Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

often financial sacrifice does not involve any improvement of the condition but is a mere 
maintenance at a minimal level of existence. If medical complications occur, the expenses are 
manifold and the family often wishes for a quick and painless death, but rarely expresses that wish 
openly. That such wishes bring about feelings of guilt is obvious. 
 
I am reminded of an old woman who had been hospitalized for several weeks and required 
extensive and expensive nursing care in a private hospital. Everybody expected her to die soon, but 
day after day she remained in an unchanged condition. Her daughter was torn between sending her 
to a nursing home or keeping her in the hospital, where she apparently wanted to stay. Her son-in-
law was angry at her for having used up their life savings and had innumerable arguments with his 
wife, who felt too guilty to take her out of the hospital. When I visited the old woman she looked 
frightened and weary. I asked her simply what she was so afraid of. She looked at me and finally 
expressed what she had been unable to communicate before, because she herself realized how 
unrealistic her fears were. She was afraid of "being eaten up alive by the worms." While I was 
catching my breath and tried to understand the real meaning of this statement, her daughter blurted 
out, "If that's what's keeping you from dying, we can burn you," by which she naturally meant that 
a cremation would prevent her from having any contact with earthworms. All her suppressed anger 
was in this statement. I sat with 
 
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the old woman alone for a while. We talked calmly about her life-long phobias and her fear of 
death which was presented in this fear of worms, as if she would be aware of them after her death. 
She felt greatly relieved for having expressed it and had nothing but understanding for her 
daughter's anger. I encouraged her to share some of these feelings with her daughter, so that the 
latter might not have to feel so bad about her outburst. 
 
When I met the daughter outside the room I told her of her mother's understanding, and they finally 
got together to talk about their concerns, ending up by making arrangements for the funeral, a 
cremation. Instead of sitting silently in anger, they communicated and consoled each other. The 
mother died the next day. If I had not see the peaceful look on her face during her last day, I might 
have worried that this outburst of anger might have killed her. 
 
Another aspect that is often not taken into account is what kind of a fatal illness the patient has. 
There are certain expectations of cancer, just as there are certain pictures associated with heart 
disease. The former is often viewed as a lingering, pain-producing illness while the latter can strike 
suddenly, painless but final. I think there is a great deal of difference if a loved one dies slowly 
with much time available for preparatory grief on both sides, compared to the feared phone call, "It 
happened, it's all over." It is easier to talk with a cancer patient about death and dying than it is with 
a cardiac patient, who arouses concerns in us that we might frighten him and thus provoke a 
coronary, i.e., his death. The relatives of a cancer patient are therefore more amenable to discussing 
the expected end than the family of someone with heart disease, when the end can come any 
moment and a discussion may provoke it, at least in the opinion of many members of families 
whom we have spoken with. 
 
I remember a mother of a young man in Colorado who did not allow her son to take any exercise, 
not even the most minimal kind, in spite of the contrary advice on part of his doctors. In 

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conversations this mother would often make statements like "if he does too much he will drop dead 
on me," as if she expected a hostile act on the part of her son to be committed against her. She was 
totally unaware of her own hostility even after sharing 
 
with us some of her resentment for having "such a weak son," whom she very often associated with 
her ineffective and unsuccessful husband. It took months of careful, patient listening to this mother 
before she was able to express some of her own destructive wishes toward her child. She 
rationalized these by the fact that he was the cause of her limited social and professional life, thus 
rendering her as ineffective as she regarded her husband to be. These are complicated family 
situations, in which a sick member of the family is rendered more incapable of functioning because 
of the relative's conflicts. If we can learn to respond to such family members with compassion and 
understanding rather than judgement and criticism, we also help the patient bear his handicap with 
more ease and dignity. 
 
 
The following example of Mr. P. demonstrates the difficulties that can occur for the patient when 
he is ready to separate himself but the family is unable to accept the reality, thus contributing to the 
patient's conflicts. Our goal should always be to help the patient and his family face the crisis 
together in order to achieve acceptance of this final reality simultaneously. 
 
Mr. P. was a man in his mid-fifties who looked about fifteen years older than his age. The doctors 
felt that h e had only a poor chance to respond to treatment, partially because of his advanced 
cancer and marasmus, but mainly because of his lack of "fighting spirit." Mr. P. had his stomach 
removed because of cancer five years prior to this hospitalization. At first he accepted his illness 
quite well and was full of hope. As he grew weaker and thinner, he became increasingly depressed 
until the time of his readmission, when a chest X-ray revealed metastatic tumors in his lungs. The 
patient had not been informed of the biopsy result when I saw him. The question was raised as to 
the advisability of possible radiation or surgery for a man in his weak condition. Our interview 
proceeded in two sessions. The first visit served the purpose of introducing myself and of telling 
him that I was available should he wish to talk about the seriousness of his illness and the problems 
that this might cause. A telephone interrupted us and I left the room, asking him to think about it. I 
also informed him about the time of my next visit. 
 
When I saw him the next day, Mr. P. put his arm out in welcome and signalled to the chair as an 
invitation to sit down. In spite of many interruptions by a change of infusion bottles, distribution of 
medication, and routine pulse and blood pressure measurements, we sat for over an hour. Mr. P. 
had sensed that he would be allowed to "open his shades" as he called it. There was no 
defensiveness, no evasiveness in his accounts. He was a man whose hours seemed to count, who 
had no precious time to lose, and who seemed to be eager to share his concerns and regrets with 
someone who could listen. 
 
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The day before, he made the statement, "I want to sleep, sleep, sleep and not wake up." Today he 
repeated the same thing, but added the word "but." I looked at him questioningly and he proceeded 
to tell me with a weak soft voice that his wife had come to visit him. She was convinced that he 
would make it. She expected him home to take care of the garden and the flowers. She also 

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