Emotional & Spiritual Issues | Hank Dunn

Compassionate, informed advice about healthcare decision making

Archive for the ‘Emotional & Spiritual Issues’ Category

Aging as a Spiritualizing Process — Part One

Posted September 21, 2021 by [email protected]

“Growing old is no good,” the 95-year-old nursing home resident told me. I asked her when it got to being “no good.” She thought for a moment and then said, “About 80.”

“What made it ‘no good’ at that time?” I wanted to know. Without hesitation she said, “When I couldn’t do things for myself anymore.”

I told her daughter of this conversation and she said, “Oh yeah, it was about that time I came into her home, and she was standing on the kitchen table changing a light bulb in the ceiling fixture.”

This resident perfectly summarized the fear of aging; the issue is really the loss of independence. Who wants that? But decline and dependence is the future for most of us, except for the few who will die suddenly while still active.

The minister’s role of “presence and witness”

That conversation, which I also recount in my book, happened over thirty years ago. The young(ish) chaplain who heard those words is now part of the “elderly class.”

So I thought of my own elderly status and that long ago conversation as I read a recent article from Kaiser Health News, “Minister for Seniors at Famed Church Confronts Ageism and the Shame It Brings.”

Rev. Lynn Casteel Harper of the Riverside Church in New York City, sees her role with congregants in their decline as one of “presence and witness.” “Sometimes if people are going through really difficult experiences, especially medically, it’s easy for the story of the illness and the suffering to take over,” Rev. Harper said. “Part of my role is to affirm the other dimensions.”

Harper is right — it’s about presence. I found it was the same in ministering to nursing home residents and hospice patients. I could not take away the pain of loss of independence. I could not lighten the heavy weight that serious illness put on my patients’ psyches. But I could be present.

It was, in a way, easy. I just had to show up.

Acceptance of death without fear — why wait?

I was drawn to another of Harper’s comments. Yes, old folks do worry about what their last days will be like — whether there will be suffering. But she “rarely encounter[ed] a fearfulness about what will happen when someone dies.”

This acceptance of death without fear is common. It may or may not have a religious element to it but, in general, those approaching death have reached a degree of serenity. Acceptance without fear.

I say this acceptance is a spiritual process whether one expresses it in religious terms or not. In a sense, aging forces this spiritual acceptance upon us all. We could do it earlier in life, and many do, but toward the end, after losing independence, we tend to accept and just let things be.

If we could learn how to accept the certainty of death earlier in life, our whole life could be more peaceful. Growing old forces this spiritual practice upon us. This is just one facet of aging as a spiritualizing process.

The Health Risks of Loneliness

Posted August 25, 2021 by [email protected]

“Oh. It’s the chaplain. How nice,” she greeted me as I entered her room at the nursing home. Mable was often alone in her room by choice. She was blind and over 100 years old.

This is the same Mable from my book, who, when I asked her, “How do you live to be 102?” responded, “Just keep breathing!”

I thought of Mable as I listened to a recent GeriPal podcast titled “Loneliness and Social Isolation: Podcast with Carla Perissinotto and Ashwin Kotwal.” (“GeriPal,” as in, Geriatrics and Palliative Care.)

As I said, Mable was often alone in her room, isolated. But was she lonely? I don’t recall if I ever asked her. The researchers on the podcast did point out that some elderly folks may be isolated but not lonely.*

Listening to the podcast, one particular visit with Mable came to mind. When I walked into her room, she was in bed, her eyes closed. I gently touched her hand and quietly said her name, “Mable.” She opened her blind eyes suddenly, startled.

“I didn’t mean to scare you,” I assured her.

“That’s okay. I was in my dream world,” Mable said.

“What’s it like in your dream world?” I asked.

“It’s wonderful!”

A couple of quotes from the podcast:

“Loneliness is different than isolation and solitude. Loneliness is a subjective feeling where the connections we need are greater than the connections we have. In the gap, we experience loneliness. It’s distinct from the objective state of isolation, which is determined by the number of people around you.” – Vivek Murthy, two-time (and current) U.S. Surgeon General.

