Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

 
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take the extra time when he feels like talking, when we are able to perceive his cues, we will 
witness that the majority of patients wish to share their concerns with another human being and 
react with relief and more hope to such dialogues. 
 
If this book serves no other purpose but to sensitize family members of terminally ill patients and 
hospital personnel to the implicit communications of dying patients, then it has fulfilled its task. If 
we, as members of the helping professions, can help the patient and his family to get "in tune" to 
each other's needs and come to an acceptance of an unavoidable reality together, we can help to 
avoid much unnecessary agony and suffering on the part of the dying and even more so on the part 
of the family that is left behind. 
 
The following interview with Mr. J. represents an example of the stage of anger and demonstrates-
at times in a disguised way-the phenomenon of ever-present hope. 
 
Mr. J. was a fifty-three-year-old Negro man who was hospitalized with mycosis fungoides, a 
malignant skin disorder which he describes in detail in the following interview. This illness 
necessitated his resorting to disability insurance and is characterized by states of relapses and 
remissions. 
 
When I visited him the day before our seminar session, the patient felt lonely and in a talkative 
mood. He related very quickly in a dramatic and colorful fashion the many aspects of this 
unpleasant illness. He made it difficult for me to leave and held me back on several occasions. 
Much in contrast to that unplanned meeting, he expressed more annoyance, at times even anger, 
during the session behind the one-way mirror. The day before the seminar session he had initiated 
the discussion of death and dying, whereas during the session he said, "I don't think about dying, I 
think about living." 
 
I mention this since it is relevant to our care of terminally ill patients, that they have days, hours, or 
minutes when they wish to talk about such matters. They may, like Mr. J. the day before, volunteer 
their philosophy of life and death and we may consider them ideal patients for such a teaching 
session. We tend to ignore the fact that the same patient may wish to talk only about the pleasant 
aspects of life the next day; we should respect his 
 
wishes. We did not do this during the interview, as we attempted to regain some of the meaningful 
material he presented the day before. 
 
I should say that this is a danger mainly when an interview is part of a teaching program. Forcing 
questions and answers for the benefit of students should never occur during such an interview. The 
person should always come first and the patient's wishes should always be respected even if it 
means having a classroom of fifty students and no patient to interview. 
 
DOCTOR: Mr. J., just for the introduction, how long have you been in the hospital? 
 
PATIENT: This time I've been in since April the 4th of this year. DOCTOR: How old are you? 

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PATIENT: I'm fifty-three years old. 
 
DOCTOR: You have heard what we are doing in this seminar? PATIENT: I have. Will you lead me 
with questions? 
 
DOCTOR: Yes. 
 
PATIENT: All right, you just go right ahead, whenever you are ready. 
 
DOCTOR: I'd be curious to get a better picture of you because I know very little about you. 
 
PATIENT: I see. 
 
DOCTOR: You have been a healthy man, married, working, ah - PATIENT: That's right, three 
children. 
 
DOCTOR: Three children. When did you get sick? 
 
PATIENT: Well, I went on disability in 1963. I think I first came in contact with this disease 
around 1948. I first started out with small rashes on my left chest, and under my right shoulder 
blade. And first it was no more than what anybody gets in the course of a lifetime. And I used the 
usual ointments, calamine lotion, vaseline, and different things that you buy in the drug store. 
Didn't bother me too much. But gradually by, I'd say by 1955, the lower part of my body was 
involved, not to any great extent. There was a dryness, a scalyness had settled in, and I'd use a lot of 
greasy ointments and things like that to keep myself moist and as comfortable as possible. I still 
kept on working. In fact, certain periods through there I had two jobs because my daughter was 
going to college and 
 
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I wanted to make sure that she finished. So I'd say by 1957 it had reached a point where I had 
started going to different doctors. I went to Dr. X for a period of about three months and he didn't 
make any improvement. The visits were cheap enough, but the prescriptions were about fifteen to 
eighteen dollars a week. When you are raising a family of three children on a workman's salary, 
even if you are working two jobs, you can't handle a situation like that. And I did go through the 
clinic and they made a casual examination which didn't satisfy me. I didn't bother to go back to 
them. And I just knocked around, feeling, I guess, more and more miserable all the time until in 
1962 Dr. Y had me admitted to the P. Hospital. I was in there about five weeks and really nothing 
happened and I came out of there and finally went back to the first clinic. Finally in March of 1963 
they admitted me to this hospital. I was in such bad shape by then that I went on disability. 
 
DOCTOR: This was in '63? 
 
PATIENT: In '63. 
 
 

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DOCTOR: Did you have any idea what kind of glen you had by then? 
 
PATIENT: I knew it was mycosis fungoides and everybody else knew it. 
 
DOCTOR: So, how long did you know the name of your illness? 
 
PATIENT: Well, I was suspicious of it for some time, but then it was confirmed by a biopsy. 
 
DOCTOR: A long time ago? 
 
PATIENT: Not a long time ago, just a few months before the actual diagnosis was made. But you 
get one of these conditions and you read everything you can get your hands on. You listen to 
everything, and you learn the names of the different diseases. And from what I read, mycosis 
fungoides fit right into the picture and finally it was confirmed, and by then I was just about shot. 
My ankles had started to swell up on me, I was in a constant state of perspiration, and I was 
thoroughly miserable. 
 
DOCTOR: Is that what you mean by "by then I was thoroughly shot?" That you felt so miserable? 
Is that what you mean? 
 
PATIENT: Sure. I was just miserable-itching, scaling, perspiring, ankle hurting, just a completely, 
thoroughly, utterly miserable human being. Now, of course, these kind of times you get a little 
resentful. I guess you wonder, why does this happen to me. And then you come to your senses, and 
you say, "Well, you are no better than anybody else, why not you?" That way you can sort of 
reconcile yourself because then everybody you see you start looking at their skin. You look if they 
have any blemishes, any signs of dermatitis since your whole sole interest in life is to see if they 
have any blemishes and who else is suffering from something similar, you know. And I guess, too, 
people are looking at you because you're much different-looking from them 
 
DOCTOR: Because this is a visible kind of illness. 
 
PATIENT: It is a visible kind of an ailment. 
 
DOCTOR: What does this illness mean to you? What is this mycosis fungoides to you? 
 
PATIENT: It means to me that up to now they haven't cured anybody. They have had remissions 
for certain periods of time, they have had remissions for indefinite periods of time. It means to me 
that somewhere, someone is going to do research. There are a lot of good brains working on this 
condition. They might discover a cure while in the process of working on something else. And it 
means to me that I grit my teeth and go on from day to day and hope that some morning I'll sit up 
on the side of the bed and the doctor will be there and he will say, "I want to give you this shot," 
and it will be something like a vaccine or something, and in a few days it will clear up. 
 
DOCTOR: Something that works! 
 
PATIENT: I will be able to go back to work. I like my job because I did work myself into a 
supervisory capacity. 

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