Emotional & Spiritual Issues | Hank Dunn

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Life and Death as Metaphor – Part 2

Posted July 8, 2019 by kbrachle

I continue to gather these quotes on life and death as metaphor. Most were found on the WeCroak app:

“Our life is a faint tracing on the surface of mystery.” —Annie Dillard
“For life and death are one, even as the river and the sea are one.” —Kahlil Gibran
“Not success. Not growth. Not happiness. The cradle of your love of life … is death.” —Stephen Jenkinson
“Life is a spark between two identical voids, the darkness before birth and the one after death.” —Irvin D. Yalom
“Life is a succession of misunderstandings, leading us on to the final truth, the only truth.” —Roberto Bolano
“We only get to be in our bodies for a limited time, why not celebrate the journey instead of merely riding it out until it’s over?” —Jen Sincero
“Yet, in a bizarre, backwards way, death is the light by which the shadow of all of life’s meaning is measured. Without death, everything would feel inconsequential, all experience arbitrary, all metrics and values suddenly zero.” —Mark Manson
“Death is our friend precisely because it brings us into absolute and passionate presence with all that is here, that is natural, that is love.” —Rainer Maria Rilke
“Life’s but a walking shadow, a poor player, that struts and frets his hour upon the stage, and then is heard no more.” —Shakespeare

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

Posted May 20, 2019 by kbrachle

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

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

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

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

We do lots for dying patients

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

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

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

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

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

Life and Death as Metaphor

Posted April 23, 2019 by kbrachle

I am a collector of quotations about life and death. (BTW, I found a great source for these in an app called WeCroak.)

I was reading through my collection the other day and noticed many of the quotations contained metaphors for life and death. Here are a few of my favorites:

“Our lives are as bubbles in boiling water, which appear, rise to the surface, pop, and disappear.” —Leo Tolstoy
“No matter how much you’ve been warned, Death always comes without knocking. Why now is the cry. Why so soon? It’s the cry of a child being called home at dusk.” —Margaret Atwood
“Another way to get a sense of your life moving continuously towards death is to imagine being on a train, which is always traveling at a steady speed—it never slows down or stops, and there is no way that you can get off. This train is continuously bringing you closer and closer to its destination: the end of your life.” —Sangye Khadro
“Death is the sound of distant thunder at a picnic.” —W.H. Auden
“Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight. She helps us discover what matters most.” —Frank Ostaseski
“Dying is a wild night and a new road.” —Emily Dickinson

Photo by Paul Jarvis on Unsplash

Letting Go of Distractions for Lent

Posted April 8, 2019 by kbrachle

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

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

The phone itself was a major source of the unimportant

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

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

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

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

Photo by William Hook on Unsplash

The “Comfort” of Nothingness

Posted June 6, 2018 by kbrachle

“When I’m dead, I’m dead.… and I just sail off into nothingness, and that brings me a lot of comfort. That doesn’t bring everyone comfort but it brings me comfort.” —Caitlin Doughty, author of Smoke Get in Your Eyes, from an interview on the documentary “Into The Night: Portraits of Life and Death.”

Some people are okay with death being the end.

Their dead father sent a snowstorm

I haven’t run into too many people like that because I have spent so much of my life around folks who believe just the opposite. Many, if not most people, both religious and nonreligious, have some sense that their lives will continue in some form after death. I even had one family insist their dead father sent a snowstorm.

This family had asked me to conduct the funeral service for this man who was one of our hospice patients. I had never met the man nor his family before, since they all claimed they were not religious and did not want a visit from the chaplain. So, he dies and they have no relationship with any church but needed someone to lead the service. Happens a lot in hospice. I was glad to help out.

Through a phone conversation with family members I planned the service which was to take place at the funeral home. They described the recently departed man as very shy and private. He was also a giving and generous man who loved his family dearly.

The night before the scheduled service we had a major snowstorm. I felt I could make it to the funeral home, as did the family, so the service was held as planned. No burial was needed since the man had been cremated.

Only one person showed up for the service besides the few family members.

This lack of turnout did not bother the family in the least. They said, “It’s just like Dad. He was so private that he sent a snowstorm to keep people away.”

“Okay,” I thought.

What do I know? Maybe the recently departed do have the power to send snowstorms. My point is that the belief in living beyond the grave is pervasive whether or not it has a religious aspect to it.

Yet, in my years at the bedsides of the dying and their families, I have gathered enough evidence that some people can be okay with the idea that the last breath is the end. I have seen scores of people face their deaths peacefully even while they have no belief that they are “going to a better place” or are going to be reunited with departed family members.

Many people agree with Caitlin Doughty that death is the end. But, I did find her use of the word “comfort” something I have not heard a lot from those who accept that there is nothingness after death.