“Loneliness and isolation…are linked with pretty serious health outcomes.… [We] demonstrated that over a six-year period, people that reported higher rates of loneliness had higher risk of dying, 45% increased risk of dying, and 59% increased risk of loss of independence and functional decline, outcomes that are significant and important to our patients.”

Fighting Covid AND loneliness

Photo by Hank Dunn, Fairfax Nursing Center

Now keep in mind, the researchers completed their findings BEFORE the pandemic. COVID made their research even more relevant. Nursing homes kept residents in their rooms, and facilities were closed to visitors to prevent the spread of the virus. This isolation may have reduced deaths by COVID but, perhaps, invited death by loneliness.

There must be a better way to mitigate the risk of both these health threats. Yes, we need to avoid the spread of COVID among residents and staff. And, so too, loneliness.

*“Loneliness in Older Persons: A Predictor of Functional Decline and Death,” JAMA Internal Medicine; July 23, 2012. “The epidemiology of social isolation and loneliness among older adults during the last years of life, ” Journal of the American Geriatrics Society; July 11, 2021.

“Prince-of-Tides” Empathy

Posted August 19, 2021 by [email protected]

My wife, Sally, and I decided to watch the 1991 movie, The Prince of Tides, for a date night at home. I had forgotten how sad, tragic, yet hopeful the film was. The next day, having lunch with a friend, we mentioned we watched it. Our friend said, “That is my favorite movie.”

It had been thirty years since we had seen it, and it was a little circuitous how The Prince of Tides came up on our radar. In researching the late Doug Marlette, creator of my favorite comic strip, Kudzu (I have a video where I talk about Marlette), I found out that Marlette was best friends with Pat Conroy, who wrote the novel and co-wrote the screenplay for The Prince of Tides.

You never know

The film’s main character, Tom, played by Nick Nolte, travels from his home on the coast of South Carolina to New York City to help his twin sister, who had just survived her third suicide attempt. Over the course of the film, we find out about how their family got so dysfunctional.

The twins, along with their brother and mother, had experienced a violently traumatic event. Their mother told the children never to talk to anyone about what happened to them. Through therapy, Tom and his sister revisited their long-suppressed past.

Curious, I asked our friend why this was her favorite movie. “Because you never know what is behind someone’s story. Why they act the way they do.” Indeed, once you know Tom’s family’s whole story, you’re more compassionate about the suicide attempts and other character flaws in the family.

We are talking about empathy here.

Assume Positive Intent

My new mantra in this age of text messages and emails: “Assume Positive Intent.” I picked this up while listening to Sam Harris’s podcast focused on communicating with colleagues at work.

If you are in the physical presence of someone, you not only hear their words, but you pick up on body language. That slight smile, the rolling of the eyes — none of which are present in a text message. A tech CEO Harris interviews reminds everyone in his company to “API,” or “Assume Positive Intent,” when reading an email or text message.

My wife occasionally says that my texts seem “curt.” At least, that’s how it feels to her. I protest, “No, that’s not what I meant at all.” API.

They’re doing the best they can

Long ago, I adopted another mantra that has served me well over the years. When I feel hurt by the actions or words of someone, I remind myself that they’re doing the best they can.

This brings us back to that Prince-of-Tides empathy. I don’t know why someone was mean or thoughtless, but something in their past (or present) brought us to this moment.

We’re all doing the best we can.

Grief Upon Grief, Upon Grief — A Funeral, FINALLY, 42 Years Later

Posted August 12, 2021 by [email protected]

Can you have a funeral for someone who died 42 years ago? Last week, I wrote about having to delay the burial of my mother-in-law’s ashes for ten months because of COVID. Why not 42 years? In 1996, I officiated this long-delayed funeral, choking back tears.

The summer of 1996 turned out to be a terrible one for me. I went through an unspeakable loss that involved a major betrayal and abandonment. By August, I couldn’t get my dead brother, Randy, out of my mind amidst my grief and sadness. By that time, he had been gone over 41 years.

Randy only lived a week, and never left the hospital. He was born without functioning intestines. It was clear that he would die within days. This was back when children were not permitted to visit hospitals, and I was just six years old. I never saw Randy. I never held him. I did not know what it was like to look upon his face.

