Emotional & Spiritual Issues | Hank Dunn

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Archive for the ‘Emotional & Spiritual Issues’ Category

Expect Delays . . . and Suffering

Posted December 4, 2013 by kbrachle

We have all seen them — those well-lit signs on the side of the highway announcing construction and that we should “Expect Delays.” The highway department is trying to manage expectations. If we are expecting delays and there are none we feel relieved, thankful. If there are, well, we expected them.

Should we expect suffering?

I have just finished a swing through the South visiting friends, family, and my old haunts. I confronted “Expect Delays” on the road and “expect suffering” in my visits.

Vineville Baptist high school youth retreat 1975

I spent my first five years in the ministry as a youth minister in Macon, Georgia. Over those years we maybe had 200 teenagers and college students active at one time or another. I have kept in touch with many . . . thank you Facebook.

I am guessing my “kids,” as I still refer to them, are little different than any other group of their same demographic as far as life experience since high school and college graduation. They are now in their 50s and have experienced much suffering.

I spent one recent night with Tom in his mountain cabin in north Georgia. Four years ago he was diagnosed with esophageal cancer. Part of his stomach and a portion of his esophagus were removed leaving a smaller stomach … but his life intact. The five-year survival for this type of cancer is 15%. Looks like Tom might make it past that magical date.

Talking with Tom, we got to reflecting on all the tragedies that have befallen this small sample of late baby boomers we called our youth group. At least two have been widowed. Many divorces. A few have lost children. Some have died. The older brother of one “kid” was just killed in a bicycling accident a few weeks ago. At one of the last outings of my time in Macon, Dan Allison drowned while swimming with the youth group. A tragedy I still relive often.

I first thought, “We have had more than our share of heartaches.”… Maybe not.

The Buddhists tell us that “life is suffering.”

The Buddhists tell us that “life is suffering.” They are managing expectations. I don’t know if I could have stood in front of this group of teenagers in 1978 and told them, “In the next 35 years a couple of you will be dead, some of you will have buried children, many will have gone through a divorce, some of you will have to deal with cancer … expect suffering.”

I would have been telling them the truth.

The human species is an amazingly resilient lot. In general, we take what life gives us and go on. I have heard little complaining from my “kids” or from the hundreds of patients I have listened to over the years. To be sure, none are glad tragedy has struck them. Yet, I have heard very little “Why me?” or even “Poor me.”

What I HAVE heard is, “What next?” “How do I go on from here?” “Life/God has been so good to me.”

Reynolds Price, in A Whole New Life, describes his emotional and spiritual recovery after having been paralyzed below the waist from a brain tumor. He said it is senseless to ask, “Why? Why me? I never asked it; the only answer is of course Why not?”

The death of a spouse, death of a child, cancer, or any other of life’s tragedies does not negate the wonderful miracle of life itself.

Just Plain “Thank You” Period

Posted September 3, 2013 by kbrachle

Can one be thankful and not really thank anyone or anything?

Can we be overwhelmed with gratitude but have no need to direct our thanks in any one direction?

These questions came to me as I finished the last pages of Wild: From lost to found on the Pacific Crest Trail by Cheryl Strayed. This memoir came out last year and has been ably reviewed in the New York Times by Dani Shapiro. My interest here is from just one line on the next to last page of the book.

She took her grief on a 1,100-mile backpacking trip

Full disclosure here—the book is about grief and backpacking, two abiding interests in my life. I probably would write favorably of anyone who takes her grief over the losses of her mother, her family, and her marriage on a months-long, 1,100-mile backpacking trip. Cheryl Strayed did and wrote about it.

Over the months she encounters the elements (heat, waterless stretches on the trail, snow, etc.) and animals (bears, snakes, cattle, more etc.) and human characters. She also encounters the demons and angels who have been with her over the years. Her 45-year-old much-loved mother died a few years before the hike. She, her siblings, and mom were abandoned by her father. Her step-father drifted away in recent years. Strayed’s own marriage fell apart primarily through her own shortcomings.

I have never attempted long-distance backpacking. The most I have ever lasted was four nights. So I only have a hint of what she went through on her arduous journey. I know and have met many through-hikers on the Appalachian Trail within a half-hour of my home. Here in Virginia the people I meet on the AT have completed one thousand miles on their way to Maine, another thousand miles to the north. Strayed’s stories of the people she ends up hiking with for a few days at a time ring true.