I do hear “comfort” from those expecting to see deceased relatives or to be in the presence of God. I can’t tell you the number of times I sat with a family around the bed of a dying relative and someone says, “I don’t know how people do this without faith in God?” Caitlin seems to have an answer to that question.

How is the thought of nothingness “comforting”?

Another way of asking that question is, “How is the thought of nothingness ‘comforting’?”

We know humans, at some point, became conscious beings in our prehistoric past. A major hint of this emerging consciousness is the fact that we buried our dead with tools and other items to help the departed in the next life. This becomes a sign of consciousness because we know our ancient ancestors had the brain capacity to understand that they were going to die and they had figured out a way to deal with it.

Religions grew and flourished as they offered an answer to the mystery of death. What happens to us when we die? The religious answers of life after death do offer many people great comfort.

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

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

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

Photo by Greg Rakozy on Unsplash

Is the Advanced Alzheimer’s Patient No Longer a Person?

Posted November 4, 2015 by kbrachle

Good question.

As people lose their memories, can no longer say who they are, can no longer recognize those closest to them … what’s left?

Blame it on the René Descartes

Blame it on the French. Well…actually, one Frenchman, René Descartes (1596-1650). He wanted to know, “What can I really know for sure?” His conclusion was, “I am thinking.” He then gave us, “I think, therefore I am.”

Fast forward to our effort to understand what is going on in the minds of dementia patients. These people are losing the ability to think. Eventually, they cannot recall the stories that made them who they became as adults. They cannot recall what they had for breakfast. They cannot tell you who they are.

So if Descartes is right, who are we when we can no longer think? Could we say, “If I don’t think, therefore, I am not”?

“Consider the phrases used [in the vast medical literature] to describe Alzheimer’s impact: ‘a steady erosion of selfhood,’ ‘unbecoming’ a self, ‘drifting towards the threshold of unbeing,’ and even ‘the complete loss of self.’” I got that sentence from a new book by Anil Ananthaswamy, The Man Who Wasn’t There: Investigations into the Strange New Science of the Self.

I just got back from speaking at an Alzheimer’s conference in Washington state. They wanted my standard talk based on my book Hard Choices for Loving People about making end-of-life decisions. I also had 90 minutes to talk about the emotional and spiritual issues at the end of life. Part of my lecture looked at the loss of the self.

But thinking is not all of who we are

Ananthaswamy’s book has a whole chapter dedicated to Alzheimer’s disease and the self. The chapter is 35 pages so I am looking at just one aspect of all this. It is true that much of what we consider “the self” is lost as dementia progresses. But thinking is not all of who we are. There is an embodied self, that literally is located in our physical body.

We learn to ride a bicycle as a child and do not ride again for 30 years. We don’t have to “think” about it. Our body knows how to ride again as an adult. Quick. Which finger do you use to type the letter “C” on the keyboard? Perhaps you could not tell me which it is but could immediately type it “without thinking.” That’s the point. There is a self unrelated to thinking, an embodied self.

The author related a story from one of the physicians conducting research on advanced Alzheimer’s patients and the self. I personally have experienced the same type of example of the embodied self.

The man said the prayer word for word in Hebrew

While I was a nursing home chaplain a local rabbi invited us to bring our Jewish residents to his synagogue. They had recently received a Torah restored from stolen scrolls hidden by the Nazis during World War II. One of our residents was a man with advanced Alzheimer’s. He could still walk and talk but did not know who he was nor who his wife of 60 years was. The man sat on the front row in the worship room with a yarmulke on his head and a prayer shawl over his shoulders as he had done in his younger non brain-damaged days. This man had not said an intelligible sentence in months if not years.

The rabbi brought the covered Torah to the man and asked him to recite the prayer said before the uncovering of the scroll. The man said the prayer, without hesitation, word for word in Hebrew. His wife next to him wept. I was in tears. A moment of clarity. Had we asked the man to repeat the prayer back at the memory care unit he would not have been able to do it. The synagogue, the rabbi, the yarmulke, the Torah, all connected with the self beyond thinking located in his body.

We all have this self. Only our thinking is so dominant that we do not recognize it. When the thinking recedes we are still there — in our bodies.

Photo by Artem Maltsev on Unsplash

The Country of Sickness

Posted June 30, 2015 by kbrachle

“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.” —Flannery O’Connor, 1956.

The southern and Catholic author was diagnosed with lupus in 1951, the same disease that killed her father when she was a teenager. She died in 1964 having lived and suffered and wrote and thrived with lupus for 13 years.

Books ONLY from My Brother

Posted February 11, 2015 by kbrachle

I do not like people giving me books

I do not like people giving me books to read that I have not requested. I have like 100 books on my wish list and when family members ask me what they can give me for a gift I go to the list and send several suggestions. I think of myself as a slow reader with a somewhat narrow range of interests and don’t want people cluttering up my reading pile with books I previously had no interest in.