And yet, during that summer, I missed him. Fresh grief has a way of bringing up old grief you didn’t even know you had.

The backstory

Mom and Dad were visiting for our son’s high school graduation in 1993. After dinner one evening, Randy somehow came up in conversation. I said to my parents, “Tell me about Randy’s death.”

Instantly, Mom burst into tears. Once she could speak, she said, “My father would not let me go to Randy’s funeral.”

My grandfather was a funeral director and arranged to remove my brother’s body quickly from the hospital. Mom had already been sent home, leaving her newborn son behind to die alone. Dad attended the graveside service, but my grieving mother was not allowed. My controlling, alcoholic grandfather decided it would be better for Mom to avoid the pain of putting her child in the ground.

In somewhat of a defense of my grandfather, this was how things were done in 1954. Avoid the pain and go on with your life as if nothing happened. At the time, funeral directors were the only grief experts. Granddaddy was doing what he thought best.

Nowadays, we encourage the parents, and even siblings, to hold their lifeless child. Some families even wash their children, preparing them for burial. These rituals are such an important part of the grief process.

Fresh grief, old grief

Although I always was aware of Randy’s short life, I can never remember him coming up in conversation until my inquiry in 1993. Just mentioning his name opened the floodgates. My mother carried that huge ocean of grief just below the surface all these years.

Did thoughts about Randy painfully arise when Granddaddy died? Randy died on November 22nd. Did Mom think about Randy when President Kennedy was killed on that same day nine years later? Did she think about Randy at my graduation from high school? I am guessing she thought of Randy all the time. I never knew.

When my father was taking his last breath in 2002, Mom’s parting words to him were, “You’re going to see Randy before me.”

Grief never goes away

Although I was not conscious of it, the loss of my brother was always a part of me, too. It didn’t occur to me until I was in the depths of despair that summer of 1996.

As Thanksgiving approached that year, I got an idea. My daughter and I were going to spend it with my parents in Florida. I decided to go to Randy’s grave and conduct a personal graveside service — a ritual. I called Mom and Dad and told them my plan, inviting them to join me. Mom said, “I would love to. You know what I told you about my father.” Indeed, I did.

So, on Thanksgiving 1996, 42 years after his death, we had a funeral for my brother. Mom, Dad in his wheelchair, my brother, his wife, my daughter, and I gathered at the grave. I read the words of committal (“Ashes to ashes, dust to dust”) and Psalm 23 (“The Lord is my shepherd”), we said the Lord’s Prayer, and I stammered through a prayer about Randy.

We turned toward each other. We embraced. We wept deeply. Forty-two years of sorrow ran down our cheeks.

You Can’t “Prevent” Alzheimer’s! But You Can “Reduce the Risk!”

Posted July 21, 2021 by [email protected]

She was the most unhappy, most angry, and most sad dying person I ever worked with as a hospice chaplain.

She thought she had done everything to prevent cancer. She was a “fitness nut.” She meditated. She did yoga. She read books on spiritual and self-help topics. She ate the healthiest of diets. She got cancer anyway.

Once diagnosed, she turned to alternative medicine to save her life. She had heard so much about those miracle cures and she wanted that, too. She doubled down on her lifestyle she had adopted to prevent the cancer in the first place.

She never got to acceptance. In my view, her biggest mistake was believing she could “prevent” cancer rather than just “reduce the risk.” Even nonsmokers can get lung cancer.

Reducing Risk vs. Preventing

I thought of this patient as I was rereading an article I had found helpful about reducing the risk of dementia. I was surprised how it was titled — “The SHIELD Plan to Prevent Dementia.” (I referenced this “plan” in a previous blog about Alzheimer’s.) As with cancer, you can’t totally prevent getting Alzheimer’s. But you can reduce the risk.

Below is Dr. Oz’s spin on the research of Dr. Rudolph Tanzi (I would drop the word “prevent” and call it The SHIELD Plan to Reduce the Risk of Alzheimer’s):

Sleep — Aim for at least eight hours of sleep each night.

Handle Stress — Tanzi recommends a short, one-minute meditation practice.

Interact With Others — Loneliness can lead to additional stress. Talking with friends and family members requires the brain to pay attention and builds new neural pathways.

