Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

medical students quickly identified with the doctor who had ordered them, and came to his defense. 
It was another medical student who then wondered whether he would react the same way 
 
if the patient were his father and he was the one who could give the orders. Suddenly the students 
of the different disciplines began to realize the magnitude of problems that some doctors are faced 
with, and they began not only to appreciate the role of the patient better but also the conflicts and 
responsibility of the different members of the treatment team. A growing respect and appreciation 
for each other's role began soon to be experienced, which enabled the group truly to share their 
problems on an interdisciplinary level. 
 
From an original feeling of helplessness, impotence, or sheer fright, they developed a dense of 
group mastery of the problems with a gradual and increasing awareness of their own role in this 
psychodrama. Each one of them was forced to deal with the relevant questions; he had to get 
involved or else someone in the group would point out his avoidance to him. And so each one in his 
own way tried to face his own attitude toward death and gradually made himself and the group 
familiar with it. Since each one in the group went through the same painful but gratifying process, 
it became easier for the individual members, just as in group therapy one's problem-solving may 
help another face his own conflicts and learn how to better deal with it. Openness, honesty, and 
acceptance made it possible to experience what each member brought to this group. 
 
Patients' Reactions 
 
In great contrast to the staff, the patients responded favorably and overwhelmingly positively to our 
visits. Less than z percent of the questioned patients flatly refused to attend the seminar, only one 
patient out of over two hundred did not ever talk about the seriousness of her illness, problems 
resulting from her terminal illness, or fears of dying. This type of patient is described in more detail 
(Chapter III, on denial). 
 
All other patients welcomed the possibility of talking with someone who cared. Most of them tested 
us first in one way or another, to assure themselves that we were actually willing to talk about the 
final hours or the final care. The majority of patients welcomed a breakthrough of their defenses, 
were relieved when they did not have to play a game of superficial conversation 
 
(P230) 
 
when deep down they were so troubled with real or unrealistic fears. Many of them reacted to the 
first meeting as if we had opened a floodgate: they poured out all their bottled-up feelings and 
responded with great relief after such a meeting. 
 
Some patients postponed the confrontation for a while only to ask us the next day or the following 
week to come -and sit with them. It is well for those who are trying to do this kind of work to 
remember that a "rejection" by such a patient does not mean, "No, I do not want to talk about it." It 
means only, "I am not ready now to open up or to share some of my concerns." If visits are not 
discontinued after such a rejection but are renewed, the patient will give the cue when he is ready to 
talk. As long as the patients know that there is someone available when they are ready, they will 
call at the right time. Many of these patients have later on expressed their appreciation for our 

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patience and shared with us the struggles they had within themselves before they were able to put 
them into words. 
 
There will be many patients who never use the word death or dying but they talk about it all the 
time in disguised ways. A perceptive therapist can answer their questions or concerns without using 
the avoided words and still be of great help to such a patient. Numerous examples are given in the 
descriptions of Mrs. A. and Mrs. K. (in Chapters II and III). 
 
If we ask ourselves what is so helpful or so meaningful that such a high percentage of terminally- 
ill patients are willing to share this experience with us, we have to look at the answers they give 
when we ask them for the reasons of their acceptance. Many patients feel utterly hopeless, useless, 
and unable to find any meaning in their existence at this stage. They wait for doctors' rounds, for an 
X-ray perhaps, for the nurse who brings the medication, and the days and nights seem monotonous 
and endless. Then, into this dragging monotony a visitor comes who stirs them up, who is curious 
as a human being, who wonders about their reactions, their strengths, their hopes and frustrations. 
Someone actually pulls a chair up and sits down. Someone actually listens and does not hurry by. 
Someone does not talk in euphemisms but concretely, in straightforward, simple language about the 
very things that are uppermost in their mind-pushed down occasionally but always coming up again. 
 
Someone comes who breaks the monotony, the loneliness, the purposeless, agonizing waiting. 
 
Another aspect which is perhaps more important is the sense that their communications might be 
important, might be meaningful at least to others. There is a sense of service at a time when these 
patients feel that they are of no earthly use to anybody anymore. As more than one patient put it: "I 
want to be of some use to somebody. Maybe by donating my eyes or my kidneys, but this seems so 
much better, because I can do it while I am still alive." 
 
Some patients have used the seminar to test their own strength in peculiar ways. They have used it 
to preach to us, to tell us about their faith in God and their readiness to accept God's will while fear 
was written all over their face. Others who had a genuine faith which enabled them to accept the 
finality of their life have been proud to share this with a group of young people in the hope that a 
little of it may rub off. Our opera singer with the malignancy of her face asked to come to our class 
as a last performance, a last request to sing for us before returning to her ward where they were 
ready to pull her teeth before radiation treatment. 
 
What I am trying to say is that the response was unanimously positive, the motivations and reasons 
different. A few patients may have wished to decline but were concerned that such a rejection 
might affect their future care. A certainly much higher percentage used it to ventilate their anger 
and rage at me hospital, the staff, the family, or the world in general for their isolation. 
 
To live on borrowed time, to wait in vain for the doctors to make rounds, lingering on from visiting 
hours to visiting hours, looking out of the window, hoping for a nurse with some extra time for a 
chat . . . this is the way many terminally ill patients pass their time. Is it then surprising when such a 
patient is intrigued by a strange visitor who wants to talk to her about her own feelings, her own 
reaction to this state of affairs? Who wants 
 
(P232) 

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