So I drove from Virginia to Florida for Christmas with a stop at my brother’s rural home near Tallahassee. He handed me a gift. You guessed it. A book. A book I had not requested. But he was generous and I do not give my do-not-give-me-a-book speech right after the kindness of a gift.

I just finished reading all 241 pages. That comes out to about 4 pages a day since I accepted the book. See…slow.

Turns out it has become one of my all time favorite books. Of course it is in the death and dying genre. Right in my narrow range of interest.

NOTE to family and friends: Only my brother Dennis can give me books I have not asked for.

A memoir of a young mortician

Smoke Gets in Your Eyes and Other Lessons from the Crematory is a memoir of a young mortician, Caitlin Doughty. Oh goodness, where do I start.

A full disclosure WARNING about the book. It contains very graphic detail about the condition of bodies of the deceased, their preparation, and what cremation actually looks like. This book is not for everyone. That said, I still would recommend it for everyone. Push through it and you find a wonderful story of a young woman finding a calling to help us all in the end.

Do yourself a favor and visit Doughty’s Web site “The Order of the Good Death” at http://www.orderofthegooddeath.com/. She has some great videos called, “Ask A Mortician.” She has a Facebook page https://www.facebook.com/OrderoftheGoodDeath. A Twitter feed @TheGoodDeath (https://twitter.com/TheGoodDeath) with 16,000 followers. And lots of photos on Instagram, thegooddeath (http://instagram.com/thegooddeath).

This is not your old chaplain’s verses about “letting be.” She recently posted a photo of a greeting card, “If I had a choice to have sex with any celebrity, living or dead, I would probably choose living.”

She is irreverent but dead serious. Get it?

There is a small but growing army of folks like Caitlin Doughty out there who want to bring death into our everyday lives. She advocates for families preparing bodies for burial or cremation. She is a leader in the “Death Salon” movement holding public forums to talk about death and dying. She is not religious but encourages rituals to help families and friends of the newly dead grieve and cope in healthy ways.

Yesterday, I sent her copies of my books (unsolicited of course). I started the cover letter, “I am sorry I arrived so late to your party. Only now have I found out about all the fun you are having.”

Can I “Like” a Death Announcement on Facebook?

Posted April 2, 2014 by kbrachle

Great article recently in the New York Times about “Millennials” (those in their teens and twenties) and grief. Grief in the age of Facebook, texting, Instagram, and selfies. “An Online Generation Redefines Mourning,” by Hannah Seligson appeared in the March 20^th edition of the Times.

Is there anything creepier

“My God, is there anything creepier than a post announcing someone lost a loved one and seeing ‘136 people like this’ underneath?” Ms. [Rebecca] Soffer said [in the article].

“The social norms for loss and the Internet are clearly still evolving. But Gen Y-ers and millennials have begun projecting their own sensibilities onto rituals and discussions surrounding death. As befits the first generation of digital natives, they are starting blogs, YouTube series and Instagram feeds about grief, loss and even the macabre, bringing the conversation about bereavement and the deceased into a very public forum, sometimes with jarring results.”

Here are some links I found through the article.

Modern Loss is a repository of essays, resources and advice that the founders try to edit so that it doesn’t sound glib, overly religious or trite. For instance, you’ll never hear, “At least they are in a better place.” (“Our least favorite line ever,” Ms. Soffer said.)

The Order of the Good Death is a group of funeral industry professionals, academics, and artists exploring ways to prepare a death phobic culture for their inevitable mortality. It was founded in January 2011 by Caitlin Doughty, a mortician and writer in Los Angeles, CA.

OMG . . . “Selfies at Funerals”

Hank

Straight to the Heart of Danger

Posted March 13, 2014 by kbrachle

[NOTE: I wrote this in 1999]

“Go straight to the heart of danger, for there you will find safety.” Chinese Proverb

It was meant to be a nice three-day hike in the Green Mountains of Vermont the first week of October.

When I was asked to come and speak at a conference on the eastern shore of Lake Champlain on the first Saturday in October I jumped at the chance. And I automatically thought of a way to squeeze in a couple days backpacking at the same time.

Everything seemed to be going fine. I got the speaking completed and then stayed with friends in Burlington on Saturday night. We dropped off my rental car at the north end of my hike and they dropped me off nineteen trail miles to the south at Appalachian Gap. Though it was eleven o’clock in the morning, it was still cold and the wind roaring through the gap added to the chill. Pleasantly, once I got into the woods and away from the gap, it was quite warm . . . T-shirt weather.

This is the most rugged trail I have ever hiked. Yep. More rugged than any 14er in Colorado. The high altitude in the Rockies makes the hiking harder but the trail itself in Vermont was just more difficult. Like straight up the side of a mountain, no switchbacks and over rocks and boulders and back down again. At one spot an aluminum ladder was chained in place to help the hiker past an impossible rock face.

