Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

Mr. P. was a fifty-one-year-old patient who was hospitalized with rapidly progressing amyotrophic 
lateral sclerosis with bulbar involvement. He was unable to breathe without a respirator, had 
difficulties coughing up any sputum, and developed pneumonia and an infection at the site of his 
tracheostomy. Because of the latter he was also unable to speak; thus he would lie in bed, listening 
to the frightening sound of the respirator, unable to communicate to anybody his needs, thoughts, 
and feelings. We might have never called on this patient had it not been for one of the physicians 
who had the courage to ask for help for himself. One Friday evening he visited us and asked simply 
for some support, not for the patient primarily but for himself. While we sat and listened to him, we 
heard an account of feelings that are not often spoken about. The doctor was assigned to this patient 
on admission and was obviously impressed by this man's suffering. His patient was relatively 
young and had a neurological disorder which required immense 
 
medical attention and nursing care in order to extend his life for a short while only. The patient's 
wife had multiple sclerosis and had been paralyzed in all limbs for the past three years. The patient 
hoped to die during this admission as it was inconceivable for him to have two paralyzed people at 
home, each watching the other without the ability to care for the other. 
 
This double tragedy resulted in the physician's anxiety and in his overly vigorous efforts to save 
this man's life "no matter in what condition." The doctor was quite aware that this was contrary to 
the patient's wishes. His efforts continued successfully even after a coronary occlusion which 
complicated the picture. He fought it as successfully as he fought the pneumonia and infections. 
When the patient began to recover from all the complications, the question arose-"What now?" He 
could live only can the respirator with twenty-four-hour nursing care, unable to talk or move a 
finger, alive intellectually and fully aware of his predicament but otherwise unable to function. The 
doctor picked up implicit criticism of his attempts to save this man. He also elicited the patient's 
anger and frustration at him. What .vas he supposed to do? Besides, it was too late to change maters. 
He had wished to do his best as a physician to prolong life and now that he had succeeded, he 
elicited nothing but criticism (real or unreal) and anger from the patient. 
 
We decided to attempt to solve the conflict in the patient's presence since he was an important part 
of it. The patient looked interested when we told him of the reason for our visit. 'Ie was obviously 
satisfied that we had included him, thus regarding and treating him as a person in spite of his 
inability to communicate. In introducing the problem I asked him to nod his head or to give us 
another signal if he did not want to disuss the matter. His eyes spoke more than words. He 
obviously struggled to say more and we were looking for means of allowing him to take his part. 
The physician, relieved by sharing his burden, became quite inventive and deflated the respirator 
tube for a few minutes at a time which allowed the patient to speak a few words while exhaling. A 
flood of feelings were expressed n these interviews. He emphasized that he was not afraid to die, 
but was afraid to live. He also empathized with the physician but demanded of him "to help me live 
now that you so vigorously tried to pull me through." The patient smiled and the physician smiled. 
 
There was a great relief of tension in the air when the two were able to talk to each other. I 
rephrased the doctor's conflicts 
 
(P18) 
 

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with which the patient sympathized. I asked him how we could be of the most help to him now. He 
described his increasing panic when he was unable to communicate by speaking, writing, or other 
means. He was grateful for those few minutes of joint effort and communication which made the 
next weeks much less painful. At a later session I observed with pleasure how the patient even 
considered a possible discharge and planned on a transfer to the West Coast "if I can get the 
respirator and the nursing care there." 
 
This example perhaps best shows the predicament that many young physicians find themselves in. 
They learn to prolong life but get little training or discussion in the definition of "life." This patient 
regarded himself appropriately as "dead up to my head," the tragedy being that he was intellectually 
fully aware of his position and unable to move a single finger. When the tube pressured and hurt 
him, he was unable to tell it to the nurse, who was with him around the clock but was unable to 
learn to communicate. We often take for granted that "there is nothing one can do" and focus oar 
interests on the equipment rather than on the facial expressions of the patient, which can tell us 
more important things than the most efficient machine. When the patient had an itch, he was unable 
to move or rub or blow and became preoccupied with this inability until it took on panic 
proportions which drove him "near insanity." The introduction of this regular five-minute session 
made the patient calm and better able to tolerate his discomforts. 
 
This relieved the physician of his conflicts and insured him of a better relationship without guilt or 
pity. Once he saw how much ease and comfort such direct explicit dialogues can provide, he 
continued them on his own, having used us merely as a kind of catalyst to get the communication 
going. 
 
I feel strongly that this should be the case. I do not feel it beneficial that a psychiatrist be called 
each time a patient-doctor relationship is in danger or a physician is unable or unwilling to discuss 
important issues with his patient. I found it courageous and a sign of great maturity on the part of 
this young doctor to acknowledge his limits and his conflicts and seek help rather than to avoid the 
issue and the patient. Our goals should not be to 
 
have specialists for dying patients but to train our hospital personnel to feel comfortable in facing 
such difficulties and to seek solutions. I am confident that this young physician will have much less 
turmoil and conflict when he is faced with such tragedies the next time. He will attempt to be a 
physician and prolong life but also consider the patient's needs and' discuss them frankly with him. 
This patient, who was still a person, was only unable to bear to live because he was unable to make 
use of the faculties that he had left. With combined efforts many of these faculties can be used if we 
are not frightened away by the mere sight of such a helpless, suffering individual. Perhaps what I 
am saying is that we can help them die by trying to help them live, rather than vegetate in an 
inhuman manner. 
 
The Beginning of an Interdisciplinary Seminar on Death and Dying 
 
In the fall of 1965 four theology students of the Chicago Theological Seminary approached me for 
assistance in a research project they had chosen. Their class was to write a paper on "crisis in 
human life," and the four students considered death as the biggest crisis people had to face. Then 
the natural question arose: How do you do research on dying, when the data is so impossible to get? 
When you cannot verify your data and cannot set up experiments? We met for a while and decided 

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