In the end, gratitude was her feeling at her core

At bottom, she writes of her journey to emotional wholeness she has found in what was once the wreck of her life. There are many moving passages in the book but I was caught by her sense of gratitude in the end. She never portrayed herself as a religious person in any sense of the word. But, in the end, gratitude was her feeling at her core.

She had touched the bridge on the Columbia River, the site of the end of her journey. She walked back to an ice cream stand to give herself a treat with the last two dollars she had to her name. She enjoyed the treat and chatted with a lawyer from Portland who pulled up in his BMW also to have an ice cream cone. She said goodbye to him and . . .

“I leaned my head back and closed my eyes against the sun as the tears I’d expected earlier at the bridge began to seep from my eyes. Thank you, I thought over and over again. Thank you. Not just for the long walk, but for everything I could feel finally gathered up inside of me; for everything the trail had taught me and everything I couldn’t yet know, though I felt it somehow already contained within me.”

Religious types say “thank you” to God. Others thank a “higher power” or thank “the universe.” Strayed evidently felt no need to tell us if there was a “you” to “thank you.” In my life-long quest to understand the spiritual journey I don’t think I have ever encountered a more simple and yet profound expression.

Thank you.

Just “thank you” period.

One is the recipient of the graciousness of life. Most of the dying people I have met in my thirty years at their bedsides have that same humility and gratitude.

Cheryl Strayed ends acknowledging the truth I tried to capture in my poem “Giving Up, Letting Go, and Letting Be.” Her last words of her book . . .

“How wild it was, to let it be.”

Thank you,

Hank

Preparing for Death as a Game . . . really

Posted July 30, 2013 by kbrachle

As I have wandered around the internet looking at things death and dying, I ran across a very intriguing project. The company, “Common Practice,” has developed a game called “Hello” to help people have discussions about death and dying.

The concept of the game is quite simple. Gather people together to talk about what is most important in life as you think about dying. Their website offers videos and testimonials that give you an idea of how it works.

This looks like it has real possibilities for staring conversations in families and among friends. In my view, the family discussion about end-of-life care is the most important part of preparing for healthcare decisions in the face of a life-threatening illness. The family conversation ranks right up there with assigning a healthcare proxy.

This game could be part of the process.

Thanks guys!

Hank

Alzheimer’s and Hope

Posted April 5, 2013 by kbrachle

I never thought I would see those two words together. Alzheimer’s and hope. Well, maybe, “I hope I never get Alzheimer’s.” Okay…I’ve heard that a lot.

I have been reading some really hopeful stuff from someone with Alzheimer’s Disease. David Hilfiker, a physician, is on a mission to make this eventually fatal disease less scary. Last September he was diagnosed with mild progressive dementia, probably Alzheimer’s. The Washington Post ran a story about David’s life now and his new vocation as one who is losing his mind.

Dr. Hilfiker has spent his life excelling. High School valedictorian. Standout at Yale. Med school grad and rural physician. Inner city physician for the poor. Founder of Joseph’s House, a hospice for homeless people with fatal diseases. Author of three books. Husband of 44 years, father and grandfather.

Our paths have actually crossed. We were members of the same faith community and in a mission group together for a while in the early 80s. I sent him a draft of my first book, Hard Choices for Loving People, and he was so kind to offer significant suggestions for improvement. That’s a whole other story. I had lost touch with him and then saw the piece about him in the Post.

Watching the lights go out

David is writing a blog about his experience, “Watching the Lights Go Out.” It begins last September with the diagnosis which confirmed his suspicions that he was losing his cognitive capabilities. He chronicles the mental mistakes he has made, the forgetfulness, preparing for a future in a nursing home, telling his family, friends, and church.

In February he gave a sermon to the congregation where he is a member, the Eighth Day Faith Community (part of Church of the Saviour). Titled “A Theology Out of My Life with Alzheimer Disease,” he tells of the lessons he has learned. He has learned to let go of shame and guilt for mistakes (whether caused by his disease or not). In other words, to be more forgiving of himself. He has become more emotionally available to his wife, family, and friends.

Live in the present

For me, the greatest lesson is one for all of us. Live in the present. He told the Post reporter the same thing, “’If I live in the future, it’s a very painful disease,’ Hilfiker said one recent afternoon as he sat at his kitchen table in Northwest Washington. ‘If I live in the present, it’s not.’”