Little did I know I would be depending…

Sunday afternoon was quite enjoyable. Occasionally I got a glimpse of the ridge stretched out in front of me all the way to my final challenge, The Camel’s Hump, ten miles away. I finally arrived at a lean-to shelter 5.5 miles from the highway. It featured an “open-air privy” which literally was a toilet seat in the woods on a wooden box over a shallow hole . . . no outhouse, no privacy. Two cousins from Maine, men perhaps in their late fifties or early sixties, had already occupied the small shelter. I found them quite enjoyable. They were out for two weeks and were planning on finishing in Canada four or five days later. Each night they played the totally incomprehensible game of cribbage. Ken, his wife and dog hiked the entire Appalachian Trail (over 2,000 miles) a couple of years ago. Little did I know I would be depending on these two men as my margin of safety.

I heard Ken and Bob rustling around about 3, 4 or 5 in the morning saying something about snow. At first light I found out what the commotion was all about. There was an inch of snow on the ground and it was still coming down. I made my coffee and ate my pop tarts. I stayed warm in my sleeping bag as long as possible and turned over in my mind my options.

I could turn back over the mountains I hiked the day before and try to hitch a ride to my car. I could stay put for a few hours and hope for a break in the weather. But if it didn’t break then I would have a late start on the day and I for sure wanted to have Ken and Bob hiking behind me. Or I could push on and hope to make it over the Camel’s Hump and on to the cabin on the other side. It was going to be an ambitious day in the best of circumstances. I packed up and pushed out ahead of my bedfellows.

At the end of hardest backpack day EVER

The trail continued to be as equally difficult as the day before . . . only more so with a layer of snow and ice. The sky did not let up and snow turned to sleet. As I crossed Burnt Rock Mountain, even finding the trail became difficult. It was marked with a painted blaze of white paint. On the treeless summit the trail marks were on the rocks beneath my feet. Rocks, snow, white trail marks, sleet, rocks . . . where the hell am I going? Later when Ken and Bob caught up with me they thanked me for finding the trail over the mountaintop.

To prepare for the event of losing my footing, I developed a technique of going down the rocky trail. In what appeared to be the slipperiest places I tried to position myself above a tree or bush that could provide a handhold. I once was holding on to such a tree and my footing gave way. I found myself leaning above perhaps a fifteen-foot drop over rocks to the snow below. I figured I had two choices. Let go of the tree and tumble down with my pack. Or I could unhook my pack and let it take the tumble without me. Duh????

As I put my pack back on while standing on terra firma, I actually felt quite satisfied that I can do this safely even if my pack takes a beating. Eventually Ken and Bob caught up with me. They had decided to stay in the cabin short of the Camel’s Hump. They suggested I do the same. The problem with that was it would leave me with an 8-mile hike the next day, through the snow, over the mountain and I had a 2:00 PM plane to catch. They correctly guessed that there was probably a short cut down to the road where I could hitch a ride.

My mother gave me a hard time

After my last letter describing my climbing the 14ers in Colorado, my mother gave me a hard time and lectured me on how I need to be more careful. I explained to her the precautions I felt I had made for my safety. So, Mother, again I made sure people knew where to find me and I always kept hikers behind me to offer aid if I were injured alone. I was prepared for the cold weather, after all it was October and Vermont. Even so, after three weeks, the big toe on my right foot has not fully recovered from a touch of frostbite . . . but it’s getting better Mom.

But you know, in the midst of the cold, snow, sleet, sweat and some anxiety, the walk was stunningly beautiful. The Fall leaves and the snow made quite a contrast. When the walking was easy I could hear the crunch of the winter ground beneath my feet. As I did walk out the last day, besides the leaves dotting the snow, there were animal tracks everywhere. Much of the walking was alone. The last day was especially serene as I walked toward the road. The trail was a gentle slope downward and I could drink in the wonder of the world.

We were discussing death anxiety among our patients

I am sure some of the enjoyment of such adventures is in overcoming discomforts and hazards. The gentle walk out was such a contrast to eight to ten hours of hard work the previous day. The warmth of dry clothes were such a luxury. My new hiking “partners” added more than just safety to my trip. Had I hurried back home after speaking I would have missed all that.

Fall leaves in Vermont snow

I flew home on Tuesday afternoon and had a hospice counseling staff meeting at 9:00 AM on Wednesday. We were discussing death anxiety among our patients, their families and in ourselves as we accompanied them on their journey. We knew we were among the privileged few who had the opportunity be close to this final journey yet are spared it leading to our own death or the death of one we love . . . at least at this time. One of my colleagues shared with us a quote she had learned in school and has never forgotten, “Go straight to the heart of danger, for there you will find safety.” We observe our patients going straight into the heart of danger and often they have a sense of safety. Being around this danger I feel safer. Not unlike the safety I felt walking in a New England wood blanketed with snow.