Exercise — Walk at least three times a week for 30-45 minutes.

Learn New Things — “Leaning new skills can build new nerve connections that maintain optimal brain health. Try adopting a new hobby, learning a new language, or playing a new musical instrument.”

Diet — Drs. Oz and Tanzi recommend The Mediterranean diet. “On the diet, you’ll eat more fruits and vegetables, nuts and olive oil and then cut back on red meat consumption.”

There you have it.

Collective Effervescence — Welcoming Back the Joy in Crowds

Posted July 14, 2021 by [email protected]

Laughter is contagious.

Years ago, I was standing at the front of a church leading a bride and groom through their vows on their wedding day. At some point, the bride started to laugh (was it at “for richer or poorer”? I don’t remember). Of course, the groom chuckled, I laughed, and the laughter spread to the congregation. We couldn’t help ourselves.

These thoughts came back to me as I read a recent article in the New York Times, “There’s a Specific Kind of Joy We’ve Been Missing.” Contributor Adam Grant is referring to the joy of being in crowds; a joy we did not experience during the worst of the pandemic.

Grant found this joy at a concert with 15,000 other fans. The same kind of joy I saw in the crowd pressing around Phil Mickelson at the PGA Championship. I talked about getting back together, in person, with my men’s group in one of my short “Hank’s Deep Thoughts” videos.

Here is a little of what Grant had to say about “Collective Effervescence”:

“Research has found that people laugh five times as often when they’re with others than when they’re alone. Even exchanging pleasantries with a stranger on a train is enough to spark joy.… Peak happiness lies mostly in collective activity.

“We find our greatest bliss in moments of collective effervescence. It’s…the sense of energy and harmony people feel when they come together in a group around a shared purpose. Collective effervescence is the synchrony you feel when you slide into rhythm with strangers on a dance floor, colleagues in a brainstorming session, cousins at a religious service or teammates on a soccer field. And during this pandemic, it’s been largely absent from our lives.”

And I would add, it is the collective effervescence you feel while laughing with a congregation at a wedding…even though you don’t know what the bride thought was so funny.

During the lockdowns we discovered that, indeed, “peak happiness lies mostly in collective activity.” You can binge watch comedy specials on TV, but it is nothing like physically being in a comedy club. Same goes for watching a movie at home versus joining others in a movie theater. Or participating in a Zoom church service as opposed to being in a room with your fellow worshippers.

Think about that — the content of each of these events is exactly the same: same jokes; same movie; same sermon and songs. Yet, experiencing them “together” makes a world of difference.

(The skeptic in me says crowds can be misled by false prophets or corrupt leaders. History — including current events — is replete with examples of these charlatans. Humor me and assume we are attending fun, positive, non-controversial events devoid of those who might lead us astray.)

When this pandemic has had its run, it will be a relief to finally be able to enjoy the best of an event with fellow humans by our side. To absorb each other’s energy. To do what we do best, by making a whole that is greater than the sum of its parts.

Our lives are not just enriched by the content we experience. Another key part is that “collective effervescence.”

Can I Trust the Russians? — Absolutely

Posted July 8, 2021 by [email protected]

Would you trust someone who contacts you by email, claims to be from Russia, and wants to publish your book in their country? This happened to my publisher and me almost two years ago. Can we trust them?

Trust, but verify

I am reminded of a Russian proverb that Ronald Reagan was fond of quoting as he negotiated arms treaties with what was then the Soviet Union, “Trust, but verify.”

Twice before this, I was contacted by foreign publishers out of the blue requesting the same thing. As a result, Hard Choices for Loving People is now available in Japan and Taiwan.

You know — I am so thankful these people contacted us. They could have stolen my copyrighted material and published it without us ever knowing it had happened. I am sure there are international agreements that supposedly protect authors like myself. But if they were to publish without contacting us, it would be highly unlikely we would find out — and very expensive to try to stop them if we did.

We live in a state of trust

Come to think about it, we all live much of our lives in a state of trust. I occasionally find myself on a rural Mississippi two-lane, and suddenly, it dawns on me I trust those people in the other lane will stay in their lane. Or trust that people are going to stop at a stoplight as I go through the green. Or that the bank is going to keep my money. Or that the building I am in is not going to collapse.

