Emotional & Spiritual Issues | Hank Dunn

Compassionate, informed advice about healthcare decision making

Archive for the ‘Emotional & Spiritual Issues’ Category

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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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.

“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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You Can Never Make a Wrong Decision

Posted April 21, 2022 by [email protected]

“I made a mistake. I made the wrong decision,” the wife of the recently deceased man said.

Several years ago, I spoke at the Centra Hospital in Lynchburg, Virginia. There were about 50 people in the room, including members of the clergy, physicians, nurses, social workers, and just plain folks. I divided my presentation, the first half devoted to helping patients and families make end-of-life decisions, and the second half to the emotional and spiritual issues at the end of life.

When I invited the audience to speak, a lady raised her hand and told her friend’s story. Her friend’s husband had been in a nursing home and on a feeding tube. He was not considered to have the capacity to make his own medical decisions, so all the medical treatment decisions rested on his wife.

On more than one occasion, the patient pulled out the feeding tube. This lady suggested to her friend that perhaps her husband was saying he did not want the feeding tube. Her friend always responded, “He doesn’t know what he is doing.” They always reinserted the tube and resumed the feedings.

“I should have left the tube out and let him die sooner.”

About six months after the patient died, the lady visited her friend. The now-widow said, “I made a mistake. I made the wrong decision. I should have left the tube out and let him die sooner.”

At times, I have heard other family caregivers express similar regrets about decisions made. “We shouldn’t have sent mom back to the ICU.” “I wish we had never started the feeding tube.” “We kept the chemo going way too long.”

You can never make the wrong decision

When I hear remorse like this, I always tell people, “You can never make the wrong decision. You make the best decision you can with the information you have at the time.” In my 28 years of being close to decision-makers, I have never thought someone made a decision intending to harm a patient. People always want the best for the patient. It is only in looking back that they say a decision was a mistake.

I even say “you can’t make a wrong decision” to people in the throes of a decision-making process. I hope to ease the burden they are placing on themselves. These choices can be hard enough. I want to assure these burdened families they can’t make the wrong decision. You just do the best you can with the information you have at the time.

[A version of this blog post appeared in 2011.]

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Photo by Nik Shuliahin on Unsplash

It’s Your Choice: You Can Change Your Views of Aging and Improve Your Life

Posted April 15, 2022 by [email protected]

I seldom picture myself becoming a demented, incontinent, and disabled patient in a nursing home. My future may indeed look like that because both of my parents ended up in such a state. On top of that, I cared for hundreds of such patients as a chaplain. Many of them were my current age (74) or younger. Why not me?

I did prepare for such a future, having bought long-term care insurance twenty years ago. Again, my parents’ aging convinced me to get the policy. They both used every dollar from their nursing home insurance benefits.

Choosing more positive aging

An article I read recently prompted these thoughts. It was titled, “It’s Your Choice: You Can Change Your Views of Aging and Improve Your Life.” Here is how it starts:

Becca Levy, a professor at Yale University, studies the way our beliefs about aging affect physical and mental health.(JULIA GERACE)

“People’s beliefs about aging have a profound impact on their health, influencing everything from their memory and sensory perceptions to how well they walk, how fully they recover from disabling illness, and how long they live.

“When aging is seen as a negative experience (characterized by terms such as decrepit, incompetent, dependent, and senile), individuals tend to experience more stress in later life and engage less often in healthy behaviors such as exercise. When views are positive (signaled by words such as wise, alert, accomplished, and creative), people are more likely to be active and resilient and to have a stronger will to live.”

Being blind is “wonderful”

I remember asking an 80-something-old patient at the nursing home what it was like being blind. She said, “Wonderful. You learn so much being blind. I can tell who is coming into my room by the sound of their footsteps. I listen to talking books. It is just one learning experience after another.” That lady would be one of those resilient folks mentioned in the article.

Judith Graham of Kaiser Health News interviewed Yale professor Dr. Becca Levy about her newly-released book, Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live. The bottom line is that if we have a more positive and hopeful view of aging when we are younger, we will more successfully move through those years to the end.

In the interview, Dr. Levy gives several suggestions on assessing our attitudes and how to develop more positive ones. Maybe someday I, too, can say being blind is “wonderful.”

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My Problem with “Happiness is a choice”

Posted April 7, 2022 by [email protected]

I am tempted to say that the cliché, “Happiness is a choice,” is wrong on the surface. But, over and over again we see people endure great hardships and they choose not to be overwhelmed. I am reminded of Viktor Frankl and his “last of the human freedoms.” The following appears in my book Light in the Shadows:

“This idea that we have a choice in our happiness is not original with me. Viktor Frankl is the one who told us this is the ‘last of the human freedoms’—the freedom to choose how we will respond in any given set of circumstances. He was a Jew and a psychiatrist who learned about this freedom as a prisoner in several concentration camps during the Second World War. Hear his words:

“The experiences of camp life show that man does have a choice of action.… Man can preserve a vestige of spiritual freedom, of independence of mind, even in such terrible conditions of psychic and physical stress.… We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.

