality of life. That’s $169,000 just to make you feel worse with no benefit. Why pay a penny for a treatment that doesn’t actually help?”

I am NOT giving medical advice here. I am encouraging all of us to ask questions of our physicians. If a recommended therapy is said to improve survival, ask, “How much improvement?” Is it just 10 days over six months while suffering uncomfortable side effects? Ask about cost. Would I be willing to spend my financial legacy for those 10 days?

This all reminds me of the importance of our own emotional and spiritual preparation for dying. When “our time” comes we will be ready to die… or be healed. Either way, we’re okay.

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Cover Photo by Marcelo Leal on Unsplash

Alone into the Alone — “A Grief Observed” Revisited

Posted August 18, 2022 by [email protected]

Why?

Why, late in his career, would an internationally famous Christian author publish a personal memoir under a pseudonym? He hid both his identity and that of his beloved wife. Why?

I was leaving on one of my daily bike rides recently and needed to pick a new book to listen to. I selected a reread — A Grief Observed (1961). But, the author was identified as N.W. Clerk in the original rendering. Only after his death in 1963, was it published as by C.S. Lewis.

So, I am peddling the hills of Oxford, Mississippi, and I am being reminded just how good this book is. Between 1940 and his marriage in 1956, this confirmed bachelor wrote his greatest works including The Screwtape Letters (1942), The Chronicles of Narnia (1950-56), and Mere Christianity (1952). His brief four-year marriage to the terminally ill Joy led to A Grief Observed.

Lewis traced his wife’s life with cancer, then death and then his grief in this very thin volume (my copy has 53 pages of text.) Only, she is not “Joy,” who became his wife when he was 57 and she 41. In A Grief she is “H.” Her full name was Helen Joy Davidman, thus the “H.” They were actually married in the hospital where she was receiving treatment.

Here is a sampling of this grief journal by one of the 20^th century’s greatest writers and Christian apologists.

“No one ever told me that grief felt so much like fear. I am not afraid, but the sensation is like being afraid.”

Years ago, I had memorized this first line of the book. C.S. Lewis starts his journaling describing how grief feels to him. He keeps this up on every page.

“For in grief nothing ‘stays put.’ One keeps on emerging from a phase, but it always recurs.”… “Grief is like a long valley, a winding valley where any bend may reveal a totally new landscape.”

How many times have I heard this? I have to remind grievers “you never ‘get over’ grieving.” Lewis sees it as a series of emerging phases always recurring. He likens it to a hike through a valley.

“Meanwhile, where is God?… But go to Him when your need is desperate, when all other help is vain, and what do you find? A door slammed in your face, and a sound of bolting and double bolting on the inside. After that, silence.”

This might come as a surprise to those who found Lewis’ writings on Christianity so helpful. He had doubts. He didn’t doubt the existence of God but that his beliefs did not take away the pain of grief. He had no time for the “trust God and all will be good” line of thinking. Perhaps, this is why he wrote under a pseudonym. Doubt was so far from the assured Lewis.

“It is incredible how much happiness, even how much gaiety, we sometimes had together after all hope was gone.”

Here seems to be a great contradiction. In the midst of no hope for cure, Lewis and his wife had great happiness. There is a scene in Shadowlands, the biopic about their life together and her death. Lewis tells Joy not to talk about her impending death. He doesn’t want to spoil their good time together. She says, “It doesn’t spoil it, it makes it real.… I’m going to die and I want to be with you.… The pain then is part of the happiness now. That’s the deal.”

“She said not to me but to the chaplain, ‘I am at peace with God.’ She smiled, but not at me. Poi si torno all’ eterna fontana.”

These are the last words in A Grief Observed. He was able to witness the exchange between his dying wife and a chaplain. She was at peace. He closed with a Latin line from Dante’s Divine Comedy. In English, “Then she returned to the eternal source.”

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Cover Photo by Ricardo Gomez Angel on Unsplash

More Nothing than Something — True Solace is Finding None

Posted July 29, 2022 by [email protected]

I was such a scaredy-cat at 8 years old. All I can remember of two particular movies in 1956 was that I kept my eyes closed during the entirety of each film. I have just discovered, through Wikipedia, that Earth Vs. The Flying Saucers and The Werewolf were released together as a double feature that summer. Who knew?

Bingo. Those were the two movies of my childhood fears. I was sitting through 160+ minutes of terror.

From my youth, outer space and the heavens brought a recuring sense of awe. Yes, the fear of flying saucers invading was real. But, there was also a sense of reverence as I gazed into the night sky. I was pretty small in the vastness of the stars above.

