Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

A few days later, she visited me, fully dressed, in my office to bid farewell. She looked cheerful, 
almost happy. She was no longer the angry nun who alienated everybody, but a woman who had 
found some peace if not acceptance and who was on her way home, where she died soon thereafter. 
 
Many of us still remember her, not for the difficulties she had caused, but for the lessons she had 
taught many of us. And so, in her last months of her life, she became what she wanted to be so 
badly, different from the others, yet still loved and accepted. 
 
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(P72) 
 
V 
 
Third Stage: Bargaining 
 
The woodcutter's axe begged for its handle from the tree. 
The tree gave it. 
 
Tagore, from Stray Birds, LXXI 
 
The third stage, the stage of bargaining, is less well known but equally helpful to the patient, 
though only for brief periods of time. If we have been unable to face the sad facts in the first period 
and have been angry at people and God in the second phase, maybe we can succeed in entering into 
some sort of an agreement which may postpone the inevitable happening: "If God has decided to 
take us from this earth and he did not respond to my angry pleas, he may be more favorable if I ask 
nicely." We are all familiar with this reaction when we observe our children first demanding, then 
asking for a favor. They may not accept our "No" when they want to spend a night in a friend's 
house. They may be angry and stamp their foot. They may lock themselves in their bedroom and 
temporarily express their anger by rejecting us. But they will also have second thoughts. They may 
consider another approach. They will come out eventually, volunteer to do some tasks around the 
house, which under normal circumstances we never succeeded in getting them to do, and then tell 
us, "If I am very good all week and wash the dishes every evening, then will you let me go?" There 
is a slight chance naturally that we will accept the bargain and the child will get what was 
previously denied. 
 
The terminally ill patient uses the same maneuvers. He knows, from past experiences, that there is a 
slim chance that he may be rewarded for good behavior and be granted a wish for special services. 
His wish is most always an extension of life, followed by the wish for a few days without pain or 
physical discomfort. A patient who was an opera singer, with a distorting malignancy of her jaw 
and face who could no longer perform on the stage, asked "to perform just one more time." When 
she became aware that this was impossible, she gave the most touching performance perhaps of her 
lifetime. She asked to come to the seminar and to speak in front of the audience, not behind a one-
way mirror. She unfolded her life story, her success, and her tragedy in front of the class until a 
telephone call summoned her to return to her room. Doctor and dentist were ready to pull all her 
teeth in order to proceed with the radiation treatment. She had asked to sing once more-to us-before 
she had to hide her face forever. 

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Another patient was in utmost pain and discomfort, unable to go home because of her dependence 
on injections for pain relief. She had a son who proceeded with his plans to get married, as the 
patient had wished. She was very sad to think that she would be unable to attend this big day, for he 
was her oldest and favorite child. With combined efforts, we were able to teach her self-hypnosis 
which enabled her to be quite comfortable for several hours. She had made all sorts of promises if 
she could only live long enough to attend this marriage. The day preceding the wedding she left the 
hospital as an elegant lady. Nobody would have believed her real condition. She was "the happiest 
person in the whole world" and looked radiant. I wondered what her reaction would be when the 
time was up for which she had bargained. 
 
I will never forget the moment when she returned to the hospital. She looked tired and somewhat 
exhausted and-before I could say hello-said, "Now don't forget I have another son!" 
 
The bargaining is really an attempt to postpone; it has to ::elude a prize offered "for good 
behavior," it also sets a self-imposed "deadline" (e.g., one more performance, the son's wedding 
and it includes an implicit promise that the patient will not ask for more if this one postponement is 
granted. None of our patients have "kept their promise"; in other words, they are like children who 
say, "I will never fight my sister again if you let me go." Needless to add, the little boy will fight 
his sister again, just as the opera singer will try to perform once more. She could not live without 
further performances and left the hospital before her teeth were extracted. The patient just 
described was unwilling to face us again unless we acknowledged the fact that she had another son 
whose wedding she also wanted to witness. 
 
Most bargains are made with God and are usually kept a secret or mentioned between the lines or in 
a chaplain's private office. In our individual interviews without an audience we have been 
impressed by the number of patients who promise "a life dedicated to God" or "a life in the service 
of the church" in exchange for some additional time. Many of our patients also promised to give 
parts of or their whole body "to science" (if the doctors use their knowledge of science to extend 
their life). 
 
Psychologically, promises may be associated with quiet guilt, and it would therefore be helpful if 
such remarks by patients were not just brushed aside by the staff. If a sensitive chaplain or 
physician elicits such statements, he may well wish to find out if the patient feels indeed guilty for 
not attending church more regularly or if there are deeper, unconscious hostile wishes which 
precipitated such guilt. It is for this reason that we found it so helpful to have an interdisciplinary 
approach in our patient care, as the chaplain often was the first one to hear about such concerns. We 
then pursued them until the patient was relieved of irrational fears or the wish for punishment 
because of excessive guilt, which was only enforced by further bargaining and more unkept 
promises when the "deadline" was past. 
 
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VI 
 
Fourth Stage: Depression 
 

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