The Russian Hospice Charity Fund that requested to translate my book seems like people I want to trust. From their website:

Someone who can’t be cured can still be helped.

The mission of Hospice Charity Fund is to make sure that every terminally ill patient in Russia has access to quality hospice care and pain relief – regardless of their age, financial and social status or place of registration.

Regardless of the differences we may have with other countries, on an individual basis, human compassion is universal.

So is trust.

The Collapse of Hope

Posted July 2, 2021 by [email protected]

Here we are again. This time a beachside condo building near Miami has collapsed. Distraught families are praying for a miracle — praying that someone they love will be found alive. Others are only hoping for the recovery of a body so that they can say properly their goodbyes.

I write this five days after the tragic event. Much can change by the time you read this.

This tragedy feels familiar. Mass casualties in a seemingly random occurrence, like 9/11, mass shootings, or airplane crashes.

I remember writing a piece around September 11, 2002, a year after the terrorist attacks killed over 3,000 people. While I acknowledged that those deaths had huge implications for national security and our nation’s foreign policy, I disagreed with those who believed there to be some special meaning to the individual deaths. Those 3,000+ deaths were not unlike other random, sudden deaths I had seen countless times in my years in the ministry.

I admit, when things like this happen, I look for reasons why I am exempt from such randomness. I don’t own a condo on the beach in Miami. I don’t fly on airplanes in Africa. I don’t go to gay night clubs in Orlando. No wonder I am still living, and those unfortunate souls are not.

This doesn’t happen here

Even the mayor of the town where the condo high-rise is located sought refuge in the “this-doesn’t-happen-here” mentality.

“‘It would be like a lightning strike happening,’ said Charles W. Burkett, the mayor of Surfside, Fla., where the collapse occurred. ‘It’s not at all a common occurrence to have a building fall down in America,’ he said. ‘There was something very, very wrong with this situation.’” (New York Times, June 27)

Mr. Mayor, it does happen here. It DID happen here. And in your town, on your watch. (By the way, on average, 26 people die in the U.S. of lightning strikes each year.)

No trite platitudes for these stunned families

If I were called on to offer pastoral care for these worried families, I would try to meet them, and be with them, where they are in the process. If they were still praying for that most unlikely miracle that someone they love is alive — I can pray with them for that. If they had moved to mourning without a recovered body — I can be with them, too.

What I would NOT do is try to offer “solace” with such platitudes like, “God never gives you more than you can handle,” or “With God, there are no accidents,” or the absolute WORST, “Everything happens for a reason.”

So, once again, we all stand vigil. Indeed, most of us truly empathize with these poor families. We will watch with interest how they get through these coming days. Most will move into a normal, sad grieving process. An added pressure on these families, that most of us will never experience, is that many of them will mourn on national television. God help them.

“Mrs. Smith, here is your pain pill.” She Lied

Posted June 14, 2021 by [email protected]

Is it ever okay to lie? Can lying be helpful at times?

Let me think about that.

I was sitting at the nurse’s station in the nursing home where I was chaplain. The most competent and compassionate charge nurse pulled a pill out of someone’s med drawer and said, “I know this is unethical, but I HAVE to do something for this patient.”

She was in what we call “moral distress”—being forced to do something she knew, in most circumstances, was wrong. The patient was in increasing amounts of pain, and the doctor had prescribed a narcotic we did not have in our in-house pharmacy. Delivery could take hours, and the patient was often on the call bell begging for relief from her pain.

So, the nurse rummaged through other patients’ meds and found a vitamin pill. She took the pill to the suffering patient and said, “Mrs. Smith, here is your pain pill.” Within minutes the pain was gone. This is the well-known and much-studied “placebo effect.” It is real, and it provided this patient what she needed.

Medical ethicist Howard Brody has called the placebo, “the lie that heals.”

I just finished reading two books that explore the placebo effect. One is Useful Delusions: The Power and Paradox of the Self-Deceiving Brain by Shankar Vedantam and Bill Mesler. The other is Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform and Heal, by Erik Vance.

