Penny Hawkins Smith, RN, educates and entertains (yes, entertains) her followers with short videos (okay, “reels”) based on her experience as a hospice nurse. She now has brought her earthy take on death, dying, and hospice to written form in her book, Influencing Death: Reframing Dying for Better Living.

Spare me a moment of shameful self-promotion — my Hard Choices for Loving People is one of just four books she recommends in her “Resources” section…I digress.

Like many of us in hospice work, Nurse Penny has learned how to live a better life as she watched her patients and their families navigate the journey unto death. In her words, “Being present with the dying and those they love has brought me joy, happiness, meaning, and purpose.”

HelpMeLeaveMyHusband.com

This outlook did not come easy for her. This book is, in part, a memoir about how a troubled young mother survived her own addictions and reckless living. Her life story is woven into the fabric of a book to help people have a better death and, she hopes, have a better life.

It turns out that Smith was an internet sensation long before TikTok and Instagram. With her first marriage dissolving and having child-rearing and nursing school expenses, she set up a website (no longer active), HelpMeLeaveMyHusband.com. This led to national publicity, including an interview on “The View” and a mention in Time magazine. Who knew?

Practical advice on having a “good death”

The real power in this book comes from the stories of her patients, their families, and her own journey with death in her family. Because of her large platform, Nurse Penny has a good read on what people currently think about death, fear of it, and how to prepare for it.

Questions and comments from Smith’s social media followers appear in Influencing Death, allowing segues to practical end-of-life advice. Here are just a few nuggets of Penny’s wisdom found in these pages:

• “The earliest signs [that death is near] are eating less, sleeping more, and socially withdrawing.”
• “[T]he reality is that thinking about our inevitable demise, accepting it, and planning for it are the best ways to have a good death.”
• “People seem to think that saying words like ‘death,’ ‘dying,’ ‘died,’ or ‘dead’ will cause it to happen. Death is what it is, and calling it by another name won’t change that outcome.”
• “No, they don’t need to eat. They’re dying, and they aren’t dying because they’re not eating. They’re not eating because they’re dying!”
• “He, like many, many family members of hospice patients, was worried that he would cause her to die faster by giving her morphine. I’ll reiterate for the people in the back that this couldn’t be further from the truth.”
• “Being present with the dying and those they love has brought me forgiveness—forgiveness for the people who hurt me and, more importantly, forgiveness for myself.”

“Is there an afterlife?”

When I started work as a hospice chaplain in 1996, two nurses at our agency had authored what became a very popular book, Final Gifts. Maggie Callanan and Patricia Kelley told stories of patients having deathbed visions or telling family members they were going to “take a trip.” It is still selling 33 years later.

Photo by Aamir Suhail on Unsplash

Fast forward to now, when Penny Smith (and two other social-media-influencer-hospice-nurses-turned-authors) address these fascinating phenomena and delve into the question, “Is there an afterlife?” Smith recounts many of these stories in a chapter titled “The Woo-Woo Stuff.”

All these influencer-nurse-authors tell similar stories of dying patients having visions or dreams of dead relatives coming to visit them. These visions are very comforting to patients, although sometimes discomforting to their families. Nurse Penny adds her own experience… read the book to find out how that goes.

Penny is very clear that she does not believe in God, nor does she practice religion. At the same time, she is also clear that observing these deathbed visions and having had her own experience, she believes that we do still exist after death.

Are these visions “real?” That’s not even a good question. They are “real” to the people who experience them. That should be the bottom line.

Thank you, Sergeant

Penny’s story takes us through some very dark places of her addiction journey, including when she spent a night in jail. The next morning, the police sergeant told her, “You are not the same person who came in here last night. You seem very bright. Why are you here? I really hope you can get on the right track because it seems like it would be such a waste if you didn’t.”

I was touched to see him listed with others in the “Acknowledgments” at the end of the book: “The sergeant at the police station, I’m sure I will never see you again, but I do hope if by chance you read this book, you will know how ultimately life-changing your words were.”