Do yourself a favor. Go to his blog and sermon. I’ll stop with just a few quotes from his blog. Thank you David!

Perhaps this Alzheimer’s is allowing me to enjoy my life for the first time, not because things are any better, but because I’m more emotionally in touch with the goodness. I feel rooted, grounded. I’m where I’m supposed to be. I’m not looking for something else, something better. And this gift comes through my disease.

So when I discovered I had Alzheimer’s, I could look back at my life without regret that I didn’t choose to do this or dare to do that. Marja and I have had a good life. And far from preventing me from doing things, so far this disease and its process have given me a richer life. I now have a well-defined call and a fulfilling vocation (writing and speaking about this illness). Sure, I’m younger than I hoped I would be when I contracted my last disease. Certainly I would like to live longer, see my grandchildren grow up. But we all have to die, and I’ve been given much more than most people.

And now I’ve been given this adventure!

[2016 UPDATE: Turned out he did NOT have Alzheimer’s and he wrote a final blog post to update his readers.]

Photo credit Nikki Kahn/The Washington Post

Emergency Preparedness

Posted March 4, 2013 by kbrachle

“Could you come to ‘labor and delivery’? We’ve had a fetal demise and the family would like a chaplain,” the nurse said. She had paged me at 5:30 AM last Monday. I told her I could be there in a half-hour.

We have a volunteer on-call chaplain program at Loudoun Hospital near Leesburg, Virginia, for just such an event. It was my turn.

The small ritual of prayer to the bedside

I entered the room and found the young mother in her bed with the father of the child sitting next to her. Her mother was in the chair next to the bed. She went into labor at 20 weeks and, of course, the baby did not survive. All in the room were very quiet. I said, “I heard you lost your baby. I am so sorry.” The mother nodded her head as she just looked down. They did not seem in the mood to talk much. I asked if they would like to have a prayer and they said, “Yes.”

It was a short visit. I offered my pastoral presence and brought the small ritual of prayer to the bedside.

I am glad to do what I can but I often am sorry that those I am called to meet did not have their own faith community to call on in such an emergency. Losing a pregnancy needs more than just a prayer. What about grief counseling? How could a faith community support this family in their loss?

This family needed more than a quick prayer

Contrast this visit to one I made a while back to the emergency room. The rescue squad was heading toward the hospital with a man who had suffered what turned out to be a fatal heart attack. The ER staff wanted a chaplain there to comfort the family. The man was in his 50s and there were two children and his wife. He had no history of heart problems and just collapsed and died.

One of the first questions I asked the family was if they had a faith community. They immediately said yes and gave me the church name and pastor’s name. I called him. He was shocked and distraught over this death of a friend and parishioner. Of course he would be right over. I stayed until he arrived.

Again, this family needed more than a quick prayer next to the dead husband and father. They had funeral plans to make then the long road of grief to follow.

America is still a very religious and spiritual nation. But more and more of our population are not connected to any faith community. Those who answer “None” on surveys asking religious preference are at an all-time high. These “nones” might consider themselves spiritual but not religious.

Spiritual needs are great yet many people have no place to turn

As a healthcare chaplain I run into these folks all the time. That is why medical facilities have staff chaplains. The spiritual needs in the midst of a health crisis are great yet many people have no place to turn. I like to think the future employment opportunities for chaplains are good given the need.

Of course, I wish more people had their own faith community to turn to. I remember in my days as a nursing home chaplain I could judge how important spiritual things were to a new patient just by reading their admission papers. The response to “religious preference” and “congregation” ran from “none” to “Christian” or “Jewish” to something like “First Methodist Church” to even including the pastor’s name and phone number. The more details I got on the form showed me someone who took their faith more seriously.

I don’t want to come across here as judging people for not going to worship somewhere. But I wish people stopped to think, “Who would I call if there were a sudden death in my family?” If the faith element is important then find a community now. Most faith communities handle crises very well. They are there when you need them. Sure, we can scurry around and find a volunteer to show up for a few minutes. But faith communities have so much more to offer.

Photo by Jonnica Hill on Unsplash

Kids, Funerals, and the Civil War

Posted January 13, 2013 by kbrachle

“Should I take my 13-year-old boys to the funeral?” a friend of mine asked. It was a very tragic situation. Her boys were on a soccer team where two of the teammates had already lost their fathers—one to cancer and another in an industrial accident. But this new loss was even worse. Two of the boys on the team were killed by their own father as part of a murder-suicide.