I just placed the latest “deep field” photo from the new James Webb Space Telescope to my home screen on my iPhone. This is a time exposure photo of a portion of the night sky the size of a grain of sand held at arms-length. Thousands of galaxies appear as we look back billions of years. Each galaxy has billions of stars — each star is not unlike our sun.

We come out of childhood, hopefully, putting away childhood fears. We gain a sense of control of our own lives. I am somebody. That is, until….

That is, until something reminds of how small we really are — how we really are not in control. Serious illness ranks up there with things that shake us to our core.

The Deep Field photo brings so many thoughts to my mind. What is really amazing is that there is more of nothing than there is of something. More empty space than stars. Perhaps “nothingness” is more important than “something.”

Even down at the microscopic level, scientists tell us that the is more empty space in each atom than solid matter. Doesn’t make sense when you fall on asphalt after a spill off your bike, but, I have to take the experts at their word.

The point is that emptiness and nothingness are where we live. Yes, I am glad I have family, friends, community, and this beautiful earth to enjoy. But, I also feel at home in the vastness of empty space or the silence which is a space empty of sound.

It is the message of the mystics and the dying have been telling us since the dawn of time. I am reminded of Gretel Ehrlich’s comment, “True solace is finding none. Then, of course, it is everywhere.”

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“During covid… I think that was my favorite time in life”

Posted July 7, 2022 by [email protected]

Imagine my surprise at getting a text from my youngest daughter, Katie, that started and ended this way: “During COVID… I think that was my favorite time in life.” Of course, it was everything in between that beginning and ending that tells the story.

Most of Generation Z spent their last year of college (2020-21) attending class in front of a computer screen. Katie was included in that cohort. It was our good fortune, in 2019, to have moved to Oxford, Mississippi, where she was going to school. Although she shared a townhouse with some friends, she and Charlie, her Cavalier Spaniel,spent a great deal of time in our home.

My wife and I tend to be news junkies. Each evening we record the ABC World News Tonight and the PBS NewsHour. And, each evening, we watch both, mercifully skipping the commercials. Katie did not share our news addiction and turned us on to a “new drug” — Grey’s Anatomy.

Thanks to COVID, we were not going out, so it was a binge of 17 seasons and close to 400 episodes. We took a pass on our basketball and baseball season tickets and went to med school. Twice, late in 2020, I blogged about Grey’s — “Grey’s Anatomy and CPR on Television” and “The Spiritual Side of Grey’s Anatomy.”

I started that first blog, “True confession: I have joined my 22-year-old daughter in binge-watching Grey’s Anatomy during the pandemic. Over 300 episodes viewed and counting. I now know about ‘10-blade,’ ‘clear!’ and the importance of declaring ‘time of death.’ Also, I never knew there was so much romance and sex going on in hospital supply closets and on-call sleeping rooms. Now I know.”

Last week, out of the blue, Katie texted us, “During covid when we watched every season of Grey’s Anatomy and you both didn’t fall asleep and paid attention I think that was my favorite time in life.” (I will not comment on the falling asleep or paying attention part, but I really did enjoy the series.)

I know, for many people, the pandemic was horrible. People died. People were exhausted. There was NO silver lining for them. To be clear, Katie did not qualify the family-watching-Grey’s as the best thing about COVID. She was more expansive — watching Grey’s with us was her “favorite time in life.”

Regardless, I’m grateful we got to make the best of a bad situation. We salvaged some uninterrupted family time and made memories with our daughter. Binge-watching TV was the silver lining of the pandemic. At least, it was for us.

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The Lonely, Difficult Journey of COVID Grievers

Posted May 26, 2022 by [email protected]

“Oh my god, they are going to blame overweight people for their own deaths.” This was my first thought in the winter or spring of 2020 when I initially heard about the risk factors leading to death by COVID. The list included obesity, diabetes, old age, compromised immune systems, and being Black.

Photo by Ben White on Unsplash

My mind revisited those first weeks of the pandemic as I saw an interview with Ed Yong of The Atlantic on the PBS News Hour. For two years, he has been talking to COVID grievers. You can read his most recent article, “The Final Pandemic Betrayal,” here or watch the seven-minute PBS interview here.

I wrote blogs about the grief rituals after the death of my mother-in-law during COVID and public displays of remembrance of those who died. Now Ed Yong has written and talked in the most moving fashion about the more than 9 million fellow Americans who have lost a close relative to the virus.

COVID Grievers Face an Unprecedented Time to Grieve

Photo by Claudia Wolff on Unsplash

We who have NOT lost someone to COVID have little concept of the unique, profound, and enduring grief now being visited upon these grievers. Here is the story of a mother who watched her son die on her phone:

“Teresita Horne had spent more than a week on a breathing machine when her 13-year-old son, Donovan, died in a different hospital; she watched him die on her phone. ‘I remember screaming,’ she told me. ‘When your kids are sick, they need you, but I couldn’t be there to comfort him. I couldn’t hold his hand one last time.’”