I, too, thank the sergeant.

__________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Book Review: “Influencing Death: Reframing Dying for Better Living” first appeared on Hank Dunn.

Photo-courtesy-of-Julie-McFadden

Julie also has a book coming out in June, Nothing to Fear: Demystifying Death to Live More Fully.

It’s a great short interview. Here are some excerpts:

Reflecting on her work as an ICU nurse, she said, “We think [death is] the worst possible thing that could happen, and I think that causes a lot of undue suffering. And suffering to me is far worse than death.”

“I do feel like it was kind of traumatic to be an ICU nurse, at least for me. Hospice was a slower pace. I was in people’s homes. There was a lot of autonomy.”

“Even as an experienced ICU nurse, I feel like I didn’t understand the scope of how our bodies really take care of us, even at the end of life.”

[The interviewer asked] “Can you expound on that a little bit? What are some of the ways that our bodies take care of us?”

“For example, almost everyone wasn’t hungry, wasn’t eating and drinking, and they were sleeping a lot of the time.…. When you start getting towards the end of life, your body knows it. So it starts like turning off that hunger and thirst mechanism in the brain, because it knows that it doesn’t really need that anymore.”

Read it for yourself. Check it out at “Hospice News.”

_____________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Hospice Nurse Julie Says Suffering is Worse Than Dying first appeared on Hank Dunn.

bomb, chronic disease, demonic, homework, influencer, milestone, remix, Roman Catholicism, swampland, unattainable, worthwhile

Milestone: 100K on 2017 VW Passat

The answer in just a moment. I emphasized “milestone” because I hit one last week. Our 2017 VW Passat passed 100,000 miles. I go into buying a new car with the hope of getting 200,000 miles out of it. We’re halfway there.

It’s funny how we have so many “milestones” in our lives are related to automobiles. Think of getting a driver’s license (for me, at 16) or that first car (for me, a 1969 Camaro). Heck, getting the Passat in September 2017 was marked by another milestone — Hurricane Irma in Florida.

My wife and I were signing papers in the VW sales office when we noticed a long line of people holding propane tanks across the street. My wife commented, “Look at all the people getting ready to grill on Labor Day.” The salesman responded, “Are you crazy? They’re getting ready for the hurricane.”

We were new arrivals in the state and failed to make the connection with the approaching hurricane. That memory is now a milestone — or rather two milestones: our first hurricane and the purchase of our ’17 Passat.

Defining milestones

Photo by Steven Brown on Unsplash

The best I can tell, the Romans were the first to use milestones along their roads. I found a photo of a milestone after the Roman era marking the distance to “London.”

There are two definitions of “milestone,” according to Apple Dictionary:

1) A stone set up beside a road to mark the distance in miles to a particular place.

2) An action or event marking a significant change or stage in development.

Synonyms of “milestone” include climacteric, climax, corner, landmark, milepost, turning point, andwatershed.

1990 – Fairfax Nursing Center. Photo by Hank Dunn

As a hospice and nursing home chaplain, I observed many milestones in people’s lives. The most obvious milestone for the patient and their family is the event of the death itself. But there were also milestones leading up to the death.

I would hear about the milestone of someone’s diagnosis, “I will never forget sitting in the doctor’s office and hearing ‘You have cancer.’” Or the milestone of the day someone entered a nursing home. A turning point at which the patient loses their freedom, and the caregiver is freed from the burden of constant caregiving.

Use rituals instead of stones

Milestones: A new Tampa home in 1961 for the Dunn family and upon selling it in 2000

I am a fan of using rituals to mark milestones in our lives. For a chaplain, of course, that can include a prayer at the bedside after the patient takes their last breath.

When my parents sold the home they had lived in for almost 40 years, I felt it was important to mark the milestone. Mom and I picked up Dad at the nursing home and went to the house before the closing to sell it.

I pushed Dad in his wheelchair from room to room, and we recalled the people and events that took place in each. We had a prayer of thanksgiving. We wept.