“The placebo effect is often described as the effect of mind over matter. But it is actually about something much more powerful: the power of the drama and rituals embedded in the practice of medicine—a theater that involves (often at an unconscious level) deception on the part of the physician [or the nurse] and self-deception on the part of the patient.” (from Useful Delusions)

And this bit of theater acted out by this nurse unlocked the patient’s “Inner Pharmacy” in the words of Eric Vance. He goes on:

“Chronic pain responds exceptionally well to placebos. In fact, pain might be the signature placebo-prone condition in the world today.… Humans do have a form of homemade opioids called endorphins—our own little hidden opium dens tucked away in our brains.… Pain placebos work because the brain self-medicates with opioid drugs.”

The theater that unlocks the placebo effect

How does this work? Vance writes, “Two complementary ideas—suggestion and expectation—are at the heart of unlocking your internal medicine cabinet.” The patient expected to receive relief from the nurse giving her a pill. The nurse suggested this was the pill that was going to bring that relief. Bada boom, bada bing—the pain was gone.

The nurse played her role in the theater. She dressed like the nurse she was. She brought in the pill as she had done scores of times before. She spoke her line, “Here is your pain pill.” The patient responded to all that the acting suggested and expected to find relief. She got that relief from an opioid released by her own brain.

I’ll give the last word to George Costanza from Seinfield: “It’s not a lie if you believe it.”

“If I had a daughter, I wouldn’t be in this nursing home!”

Posted May 27, 2021 by [email protected]

The old lady was stuck with three sons. And because of this — in her mind — she was stuck in a nursing home.

Her sons visited. They met with the nursing home staff to make sure their mother’s needs were met. They were as good of family caregivers as I had ever seen in my years as a nursing home chaplain. But, more than once, she said, “If I had a daughter, I wouldn’t be in this nursing home.” The notion seems a bit old-fashioned in today’s world, where gender equality is such an important issue.

Well, it turns out she might have been correct.

A study reported in the current issue of the Journal of the American Geriatrics Society (JAGS) found that a patient was more likely to die at home (as opposed to in a hospital or nursing home) if you had more family members… especially more daughters.

The burdens of a family caregiver

Being a family caregiver at home is a tremendous burden. In the JAGS study, the average number of caregiving hours in the last month of life provided by the family to someone who dies at home is 210. For those who die in a nursing home or hospice inpatient unit, it is 81.

Interestingly, the emotional burden for families is highest when the patient dies in a hospital and lowest when they die at home. Perhaps the transfer to the hospital in itself is a great emotional strain. Guilt about NOT being able to take care of the patient at home must also be a factor. And though providing hands-on care can be a physical burden, it may give the caregiver the self-satisfaction that they are doing their best. The caregiver feels more in control.

What about the daughters? Why does having daughters make it more likely to die at home? Unfortunately, the study did not tease out why, but we can guess.

Right or wrong, the cultural norm in our society is that nurturing and caring for the young and elderly are duties more often performed by women. Yet, I have witnessed so many men who admirably performed caregiving duties to their elderly parents that I know men can be great caregivers. But in these cases, the men usually stepped in because there were no women available.

Who’s going to take care of mother?

Hank’s mother, Charlotte, after her move to Colorado, with her namesake great-granddaughter, Lia Charlotte

I saw this “Who’s-going-take-care-of-mother?” question play out in my own family. Mom had lived for years independently in a retirement facility in Tampa before moving into assisted living. My brother, sister, and I took turns visiting our mother. I like to think we each took about the same amount of time away from our work and families to serve as long-distance caregivers.

As our mother’s dementia progressed, it became clear that we needed to move her to a facility closer to one of us. We each visited memory care units near our homes in Tallahassee, Boulder, and Northern Virginia. Each of us was willing and able to become “the caregiver.” We weighed the quality and cost of the facilities we had found.

After we all had done our due diligence, my sister declared, “I want to do this. I want mom to come to Colorado.”

I called Janice last week to see if my memory of this decision-making process was the same as hers. “Yes,” she said. “I knew you and Dennis were quite capable of caring for our mother, but I was her daughter. There is a special bond between mothers and their daughters.”

And that was that.