Don’t ask, “Were they vaccinated?”

Then there was the tone in our questions to those who lost a loved one to COVID. “Did they get the vaccine?” What does that have to do with our attempt to reach out to someone caught up in grief? The mere question implies that there was something the dead person should have done or, worse yet, the griever should have done to prevent the death. Aside from appeasing our curiosity about if they got the vaccine, how does that question comfort the bereaved?

Photo by Pierre Bamin on Unsplash

Again, Yong writes, “Many grievers end up blaming themselves. Should I have pulled them out of that nursing home? Should I have pushed them harder to get vaccinated? And worst of all: Did I give them COVID?“

He concludes: “In her book, The Myth of Closure, Pauline Boss, a therapist and pioneer in the study of ambiguous loss, offers some advice for pandemic grievers: ‘It is not closure you need but certainty that your loved one is gone, that they understood why you could not be there to comfort them, that they loved you and forgave you in their last moments of life,’ she wrote. Instead of waiting for a clean but mythical endpoint to one’s loss, it is better to search for ‘meaning and purpose in our lives after this horrific time in history,’” she said.

Do yourself a favor. Read Yong’s article or listen to the short interview. I was moved by the stories of these COVID grievers

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Cover Photo by Shane on Unsplash

The Rise of Cremations and Our Need to be with the Dead

Posted May 13, 2022 by [email protected]

While we were planning a funeral for her 22-year-old son, Scott, she put down her beer, took the cigarette from her lips, and said, “So, I remind you of the Virgin Mary?” A lighter moment amid grief. Scott died from a long and debilitating illness. He may have weighed 80 pounds in the end.

I lived a few doors down from Scott and his family for four years. His sisters babysat my kids. I was Scott’s den leader in Cub Scouts. As disease ravaged his young body, Scott graduated from college in a wheelchair. I was so privileged to be a part of his care.

In Scott’s last days, one of my fellow chaplains called me as he was preparing to leave town on vacation. He was aware I was an old friend of Scott and his family. He asked if I could check in on Scott and even do the funeral if he died. I was glad to do it.

On my second visit to see Scott in our hospice in-patient unit, I could tell he was taking his last breaths. His mom and sisters were at his side. He had been in such great pain that he was totally sedated. His breathing stopped. The tears flowed after months of anticipating this moment.

I summoned the nurse. She asked Scott’s mother, “Would you like to hold him?” Of course, she would. It had been months since she could even touch him because of the pain.

The nurse gathered the sheet around Scott’s body and placed him in his mother’s lap. She held him tenderly, stroking his face, and telling him of her love. I later told a friend of the scene and he said it reminded him of Michelangelo’s Pietà. It was indeed a very similar scene, a mother cradling the body of her broken son.

A few days later, I told Scott’s mother about my friend’s comment. That’s when, beer and cigarette in hand, she said, “So, I remind you of the Virgin Mary?”

This experience came to mind as I read a Washington Post story about the stunning rise in the use of cremation. Now, 57% of our dead are cremated compared to 27% just two decades ago. Along with the traditional casket burials, Americans are having less to do with the dead. Many have no rituals at all surrounding the death of one they love.

Undertaker Author Thomas Lynch

Many want to avoid the greater expense of a traditional funeral and burial. But, perhaps, many want to avoid being around the dead body or the emotional strain of the rituals. Thomas Lynch, a Michigan poet and funeral director of 50 years said in the Post article, “People want the body disappeared, pretty much. I think it reminds us of what we lost.” In the United States, Lynch notes, “this is the first generation of our species that tries to deal with death without dealing with the dead.”

I will say, there is another trend that runs counter to this criticism that we Americans are avoiding the dead. More and more people are dying at home which gives the family the opportunity to be with the departed. A century ago, almost everyone died at home. This can provide that ritual lost with the demise of the traditional funeral.

Rest in peace.

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The Brutal Truth of Growing Through Grief…It’s Normal

Posted May 4, 2022 by [email protected]

Barbara Lazear Ascher’s husband gave her the news in the most straightforward way. “Looks like pancreatic cancer,” he told her matter-of-factly after the test results came back.

She and their friends gave him a wonderful death. They had theme parties with matching drinks. “Dying was intimate, and I drew close,” Ascher writes in her moving memoir, “Ghosting,” “We were single-minded, welded together in the process of this long leave-taking.”

This is how David Brooks starts a recent piece in The New York Times, “Some People Turn Suffering Into Wisdom.” I might as well borrow from one of the best. Brooks often writes about living life — its goodness and the difficulties. In this one, he covers the landscape of grief and trauma and moving on.