So, what does “milestone” have in common with “homework,” “influencer,” “swampland,” and those other words I listed above? The first known use of each in the English language occurred in 1662. Who knew someone could be an “influencer” hundreds of years before the internet existed?

_____________________

Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving Peopleand Light in the Shadows (also available on Amazon).

Follow Hank: LinkedIn | Instagram | Facebook | YouTube

The post Milestones first appeared on Hank Dunn.

“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.

Photo by Ethan Hu on Unsplash

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’?”

Photo by Ankit Sood on Unsplash

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:

1. 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.
2. 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.

________________________

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.

Photo by Greg Rakozy on Unsplash

The post The “Comfort” of Nothingness first appeared on Hank Dunn.

Patient: “Oh, hi… (pause) No, not then. How ‘bout Thursday at 10?”

Me: “Great, see you then.”

I thought of this conversation as I was digging down into a Canadian governmental report.

Why are we so different than our Canadian neighbors? We share a 5,525-mile-long border yet, in response to one question, we are miles apart. Do we really live and die that differently?

I have this nerdy side of myself. I read through medical journal articles and government reports looking for insights into all things end-of-life. The government of Canada and the State of Oregon recently released their annual reports on Medical Assistance in Dying (MAID) or, in Oregon, Death with Dignity. These are the rebranded names for what used to be called Physician Assisted Suicide.

One number jumped out

End-of-life concerns: U.S.A.

End-of-life concerns: CANADA

I’m reading through these reports and one number jumped out at me. Physicians who aided these terminally ill patients in hastening their deaths with medications were asked, “Why did the patient want to end their life by taking a lethal medication?”

In Oregon, the number one reason out of seven choices that patients gave was concern over “Losing Autonomy.” 93.3% of these patients listed that as one of their end-of-life concerns. In Canada, at the BOTTOM of a list of eleven possible concerns, “Loss of control / autonomy / independence” is only mentioned by 1.7% patients.

My interest was piqued by that “autonomy” difference. So, I contacted my friend, Tim Ward, who is now writing about his travels in Europe. He and his wife are taking “senior gap year” as in “senior citizen gap year” traveling. Tim is a Canadian by birth and has recently become a U.S. citizen.

He emailed back from Paris, “It might be that in Canada, autonomy is less of a value than, say, meaningful social connection” and “the rugged individualism of the West is part of eastern Oregon’s make up.”

Individualism/Autonomy vs. social connection

I think he is on to something here. For example, the social connection vs. autonomy shows up in how we provide healthcare. In the U.S. we do not provide universal healthcare, Canada does. There is no for-profit health insurance industry in Canada, yet everyone has access to healthcare. The U.S. system is built upon a for-profit system that leaves 8.6% (28 million) of our fellow citizens without health insurance. How we provide healthcare is just the most glaring example of how we value individual choices over the common good. Also, the social safety net is very weak for the poorest among us in the U.S. — as we witnessed in the pandemic.

I got curious about where in the world people are the happiest. Turns out, Canada (#15) and the U.S. (#16) show up next to each other in a recent ranking of the happiest countries. The top countries are in northern Europe.

From the Gallup World Poll report, “[Finland] and its neighbors Denmark, Norway, Sweden and Iceland all score very well on the measures the report uses to explain its findings: healthy life expectancy, GDP per capita, social support in times of trouble, low corruption and high social trust, generosity in a community where people look after each other and freedom to make key life decisions.”

Critics would say that’s true, they may be happier, but they pay very high taxes. The countries highest on the “Happiest” list are often labeled as “socialist” by those same critics. That’s a discussion for another time and place. The point here is that the autonomy cherished by U.S. citizens shows up in less “social support.”

The myth of the cowboy

Photo by Taylor Brandon on Unsplash

Tim’s other point, about “rugged individualism,” caught my eye because of another nerdy side of me — I read books about the American South and how we got the way we are down here. Currently, I am into How the South Won the Civil War: Oligarchy, Democracy, and the Continuing Fight for the Soul of America by Heather Cox Richardson.

