Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

* I used to give such a seminar as an introduction to psychiatry before I began my present work, 
which is described in this book. 
 
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actually attended a seminar, they were almost sure to continue. We have had over two hundred 
interviews over a period of almost three years. During all this time we have had physicians from 
abroad, from Europe, from the East and the West Coast of the United States attending the seminars 
on their way through Chicago, but we have had only two members of the faculty from our own 
University honor us with their presence. I guess it is easier to speak about death and dying when it 
concerns someone else's patient and we can look at it as we view a stage play rather than be actual 
participants in the drama. 
 
The nursing staff were more divided in their responses. Originally they met us with similar anger 
and often quite inappropriate remarks. Some referred to us as vultures and made it clear that our 
presence was unwarranted on their ward. There were others, though, who greeted us with relief and 
anticipation. Their motivations were manifold. They were angry at certain doctors for the way and 
manner they conveyed the seriousness of an illness to their patients; they were angry at them for 
avoiding the issue or for leaving them out during rounds altogether. They were angry at the many 
unnecessary tests they ordered as a substitute for spending time with them. They sensed their own 
impotence in the face of death and when they became aware of the doctors' similar feelings, it 
angered them out of proportion. They blamed them for their inability to acknowledge that there was 
nothing else to be done for a given patient and for ordering tests solely to prove that somebody was 
doing something for them. They were bothered by the discomfort and lack of organization in regard 
to family members of such patients and were naturally much less able to avoid them than the 
doctors. Their empathy and exposure to the patients were greater, they felt, but also their 
frustrations and limitations. 
 
Many nurses felt a great lack of training in this area and had little instruction as to their role in the 
face of such crisis. They acknowledged their conflicts with more ease than the physicians, and they 
extended themselves often beyond expectations to attend at least part of the seminar while one of 
their colleagues guarded the ward. Their attitudes changed much more quickly 
 
(P224) 
 
than those of the doctors, and they opened up in the discussions without hesitation once they 
realized that frankness and honesty were more valued than socially expected kind words about their 
attitude toward patients, family members, or members of the treatment team. When one of the 
doctors was able to say that a patient almost moved him to tears, the nurses were quick to 
acknowledge that they avoided entering the woman's room in order to avoid the picture of her small 
children on the nightstand. 
 
They were quickly able to express their real concerns, conflicts, and coping mechanisms when their 
statements were used to understand a given conflictual situation rather than to judge them. They 
were equally free in supporting a doctor who had the courage to hear his patient's opinion about 
himself and they soon learned to point out when he became defensive, as well as to look at their 
own defensiveness. 

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There was one ward in the hospital where the terminally ill patients seemed to remain alone much 
of the time. The nursing supervisor arranged for a meeting with her nursing staff in order to 
understand the specific problems. We all met in a small conference room and each nurse was asked 
what she thought about the role of the nurses vis-à-vis a terminally ill patient. An older nurse broke 
the ice and expressed her dismay about "the waste of time spent on these patients." She pointed out 
the reality of the shortage of nursing staff and the "absolute absurdity of wasting the precious time 
on people who cannot be helped any longer." 
 
A younger nurse then added that she always felt very bad when "these people die on me," and yet 
another one was especially angry when "they died on me while others members of the family were 
present" or she had "just shaken the pillow." Only one out of twelve nurses felt that dying patients, 
too, needed their care, and while there was not very much that they were able to do, they could at 
least make them physically comfortable. The whole meeting was a courageous expression of their 
dislike for this kind of work mixed with a sense of anger, as if these patients committed an angry 
act against them by dying in their presence. 
 
The same nurses have come to understand the reasons for their feelings, and now perhaps they can 
react to their terminally ill patients as suffering human beings who need good nursing care more 
than their healthier roommates. 
 
Gradually their attitude has changed. Many of them have taken over the role we used to play in the 
seminar. Many of them feel quite comfortable now when a patient asks them a question in regard to 
his future. They are much less afraid to spend time with a terminally ill patient and they do not 
hesitate to come and sit with us to share some of their problems with an especially troubled person 
and difficult relationship. At times they bring relatives to us or to the chaplain's office, and they 
organize nurses' meetings to discuss different aspects of total patient care. They have been both 
students and teachers to us and have contributed a great deal to the seminar. Most credit has to be 
given to the administrative and supervisory staff who have supported the seminar from the 
beginning and who have even made arrangements to have the floors covered while others were 
given the time to attend the interview and discussion. 
 
The social workers, occupational therapists, and inhalation therapists, though fewer in number, 
have equally contributed and made this a truly interdisciplinary workshop. Volunteers have visited 
our patients later on and functioned as readers to those too handicapped to open a book. Our 
occupational therapists have helped many of our patients with little arts and crafts projects as a 
means of showing them that they can still function on some level. Of all the staff involved in this 
project, the social workers appeared to have the least apprehension in dealing with the crisis. It may 
be that the social worker is so busy taking care of the living that she does not have to really deal 
with the dying. She is usually concerned with the care of the children, the financial aspects of the 
care, a nursing home perhaps, and last but not least, with the conflicts of the relatives, so that a 
death may be less threatening to her than to those members of the helping profession who deal 
directly with the terminally ill and whose care is terminated when the patient dies. 
 
A book on the interdisciplinary study of the care of the terminally ill would not be complete 
without a word about the role of the hospital chaplain. He is the one who is often called when 
 

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