This kind of disorientation is brutal … and normal. Grief and suffering often shatter our assumptions about who we are and how life works. The social psychologist Ronnie Janoff-Bulman notes that many people assume that the world is benevolent, that life is controllable, and that we are basically good people who deserve good things. Suffering and loss can blast that to smithereens.

My few (and relatively small) hard knocks in life taught me years ago about the lesson of impermanence. That is — all things change. The grief that follows loss bumps up to this piece of wisdom. This is normal. I have written before about my habit of journaling. I didn’t say then that I tend to journal more and with more passion when things are not going so well in my life. Brooks introduced an exercise to use journaling to tell our stories differently.

Gradually the process of re-storying begins. This is taking a now fragmented life and slowly cohering it into a new narrative. The social psychologist James Pennebaker has people do free expressive writing, sometimes for just 20 minutes a day for four days. Don’t worry about spelling and grammar, he advises; just let it flow — for yourself. In the beginning, people who take part in expressive writing exercises sometimes have different voices and handwriting styles. Their stories are raw and disjointed. But their narratives grow more coherent and self-aware as the days go by. They try on different perspectives. Some studies show that people who go through this process emerge with lower blood pressure and healthier immune systems.

I never took my blood pressure and can’t quantify how much, if at all, journaling helped me. I would have to go back through the losses in my life and do it over WITHOUT journaling — no, thank you. But I do agree with Brooks. Some people take grief and loss and make a new life.

Gradually, for some people, a new core narrative emerges answering the question, “What am I to do with this unexpected life?” It’s not that the facts are different, but a person can step back and see them differently. New frameworks are imposed, which reorganize the relationship between the events of a life. Spatial metaphors are helpful here: I was in a dark wood. This train is not turning around. I’m climbing a second mountain.

David Brooks’ most recent book is The Second Mountain: The Quest for a Moral Life.

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Not much has changed in 40 years — My radio interview

Posted April 28, 2022 by [email protected]

Are people more willing to have a conversation about end-of-life planning today than they were in the 1980s? That was Jeanne McCusker’s opening question as she interviewed me for her weekly program, “A Graceful Life.” What was I to say?

Jean McCusker, host of “A Graceful Life”

I had to admit, “Not much has changed.”

Why? Why, in almost 40 years, has not much changed about end-of-life conversations?

Dying is very personal. You only die once. Although you may get some experience making healthcare decisions for others, like your parents, that is still limited experience. Every end of life is unique. We may have made great strides toward facilitating more peaceful deaths, but each person still faces their death anew.

Hospice and advance directives have not guaranteed peaceful deaths

I do think healthcare professionals and healthcare systems are better today. Take hospice, for example. Medicare started the hospice benefit in 1982. Since then, hospices have grown exponentially. Now, almost everyone knows stories of good hospice deaths. About half of the people who die on Medicare receive hospice care.

Sadly, if you dig down into those numbers, over one-quarter of those on hospice were there less than a week. In other words, they waited until the “last minute” to receive this vital service. Hospice professionals know it is hard to provide the best comfort-focused end-of-life care in less than a week.

Another change in the last 40 years has been the increased use of advance directive documents like living wills and durable powers of attorney for healthcare. About half the adult population now has such papers.

Again, all this paper has not improved how well we die. An important article in JAMA last fall questioned whether the emphasis on these documents has led to improvements in end-of-life care. Healthcare professionals might want to listen to a recent GeriPal podcast on this very topic. Just having a piece of paper does not guarantee a peaceful death.

I came to the end of the interview repeating what I often say, “End-of-life decisions, for patients and families, are mainly emotional and spiritual. The big question is, ‘Can I let go?’” THAT truth has not changed. Letting go and letting be can still be difficult.

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Archive for the ‘Emotional & Spiritual Issues’ Category

Don’t Tell Me, “God protected you!”

Setting the stage for disaster

Disaster strikes

Some things went right…

It’s “No problem”

A real miracle

**The miracle is not that I did not die last week — the real miracle it is that I am alive in the first place.**

She Fasted to Hasten Death — VSED

The importance of medical support during the process

“How effective is chemotherapy?” — That is the Question

Alone into the Alone — “A Grief Observed” Revisited

More Nothing than Something — True Solace is Finding None

“During covid… I think that was my favorite time in life”

The Lonely, Difficult Journey of COVID Grievers

COVID Grievers Face an Unprecedented Time to Grieve

Don’t ask, “Were they vaccinated?”

The Rise of Cremations and Our Need to be with the Dead

The Brutal Truth of Growing Through Grief…It’s Normal

Not much has changed in 40 years — My radio interview

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