“[I]n the final analysis it becomes clear that the sort of person the prisoner became was the result of an inner decision, and not the result of camp influences alone.… I became acquainted with those martyrs whose behavior in camp, whose suffering and death, bore witness to the fact that the last inner freedom cannot be lost.… It is this spiritual freedom—which cannot be taken away—that makes life meaningful and purposeful. (Viktor E. Frankl, Man’s Search for Meaning, New York: Washington Square Press, 1984, pp. 86-87.)

“The sort of person we become is the result of an inner decision and not the result of the influences of… cancer… the illness of a child… divorce… disability.

“A thought for this day: When the circumstances seem to be overwhelming, I will know I have a choice in how I am going to respond. I will not blame my illness, or other people, for how I feel inside.”

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“God has a lot of explaining to do.”

Posted March 24, 2022 by [email protected]

The daughter started her eulogy, “I am so angry. God has a lot of explaining to do….” I sat there, stunned, now wondering how in the world I could follow such a performance.

I’ve had the opportunity to officiate many funerals over the years. This was supposed to be one of the “easy” ones. The dead man’s family had a relative who once was a member of my church in Vienna, Virginia, back in the day. None of the family attended that church now — or any church. So, when the man died suddenly of a heart attack at 64, they turned to us for a minister to conduct the service — kind of a rent-a-preacher.

Our pastor was out of town, and it fell to me to fill in. It sounded straightforward enough. They just needed me to be an emcee, so to speak. The daughter would do a eulogy, and we would open the floor for others to give tribute to the recently departed.

As I met with the daughter and granddaughter to plan the funeral, they made it clear that this family was not religious and did not want a lot of God-talk. They agreed to a prayer and Psalm 23. That was that. No sermon. Little religion. I would just show up at the funeral home, conduct the service, get paid, and go home.

I walked into a whole new world

When I entered the funeral home before the service, I walked into a whole new world (for me, at least). At the front of the chapel, a NASCAR flag draped the casket. The deceased’s helmet sat on top — a tribute to his years as a driver on the small-town racing circuit. Scores of people milled around, some laughed, some cried.

Vince Gill

Overhead speakers pumped in country music. Vince Gill sang, “I know your life on earth was troubled / And only you could know the pain… Go rest high on that mountain / Son, your work on earth is done.”

People took their seats in the pews, and I started the service with a few opening remarks. Then it was the daughter’s turn. “I am so angry. God has a lot of explaining to do. My father was a good man. He had no enemies. He loved his children and grandkids. He worked hard and provided for us. God has a lot of explaining to do.”

This was no time for theological argument

As she spoke, I sat there running through my mind things to say to offer another view of her father’s sudden, unexpected death. I thought about referencing Rabbi Kushner’s When Bad Things Happen to Good People. Kushner believed some things, including some deaths of people we love, just happen at random — a belief I share. But obviously, this was not the time nor place to get in a theological argument.

Then the wisdom of Fr. Seamus O’Reilly came to mind. As he talked to his parishioners about the AIDS epidemic in the 1980s, which some Catholics believed was punishment for sin, the wise priest said:

“God always forgives.
“Humans sometimes forgive.
“Nature never forgives.”

The man had died from a malfunction of his heart. Nature requires that our hearts pump life-giving blood in our veins. This man died of natural causes. “Nature never forgives”? No, that wouldn’t do.

Bless her heart — she was deeply grieving

The daughter’s angry tone did soften partway through her speech. It was clear she was an adoring daughter. She gave a touching and loving tribute to her father, as good a eulogy as I had ever heard from a family member. But she ended where she began, “God has a lot of explaining to do.”

When my turn came, I know I started with, “Death is always a mystery…” and kept it brief. I was speechless after witnessing this woman’s pain. I think everyone else was speechless, too, because few spoke when I opened the floor.

I’m always amazed when those who claim not to be religious will often blame God for tragedy. The funeral could have been a wonderful opportunity to be thankful for the great gift of the time she had with her father. But, bless her heart, she was deeply grieving the loss of her beloved father. I felt so sorry for her that her hurt had turned to anger.

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Archive for the ‘Emotional & Spiritual Issues’ Category

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

You Can Never Make a Wrong Decision

“I should have left the tube out and let him die sooner.”

You can never make the wrong decision

It’s Your Choice: You Can Change Your Views of Aging and Improve Your Life

Choosing more positive aging

Being blind is “wonderful”

My Problem with “Happiness is a choice”

“God has a lot of explaining to do.”

I walked into a whole new world

This was no time for theological argument

Bless her heart — she was deeply grieving

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