Richardson is a historian with 1.6 million followers on Facebook. She writes on that platform often and produces long videos discussing various history-related topics. In this current book she explains the growth of the “myth of the cowboy,” the ultimate “rugged individual.” According to her, since the late 19^th century, Americans have bought into this idea that anybody can attain whatever they want, that this country was built by autonomous “rugged individualists.” This is a myth because wealth actually went to a few elites from the days of the Founders to today.

Our founding documents lay out this contradiction in spades. The same property-owning White men who wrote, “All men are created equal,” enslaved Black people and did not give women or poor Whites a vote. We, as a nation, have been struggling with this contradiction ever since. Although Canadians do not have the history of slavery we do, we both share shameful treatment of indigenous peoples. Also, a discussion for another time and place. The point here is lionizing the “rugged individual” can show up as valuing autonomy at the expense of social connection.

Pastoral care at the end of life and autonomy

The phone exchange with the patient was typical of many we had over the months I was his chaplain. He ALWAYS chose another time. As a chaplain for those at the end of their lives I am always looking for ways to enhance autonomy, because I know it is so important to most of us. I gladly changed my plans. I figured this was my little way of affirming his autonomy.

________________________________________

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.

The post Canada vs. U.S.A. at the End of Life first appeared on Hank Dunn.

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

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

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

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

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

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

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

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

________________________________________

Cover Photo by Marcelo Leal on Unsplash

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.

The post “How effective is chemotherapy?” — That is the Question first appeared on Hank Dunn.

Searching for Stars on an Island in Maine (2018) By Alan Lightman

“As a physicist, Alan Lightman has always held a purely scientific view of the world.… But one summer evening, while looking at the stars from a small boat at sea, Lightman was overcome by the overwhelming sensation that he was merging with something larger than himself — a grand and eternal unity, a hint of something absolute and immaterial.”

Almost Human: The Astonishing Tale of Homo Naledi and the Discovery That Changed Our Human Story (2017) By Lee Berger and John Hawks

My interest in human evolution stems from one of my core spiritual beliefs — that the self is an illusion. My work with the dying, my reading death and dying literature, my contemplation of the mystics, and my pondering of my own Christian beliefs led me down this path. I am curious about how we evolved from being animal-like with no sense of self to being self-aware. Genesis pinpoints the moment when Adam and Eve’s eyes opened, and they saw they were naked — they became self-aware. This book is just another piece of this puzzle looking into our human ancestors. “This is Lee Berger’s own take on finding Homo Naledi, an all-new species on the human family tree and one of the greatest discoveries of the 21^st century.”

The Home Place: Memoirs of a Colored Man’s Love Affair with Nature (2016) By J. Drew Lanham (audio read by the author)

Lanham is a “birder” with a PhD from Clemson University, where he teaches. He touches on two themes close to my heart — love of the outdoors and growing up Southern. Lanham’s viewpoint is that of a Black man who descended from generations of family in South Carolina, whose professional field is almost entirely comprised of White scholars and birders. “By turns angry, funny, elegiac, and heartbreaking, The Home Place is a remarkable meditation on nature and belonging, at once a deeply moving memoir and riveting exploration of the contradictions of Black identity in the rural South — and in America today.”

Useful Delusions: The Power and Paradox of the Self-Deceiving Brain (2021) By Shankar Vedantam and Bill Mesler

I have long been fascinated by the placebo effect and reviewed this book in a previous blog about my experience with it. Our delusions are not only helpful in medicine but marriage, too. Here is a quote from the book: “The researchers found that the couples who had the most inflated views of their partners — the ones who saw their relationships with the greatest degree of self-deception — were the happiest. This is hardly a new idea: Benjamin Franklin once offered the advice, ‘Keep your eyes wide open before marriage — and half-shut afterward.’” Vedantam hosts a great podcast, “Hidden Brain.”