Would this haunt them for years if they got too close?

This mother was concerned about the long-term effects of the boys being exposed to such a horrific loss of life. Would taking them to the wake and funeral make them overly anxious about whether this could happen to their family? Would they have nightmares? Would this haunt them for years if they got too close?

It almost goes without saying, but I assured this mother that she knows her boys better than anyone and she will make the right decision. I repeated my oft-repeated mantra—you can never make a wrong decision. You make the best decision you can with the information you have at the time.

I did say, in general, 13-year-olds should be able to handle the emotions and thoughts that may arise by attending a funeral. Also, in general, I feel it is good for this age children to be exposed to the rituals around death and dying. As much as death is a part of movies, TV, and video games, most of our society does not see death as a normal part of life. Such unfamiliarity makes it so much harder to deal with when it strikes close to home. I went on to say that the horrific nature of these particular deaths may be cause to limit her boys’ exposure. She has to make that call.

In some ways it is actually a good sign that our society does not often see death personally. Many people do not lose their grandparents until they reach adulthood. With rising life expectancy most of those who die are very old. There are exceptions for some segments. The poor may have more health problems that bring early death and some communities experience have higher rates of violent deaths. I would not wish higher death rates on any portion of our citizenry.

How does a nation cope with the enormity of this loss of life?

There was a time when death was all too familiar. Coincidently, this family tragedy happened the same week as the PBS special “Death and the Civil War” aired. From 1861 to 1865 an estimated 750,000 Americans died in the conflict or 2.5 percent of the population. Transpose those figures to our current population and it would be like seven million people died. How does a nation cope with the enormity of this loss of life?

The PBS presentation was based on a book, This Republic of Suffering: Death and the American Civil War by Drew Gilpin Faust. Although Americans, in 1860, would have been familiar with death, the nature and scale of the suffering brought on by the Civil War were unimaginable. We know our ancestors lived close to death. Visit any old cemetery and one is struck with how many young children died. Before the Civil War people often died of a short illness, at home with their family around them. There were last words spoken, prayers, the deceased laid out in the living room, and a funeral service. These practices made up the “good deaths.” But these rituals rarely happened with wartime deaths.

Both sides expected the Civil War to be short and not that painful. The Union army drafted men to serve for only 90 days. There was no ambulance service, no provision for identifying and burying the dead, no system for notifying the next of kin. The soldiers faced a death unlike the “good deaths” they might have witnessed back home. Often killed instantly by a bullet, there was no time for last words. There was no family gathered around. If the soldier’s army had been defeated on the battlefield and fled, there were no comrades to bury them.

Wartime deaths beg for meaning. Why did all these men die? For the North, Lincoln’s Gettysburg Address summarized the meaning that these men “shall not have died in vain.” They died to preserve the union and grant freedom to all who dwell in our land. He spoke at the dedication of the first of the National Cemeteries. For the South, finding meaning was more difficult but in the years that followed, the idea of the “lost cause” helped give meaning. Both North and South spent years repatriating remains and establishing cemeteries near sites of battles or prisons.

Death is more distant, remote

And today? Most often the old in poor health are in nursing homes or other facilities and not an active part in the lives of their families. Most people die in institutions like hospitals, although hospice is helping more die at home. Death is more distant, remote. Because sickness, decline and death are often hidden we lose the opportunity for personal and spiritual growth by not contemplating death. The boys on the soccer team can benefit from learning early the harsh realities of life. Hopefully, they will appreciate the gifts of life and of their healthy families. Hide death from them and you hide one of the most profound aspects of life on earth.

Read the words of Michel de Montaigne, c. 1580-1595:

“To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness; let us frequent it, let us get used to it; let us have nothing more often in mind than death. At every instant let us evoke it in our imagination under all its aspects….To practice death is to practice freedom. A man who has learned how to die has unlearned how to be a slave. Knowing how to die gives us freedom from subjection and constraint. Life has no evil for him who has thoroughly understood that loss of life is not an evil.”

Photo by Jesús Rodríguez on Unsplash

CPR Did It For Me

Posted September 23, 2011 by kbrachle

CPR did it for me.

Not the procedure ON me but my awakening to the fact that some widely used treatments have little benefit for vast numbers of patients.

