Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

horrible question. We make rounds and talk about many trivialities or the wonderful weather 
outside and the sensitive patient will play the game and talk about next spring, even if he is quite 
aware that there will be no next spring for him. These doctors then, when asked will tell us that 
their patients do not want to know the truth, that they never ask for it, and that they believe all is 
well. The doctors are, in fact, greatly relieved that they are not confronted and are often quite 
unaware .that they provoked this response in their patients. 
 
Doctors who are still uneasy about such discussions but not so defensive may call a chaplain or 
priest and ask him to talk to the patient. They may feel more at ease having passed on the difficult 
responsibility to someone else, which may be better than avoiding it altogether. They may, on the 
other hand, be so anxious about it that they leave explicit orders to the staff and chaplain not to tell 
the patient. The degree of explicitness in such orders will reveal more about the doctors' anxiety 
than they wish to recognize. 
 
There are others who have less difficulty with this issue and who find a much smaller number of 
patients unwilling to talk about their serious illness. I am convinced, from the many patients with 
whom I have spoken about this matter, that those doctors who need denial themselves will find it in 
their patients and that those who can talk about the terminal illness will find 
 
their patients better able to face and acknowledge it. The need of denial is in direct proportion with 
the doctor's need for denial. But this is only half of the problem. 
 
We have found that different patients react differently to such news depending on their personality 
makeup and the style and manner they used in their past life. People who use denial as a main 
defense will use denial much more extensively than others. Patients who faced past stressful 
situations with open confrontation will do similarly in the present situation. It is, therefore, very 
helpful to get acquainted with a new patient, in order to elicit his strengths and weaknesses. I will 
give an example of this: 
 
Mrs. A., a thirty-year-old white woman, asked us to see her during her hospitalization. She 
presented herself as a short, obese, pseudo-gay woman who smilingly told us of her "benign 
lymphoma" for which she had received a variety of treatments including cobalt and nitrogen 
mustard, known by most people in the hospital to be given for malignancies. She was very familiar 
with her illness and readily acknowledged having read the literature about it. She suddenly became 
quite weepy and told a rather pathetic story of how her doctor at home told her of her "benign 
lymphoma" after receiving the biopsy results. "A benign lymphoma?" I repeated, expressing some 
doubt in my voice and then sitting quietly for an answer. "Please, doctor, tell me whether it's 
malignant or benign?" she asked but without waiting for my answer, she began a story of a fruitless 
attempt to get pregnant. For nine years she had hoped for a baby, she went through all possible tests, 
finally through agencies in the hope of adopting a child. She was turned down for many reasons 
first because she had been married only two and a half years, later because of emotional instability 
perhaps. She had not been able to accept the fact that she could not even have an adopted child. 
Now she was in the hospital and was forced to sign a paper for radiation treatment with the explicit 
statement that this would result in sterility, thus rendering her finally and irrevocably unable to bear 
a child. It was unacceptable to her in spite of the fact that she had signed the paper and had 
undergone the preliminary work-up for the radiation. Her abdomen was marked and she was to 
have her first treatment the following morning. 

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This communication revealed to me that she was not able to 
 
(P30) 
 
accept the fact yet. She asked the question of the malignancy but did not wait for an answer. She 
also told me of her inability to accept the fact of her childlessness in spite of her acceptance of the 
radiation treatment. She went on at great length to tell about all the details of her unfulfilled wish 
and kept on looking at me with big question marks in her eyes. I told her that she might be talking 
about her inability to face her illness rather than her inability to face being barren. I told her that I 
could understand this. I also said that both situations were difficult but not hopeless and left her 
with the promise to return the next day after the treatment. 
 
 
It was on the way to the first radiation treatment that she confirmed her knowledge of her 
malignancy, but she hoped that this treatment might cure it. During the following informal, almost 
social visits, she fluctuated between talking about babies and her malignancy. She became 
increasingly tearful and dropped her pesudo-gay appeaarnce during these sessions. She asked for a 
"magic button which would enable her to get rid of all her fears and free her from the heavy burden 
in her chest. She was deeply concerned about the expected new roommate, "worrying to death" as 
she called it that she would get a terminally sick woman. Since the nursing staff on her ward was 
very understanding, we related her fears to them, and she became the companion of a cheerful 
young woman who was a great relief to her. The nursing staff also encouraged her to cry when she 
felt like it, rather than expecting her to smile all the time, which the patient appreciated. She had a 
great capacity to determine with whom she could talk about her malignancy and chose the less 
willing ones for her conversations about babies. The staff was quite surprised to hear of her 
awareness and ability to discuss her future realistically. 
 
It was after a few very fruitful visits that the patient suddenly asked me if I had children and when I 
acknowledged this, she asked to terminate the visit because she was tired. The following visits were 
filled with angry, nasty remarks at the nursing staff, psychiatrists, and others until she was able to 
admit her feelings of envy for the healthy and the young, but especially towards me since I seemed 
to have everything. When she realized that she was not rejected in spite of becoming at times a 
rather difficult patient, she became increasingly aware of the origin of her anger and expressed it 
quite directly as anger at God for allowing her to die so young and so unfulfilled. The hospital 
chaplain fortunately was not a punitive but a very understanding man and talked with her about this 
anger in much the same terms as I did until her anger subsided to make room for more depression 
and, it is hoped, final acceptance of her fate. 
 
Until the present time, this patient still maintains this dichotomy in regard to her chief problem. To 
one group of people she only relates as a conflicted woman in terms of her childlessness; to the 
chaplain and me, she talks about the meaning of her short life and the hopes she still maintains 
(rightfully so) for prolonging it. Her greatest fear at the time of this writing is the possibility of her 
husband marrying another woman who might bear children, but then she laughingly admits, "He is 
not the shah of Persia, though a really great man." She still has not completely coped with her envy 
for the living. The fact that she does not need to maintain denial or displace it onto another tragic 
but more acceptable problem allows her to deal with her illness more successfully. 

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