Illness as Metaphor (1978) and AIDS and Its Metaphors (1989) By Susan Sontag in one audio program

In the 1978 monograph, “Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment. By demystifying the fantasies surrounding cancer, Sontag shows cancer for what it is — just a disease. Cancer, she argues, is not a curse, not a punishment, certainly not an embarrassment, and it is highly curable, if good treatment is followed.” She then expands on this regarding AIDS. The backstory of these two pieces is that she twice “beat” cancer with treatment. She died of the disease in 2004. Her son, David Rieff, wrote of the tragic (in my view) ending of her life in Swimming in a Sea of Death: A Son’s Memoir.

Blue Mind: The Surprising Science That Shows How Being near, in, on, or under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do (2014) By Wallace J. Nichols

It is no secret that I get spiritual refreshment from paddling my kayak. I did a video while on a kayak trip in the Mississippi Delta where I mentioned this book. The subtitle says it all. We humans benefit spiritually by being near water.

__________________________________________

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.

The post Hank’s 2021 Books on the Spiritual Side of Science first appeared on Hank Dunn.

The response from our new hospice patient took me aback, “Oh God, NO!”

One of the great things about being a chaplain is that, generally, people are glad to see you.

…Let me restate that: People are not glad that they are in hospice and need to see a chaplain. People who are seriously ill and dying are usually pleased to see the chaplain. My standard greeting on a first meeting is, “I am glad to meet you but sorry for what has brought us together.”

An invitation to revisit my experience as chaplain

 A recent “GeriPal Podcast” has caused me to reflect on my years as a healthcare chaplain. That’s “GeriPal,” as in geriatrics and palliative care. “Spiritual Care in Palliative Care” is discussed by three chaplain educators and trainers and the two physician hosts.

Years ago, by chance, I became part of an experiment to find out how people actually felt about the prospect of seeing a hospice chaplain. I was the only chaplain working out of the Loudoun/Western Fairfax office of the Hospice of Northern Virginia.

When a new patient came into our service, the admitting nurse would ask the patient or family, “Would you like to see the chaplain?” About 30% said, “Yes.” Even at that low rate, my caseload was getting too much for me to cover adequately.

Then, something very fortuitous happened. We merged with another hospice, and suddenly, we had another chaplain to cover the whole eastern half of the region.

Now, we were looking to find a way to increase the caseload to fill this new abundance of chaplain hours. We changed from a question (“Would you like to see the chaplain?”) to a simple statement from the admitting nurse — “The chaplain will be calling to set up an appointment in a few days.” Bingo! We went from seeing 30% of the patients to seeing more than 75% overnight.

Why would so many people go from saying “No” to a question to so willingly accepting a call from a chaplain?

There are all kinds of reasons people said “No” to the question. Perhaps saying “Yes” implied, “I am not spiritual enough and need help.” Or people think of chaplains as “religious” and “I am not religious.” Or maybe accepting a visit from the hospice chaplain means, “I don’t think my pastor is good enough.”

Or, maybe it’s the reason the man who said, “Oh God NO!” had when I introduced myself. I asked him, “Why did you respond like that?” He immediately said, “I don’t want to die.”

Oh my goodness. He was equating meeting the chaplain as meaning he is going to die. In his mind, you only see the chaplain when you are dying. In truth, to be admitted to hospice, he had to acknowledge that his physician was estimating that he had only six months to live. Perhaps, he had seen too many movies with a chaplain escorting a prisoner to the gas chamber or a chaplain comforting a dying soldier.

I used that first visit to assure the man he didn’t have to die just yet. I told him people flunk out of hospice all the time by their condition improving. In my mind, I could explore his fear of death in a future visit. But it was not to be.

He had another stroke and never spoke another word. His pastor and I could provide general words of comfort and encouragement in the face of the fear of death, but we had no idea what he was thinking.

So, people refuse to see the chaplain because seeing the chaplain means, “I am dying.” The ill-founded logic goes, “Asking to see the chaplain means I am dying. I don’t want to die. Therefore, I will refuse the chaplain visits and will not die.”