I became a nursing home chaplain in 1983 with no experience in healthcare. I was introduced to the standard practice of performing CPR on all patients without a pulse unless they had a “Do Not Resuscitate” (DNR) order. Actually, at our nursing home, the order was “No CPR.”

It is a “death-and-death” decision

That language choice was intentional. The DNR order implies that if you use the procedure the patient would be resuscitated. It was presented as a choice for the patient or family. “Would you like us to resuscitate your mother?” In fact, less than 2% of nursing home residents who receive the procedure have their hearts restarted with CPR. So our order was more honest. “No CPR” meant we would not perform the procedure. You weren’t choosing between resuscitation back to full health or death. There was almost no chance the procedure would work, therefore, you were choosing between CPR attempts and no attempts. I tell people this is not a “life-and-death” decision. It is a “death-and-death” decision. The patient will die no matter what the choice is but one is choosing the nature of the death.

In recent years some facilities have stopped using “DNR” for this very reason. Other terms are gaining in use. DNAR for “Do Not Attempt Resuscitation.” My favorite is AND for “Allow Natural Death.” This implies we are not withholding something, we are just allowing the natural processes to reach their expected conclusion. Letting be.

Cardio Pulmonary Resuscitation started in the late ‘50s as a means to restart otherwise healthy hearts which had failed. Drowning victims or those who have had accidental electrocution were good candidates. It originally was never intended to be applied on patients where death was not unexpected. Slowly, it made its way into all healthcare facilities as a standing order against death.

[As an aside, I would hope, in the event of sudden cardiac arrest, my children or grandchildren would have CPR attempts. I do not have the same hope for my 92-year-old mother with Alzheimer’s.]

CPR has been shown to be virtually ineffective for large groups of patients.

Now, even after decades of “improvements” in the procedure and research into its effectiveness, CPR has been shown to be virtually ineffective for large groups of patients. And we know before we start who some of these patients are. CPR offers no benefit to: patients in the terminal phase of an illness; patients who cannot live independently (all long term nursing home patients and assisted living residents); and patients who have multiple medical problems in advanced stages.

Why?

Why do we attempt to resuscitate a patient when we know ahead of time it will not work?

One of the reasons is that many physicians do not know the truth and/or fail to inform patients or their families about the ineffectiveness of CPR in a particular case. Conversations to inform patients and families take time and can be emotionally laden. So, some physicians take the easy road and never have the conversation or just ask, “Do you want us to resuscitate your mother?” without informing the family that the attempt will not work.

Another reason for widespread use of resuscitation attempts are the unrealistic expectations of the general public, often influenced by television portrayal of patients being rescued by paramedics or hospital personnel. A few years ago study analyzed how CPR was depicted on popular TV shows. On “Rescue 911” 100% of resuscitation attempts were successful, when in the real world only about 15% are successful on all patients. No wonder families inform physicians to “try everything” when they have seen “everything” on TV and it works all the time.

An even greater reason CPR is performed on patients who will not benefit are the emotional and spiritual issues surrounding the “No CPR” order. I had a nursing home patient who was failing and near death. He was still a “full code,” meaning everything should be done to save his life including resuscitation attempts. I spoke with his daughter and explained the ineffectiveness of CPR on patients like her father and that our medical director recommended a “No CPR” order for all such patients. She said, “I know CPR will never save my father’s life, but it is just so hard letting go.”

Symbolic gestures only with no medical benefit.

CPR has become a symbolic gesture. In many cases, we know it has no medical purpose. Yet it allows patients and families to maintain the illusion of holding on, the illusion of control. They can’t let go or let be.

Later in my career, I learned of other ineffectual treatments like IV hydration for dying patients or feeding tubes for advanced Alzheimer’s patients. These have their own illusions for doctors and families but are symbolic gestures only with no medical benefit.

As a pastoral caregiver I see a great opportunity for ministry with those who say they want to “try everything” in face of certain death. There is something else going on when people say they want a resuscitation attempt when they know it to be ineffectual. I say, “Tell me more about wanting CPR. That is a very unusual request for someone in your condition.” The tears and the words come forth. “I am afraid of dying.” “I don’t want to lose mother.” “I hope to reconcile with my father.” These are real issues but CPR attempts do not address them.

Beating on someone’s chest will not take away their fear of death nor reconcile them with a family member. Perhaps a chaplain, social worker, or clergy person could help. Please, somebody tell these people the truth and deal with the real issues behind resuscitation attempts.