Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

 
Mrs. K. was a twenty-eight-year-old white Catholic woman, mother of two preschool children. She 
was hospitalized with a terminal liver disease. A very careful diet and daily laboratory 
measurement were mandatory to keep her alive. 
 
We were told that two days before her admission to the hospital, she visited the medical clinic and 
was told that there was no hope for a recovery. The family reported that the patient "fell apart" until 
a neighbor reassured her that there was always some hope, encouraging her to attend a tabernacle 
where many people had been healed. The patient then asked her priest for support but was told not 
to go to a faith healer. 
 
On Saturday, the day after the clinic visit, the patient went to this faith healer and "immediately felt 
wonderful." She was found in a trance on Sunday by her mother-in-law, while the husband was out 
at work and the small children were left alone without being fed or otherwise attended to. The 
husband and mother-in-law brought her to the hospital and left before the physician was able to talk 
to them. 
 
The patient asked for the hospital chaplain "to tell him of the good news." When he entered her 
room she welcomed him in an exalted mood: "Oh, Father, it was wonderful. I have. 
 
been healed. I am going to show the doctors that God will heal me. I am all well now." She 
expressed her sorrow that "even my own church did not understand how God works," referring to 
the priest's advice not to visit the tabernacle. 
 
The patient was a problem for the physicians since she denied her illness almost completely and 
became quite unreliable in regard to her food intake. She occasionally stuffed herself to a degree 
that she became comatose; at times she followed the orders obediently. For this reason a psychiatric 
consultation was requested. 
 
(P39) 
 
When we saw the patient she was inappropriately cheerful, laughed and giggled, and reassured us 
that she was completely well. She went around the ward visiting patients and staff, attempting to 
collect money for a gift for one of the staff physicians in whom she had immense faith, which 
seemed to indicate at least a partial awareness of her present condition. She was a difficult 
management problem as she was unreliable about her diet and medications and "did not behave like 
a patient." Her belief in her well-being was unshakable and she insisted on hearing it confirmed. 
 
A discussion with the husband revealed a rather simple, unemotional man who seriously believed 
that his wife was better off living a short time at home with the children rather than having her 
suffering prolonged by long hospitalizations, endless costs, and all the ups and downs of her 
chronic illness. He had little empathy with her and separated his feelings quite effectively from the 
context of his thoughts. He matter-of-factly related the impossibility of having a stable home 
environment, with him working nights and the children living out during the week. Listening to 
him and placing ourselves into his position, we were able to appreciate that he could deal with his 
present life situation only in this detached manner. We were unable to relate some of her needs to 
him, in the hope that his empathy might diminish her needs for such denial, thus rendering her 

---

more amenable to effective treatment. He left the interview as if he had completed a compulsory 
task, obviously unable to change his attitude. 
 
Mrs. K. was visited by us at regular intervals. She appreciated our chats, which dealt with daily 
happenings and inquiries about her needs. She became gradually weaker and-for a couple of weeks-
just dozed and held our hand, and did not speak much. After this she became increasingly confused, 
was disoriented, and had delusions of a beautiful bedroom filled with fragrant flowers brought to 
her by her husband. When she became more clear, we tried to help her with arts and crafts to make 
the time go by a bit faster. She had spent much of her past weeks alone in a room, with the double 
doors closed, and few staff people dropped in since there was so little they felt they could do. The 
staff rationalized their own avoidance by such remarks as, "She is too confused to know" and "I 
would not know what to say to her, she has such crazy ideas." As she felt this isolation and 
increasing loneliness, she was often observed to take the telephone off the hook, "just to hear a 
voice. 
 
(P40) 
 
When she was put on a protein-free diet she became very hungry and lost much weight. She would 
sit on her bed, holding the little bags of sugar between her fingers and say, "This sugar is finally 
going to kill me." I sat with her, and when she held my hand she said, "You have such warm hands. 
I hope you are going to be with me when I get colder and colder." She smiled knowingly. She knew 
and I knew that at this moment she had dropped her denial. She was able to think and talk about her 
own death and she asked for just a little comfort of companionship and a final stage without too 
much hunger. 
 
We did not exchange more than the abovementioned words; we just sat silently for a while, and 
when I left she asked if I would be sure to return and bring that wonderful OT (occupational 
therapist) girl with me, who helped her make some leatherwork for her family "so they have 
something to remember me by." 
 
Hospital personnel, whether they are physicians, nurses, social workers, or chaplains, don't know 
what they miss when they avoid such patients. If one is interested in human behavior, in the 
adaptations and defenses that human beings have to use in order to cope with such stresses, this is 
the place to learn about it. If they sit and listen, and repeat their visits if the patient does not feel 
like talking on the first or second encounter, the patient will soon develop a feeling of confidence 
that here is a person who cares, who is available, who sticks around. 
 
When they are ready to talk, they will open up and share their loneliness, sometimes with words, 
sometimes with little gestures or nonverbal communications. In the case of Mrs. K. we never 
attempted to break her denial, we never contradicted her when she assured us of her well-being. We 
just reinforced that she had to take her medication and stick to her diet if she wanted to return home 
to her children. There were days when she stuffed herself with forbidden foods, only to suffer twice 
as much the next days. This was intolerable and we told her so. This was part of reality that we 
could not deny with her. So, in a way, implicitly, we told her that she was critically sick. Explicitly, 
 
we did not do it because it was obvious that she was unable to tolerate the truth at that stage of her 
illness. It was much later, after having gone through stages of semi-comatose stupor and extreme 

---