I wish it were that simple.

__________________________________________

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.

The post Me: “I’m the chaplain.” Patient: “Oh God NO!” first appeared on Hank Dunn.

The nurse warned me that this was coming. The patient had breast cancer that had metastasized to the bone — a usually fatal prognosis.

Photo by National Cancer Institute on Unsplash

He went on to say, “I don’t want any talk about death or dying, only hope and healing.” Months before, I was asked not to return to a home where I had pushed a family to discuss possible death before they were ready.

I was wrong then, and I did not want to blow it again. As a chaplain, I was a guest in their home, so I would abide by his rules. I did say that if the topic of death came up, I would pursue it but would leave it up to them to introduce it. Until then, hope and healing.

Hope and optimism are all around us

There is hope at weddings. I have led many couples to repeat the phrase, “Till death do us part.” One pair deleted this phrase from their vows. It was his third marriage and her second. Another bride asked me to remove, “for richer, for poorer.”

The couples who didn’t edit their vows were being optimistic. The truth is half of all marriages end in divorce.

There’s hope in business. Would entrepreneurs start new ventures if they were not hopeful? Sure, they have a business plan and capital. Yet, there has got to be some self-deception, a bit of hopefulness in the face of long odds.

People who study such things call this self-deception the optimism bias. “The optimism bias is defined as the difference between a person’s expectation and the outcome that follows. If expectations are better than reality, the bias is optimistic; if reality is better than expected, the bias is pessimistic.”

Diversifying hope

It turns out optimists are happier and live longer than pessimists. I wrote in a previous blog about how the self-deception of the placebo effect can take away pain. With these kinds of benefits, so what if an optimist’s expectations are better than reality?

The Journal of the American Medical Association recently published an opinion piece, “Holding Hope for Patients With Serious Illness.” It is about doctors who encounter patients or family members who are hopeful for a happy outcome in the face of a fatal illness. What do they do? They don’t take away the hope but diversify it. Here is their summary:

“How can clinicians help patients hold multiple hopes? One approach may be to ask patients what they have heard about their prognosis from their clinical team. Patients could then be asked, ‘Given what is coming, what are you hoping for?’ It is not necessary to contest the answers nor convince patients to consider other futures. Instead, the clinician could acknowledge the response and ask, ‘What else are you hoping for?’ And then again, ‘What else?’ The point is to help patients balance and diversify their hopes, providing flexible future directions and possibilities.”

“Satan is trying to get me to doubt it.”

I stumbled onto this idea of diversifying hope on my own with the husband who heard a message from God. As I arrived for one visit, he was about to leave for work. He said, “Hank. You know how I said, ‘God told me my wife is not going to die’? Well, I still believe that, but Satan is trying to get me to doubt it. Would you pray for me?” I said I would, and he left.

I turned to the wife, who had just found out the cancer had spread to her liver. “Do you have as much confidence as your husband that you will not die?” She burst into tears and said, “I am afraid if I die, my husband will be disappointed in me.” My heart sank for them both.

Photo by Gus Moretta on Unsplash

On the next visit, I sat with the two of them. I told the husband about my conversation with his sick wife. He immediately got up from his chair, took this poor woman’s hand, and said, “I would never be disappointed in you. You have done all you can to fight this.”

I told them I had two concerns about people in their situation not contemplating the possibility of death. One was some people, believing a patient is not dying, refuse narcotics for extreme pain. (This was not the case with these two.) My other concern was that they might miss some crucial conversations. Conversations about their love for one another, saying good-bye, or finding ways to live fully in the limited time she had left.

The couple assured me they had been doing that, too. They were still hoping for a cure, but they also hoped for enough time to say all that needed to be said. They hoped for freedom from pain by accepting pain medication.

They had already diversified their hopes.

The post “God has told me my wife is not going to die!” first appeared on Hank Dunn.

“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 post Aging as a Spiritualizing Process — Part One first appeared on Hank Dunn.