Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

Tagore, from Stray Birds, LXXV 
 
IF our first reaction to catastrophic news is, "No, it's not true, no, it cannot involve me," this has to 
give way to a new reaction, when it finally dawns on us: "Oh, yes, it is me, it was not a mistake." 
Fortunately or unfortunately very few patients are able to maintain a make-believe world in which 
they are healthy and well until they die. 
 
When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, 
rage, envy, and resentment. The logical next question becomes: "Why me?" As one of our patients, 
Dr. G., put it, "I suppose most anybody in my position would look at somebody else and say, `Well, 
why couldn't it have been him?' and this has crossed my mind several 
 
 times .  An old man whom I have known ever since I was a little kid came down the street. He was 
eighty-two years old, and he is of no earthly use as far as we mortals can tell. He's rheumatic, he's a 
cripple, he's dirty, just not the type of a person you would like to be. And the thought hit me 
strongly, now why couldn't it have been old George instead of me?" (extract from interview of Dr. 
G.). 
 
In contrast to the stage of denial, this stage of anger is very difficult to cope with from the point of 
view of family and staff. The reason for this is the fact that this anger is displaced in all directions 
and projected onto the environment at times almost at random. The doctors are just no good, they 
don't know what tests to require and what diet to prescribe. They keep the patients too long in the 
hospital or don't respect their wishes 
 
(P45) 
 
in regards to special privileges. They allow a miserably sick roommate to be brought into their 
room when they pay so much money for some privacy and rest, etc. The nurses are even more often 
a target of their anger. Whatever they touch is not right. The moment they have left the room, the 
bell rings. The light is on the very minute they start their report for the next shifts of nurses. When 
they do shake the pillows and straighten out the bed, they are blamed for never leaving the patients 
alone. When they do leave the patients alone, the light goes on with the request to have the bed 
arranged more comfortably. The visiting family is received with little cheerfulness and anticipation, 
which makes the encounter a painful event. They then either respond with grief and tears, guilt or 
shame, or avoid future visits, which only increases the patient's discomfort and anger. 
 
The problem here is that few people place themselves in the patient's position and wonder where 
this anger might come from. Maybe we too would be angry if all our life activities were interrupted 
so prematurely; if all the buildings we started were to go unfinished, to be completed by someone 
else; if we had put some hard-earned money aside to enjoy a few years of rest and enjoyment, for 
travel and pursuing hobbies, only to be confronted with the fact that "this is not for me." What else 
would we do with our anger, but let it out on the people who are most likely to enjoy all these 
things? People who rush busily around only to remind us that we cannot even stand on our two feet 
anymore. People who order unpleasant tests and prolonged hospitalization with all its limitations, 
restrictions, and costs, while at the end of the day they can go home and enjoy life. People who tell 
us to lie still so that the infusion or transfusion does not have to be restarted, when we feel like 

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jumping out of our skin to be doing something in order to know that we are still functioning on 
some level! 
 
Wherever the patient looks at this time, he will find grievances. H e may put the television on only 
to find a group of young jolly people doing some of the modern dances which irritates him when 
every move of his is painful or limited. He may see a movie western in which people are shot in 
cold blood with different onlookers continuing to drink their beer. He will compare them with his 
family or the attending staff. He may listen 
 
(P46) 
 
to the news full of reports of destruction, war, fires, and tragedies -far away from him, unconcerned 
about the fight and plight of an individual who will soon be forgotten. So this patient makes sure 
that he is not forgotten. He will raise his voice, he will make demands, he will complain and ask to 
be given attention, perhaps as the last loud cry, "I am alive, don't forget that. You can hear my 
voice, I am not dead yet!" 
 
A patient who is respected and understood, who is given attention and a little time, will soon lower 
his voice and reduce his angry demands. He will know that he is a valuable human being, cared for, 
allowed to function at the highest possible level as long as he can. He will be listened to without the 
need for a temper tantrum, be will be visited without ringing the bell every so often because 
dropping in on him is not a necessary duty but a pleasure. 
 
The tragedy is perhaps that we do not think of the reasons for patients' anger and take it personally, 
when it has originally nothing or little to do with the people who become the target of the anger. As 
the staff or family reacts personally to this anger, however, they respond with increasing anger on 
their part, only feeding into the patient's hostile behavior. They may use avoidance and shorten the 
visits or the rounds or they may get into unnecessary arguments by defending their stand, not 
knowing that the issue is often totally irrelevant. 
 
An example of a rational anger provoked by the reaction of a nurse was the case of Mr. X. He had 
been flat in bed for several months and had just been allowed to come off the respirator for a few 
hours during the daytime. He had led a life of many activities and had taken it hard to b e so utterly 
restricted. He was quite aware that his days were numbered, and his greatest wish was to be moved 
into different positions (he was paralyzed to his neck). He begged the nurse never to put the side 
rails up as it reminded him of being in a casket. The nurse, who was very hostile to this patient, 
agreed that she would leave them down at all times. This private duty nurse was very angry when 
she was disturbed in her reading, and she knew that he would keep quiet as long as she fulfilled this 
wish. 
 
During my last visit to Mr. X., I saw that this usually dignified man was furious. He said over and 
over again to his nurse, "you lied to me," staring at her in angry disbelief. I asked him the reason for 
this outburst. He tried to tell me that she had put the side rails up as soon as he asked to be put in an 
upright position so that he could put his legs out of bed "once more." This communication was 
interrupted several times by the nurse, who, equally angry, stated her side of the story, namely, that 
she had to put the side rails up in order to get help to fulfill his demands. A loud argument ensued 
during which the nurse's anger was perhaps best expressed in her statement: "If I had left them 

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