Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

DOCTOR: And you can't generalize. No, we agree that we can't. do that. That's what we are trying 
to do here, to look at each individual and try to learn how we can help this type of individual. And I 
think you are the kind of fighter who would do as much as you can possibly do till the last day. 
 
PATIENT: I'm gonna do it. 
 
DOCTOR: And then when you have to face it, you'll face it. Your faith has contributed a lot to your 
being able to smile through this. 
 
PATIENT: I hope so. 
 
DOCTOR: What faith do you belong to? 
 
PATIENT: Well, Lutheran. 
 
DOCTOR: What in your faith helps you most? 
 
PATIENT: I don't know. I can't pin point it. I've found a lot of comfort in talking to the chaplain. 
And I've even called him on the phone to talk to him. 
 
DOCTOR: When you are really having the blues and feeling lonely and nobody around, what kind 
of things do you do? 
 
PATIENT: Well, I don't know. Anything that comes to my mind, I guess, that has to be done. 
 
DOCTOR: For example? 
 
PATIENT: Well, I've turned on a panel show the last few months on TV and gotten my mind off of 
myself. That's the only thing. Look at something else or call my daughter-in-law to talk to her and 
the youngsters. 
 
(P216) 
 
DOCTOR: On the phone? 
 
PATIENT: On me phone and keeping busy. 
 
DOCTOR: Doing things? 
 
PATIENT: just to do something to get my mind off myself. And I call the chaplain just for a little 
moral support once in a while. I don't really talk about my condition to nobody. My daughter in-law 
usually gets an idea of when I call that I might be blue or down in the dumps. She'll put one of the 
youngsters on or she'll tell me something that they did and it's over with by that time. 
 
DOCTOR: I admire your courage for coming in here for this interview. You know why? 
 
PATIENT: No. 

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DOCTOR: We have a patient every week, and we do this every week, but you are somebody who, 
I'm finding out now, doesn't really want to talk about it, and you knew that we were going to talk 
about it. And yet you were willing enough to come. 
 
PATIENT: Well, if I can help somebody else in some way I'm willing to do it. Like I say, as far as 
my physical condition or health, why, I feel just as healthy as you and the chaplain here. And I'm 
not sick. 
 
DOCTOR: I just think it is remarkable that Mrs. L. volunteered to come here. You mean to be of 
some service in a way, or to help us. 
 
PATIENT: I hope so. If I can help somebody else, I'm glad to do it, even though I'm not able to get 
out and do something. Well -I'm going to be around for a long time. Maybe I'll have a few more 
interviews. (Laughter) 
 
Mrs. L. accepted our invitation to share some of her concerns but showed a peculiar discrepancy 
between facing her illness and denying it. It was only after this interview that we were able to 
understand some of this dichotomy. She offered to come to the seminar not because she wanted to 
talk about illness or dying but to be of some service while restricted and unable to function outside 
of her bed. "As long as I function I live," she said at one point. She consoles other patients but is 
really quite resentful that she cannot lean on somebody's shoulders. She calls the chaplain for a 
confidential private confession, almost in secret, but admits only briefly during the interview some 
feelings of occasional depression and need for conversation. She terminates the interview by saying, 
"I am as well and healthy as you and the chaplain," which means: "I have lifted the veil, now I will 
cover my face again." 
 
It became evident in this interview that complaining was equated with dying. Both her parents 
never complained and only admitted to being sick prior to their death. Mrs. L. has to function and 
keep busy if she wants to live. She has to be the eyes of her visually handicapped husband and 
helps him deny the gradual loss of his vision. When he has an accident because of his poor vision, 
she imitates a similar accident to emphasize that this is not related to his illness. When she is 
depressed she has to talk to someone but should not complain: "People who complain are in a 
wheelchair for seventeen years!" 
 
It is understandable that progressive illness with all its implications is very difficult to tolerate for a 
patient who feels so strongly that complaining is necessarily followed by being permanently 
crippled or dead. 
 
This patient was helped by relatives who allowed her to call up and talk about "other things," by 
having a television in her room to distract her, later on by little arts and crafts which she was able to 
do in order to give her a feeling of "still functioning." When the teaching aspects of such interviews 
are stressed, a patient like Mrs. L. can share a lot of grievances without feeling that she will be 
labeled a complainer. 
 
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XI - Reactions to the Seminar on Death and Dying 
 
The storm of the last night has crowned this morning with golden peace. 
 
Tagore, from Stray Birds, CCXCIII 
 
Staff Reactions 
 
As described earlier, the hospital staff reacted with great resistance, at times overt hostility, to our 
seminar. At the beginning, it was almost impossible to get permission from the attending staff to 
interview one of their patients. Residents were more difficult to approach than interns, the latter 
more resistant than externs or medical students. It appeared that the more training a physician had, 
the less he was ready to become involved in this type of work. Other authors have studied the 
physician's attitude toward death and the dying patient. We have not studied the individual reasons 
for this resistance but have observed it many times. 
 
We have also noticed the change in attitude once the seminar was established and the attending 
physician had the opinion of either his colleagues or some of the patients who came to the class. 
Students and hospital chaplains equally contributed to the staff's increased familiarity with our 
work, and the nurses have perhaps been the most helpful assistants. 
 
It may not be a coincidence that one of the doctors best known for the total care of the dying patient, 
Cicely Saunders, started her work as a nurse and is now physician attending the terminally ill in a 
hospital set-up especially designed for their care. She has 
 
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confirmed that the majority of patients know of their impending death whether they have been told 
or not. She feels quite comfortable discussing this matter with them, and since she does not need 
denial she is unlikely to meet much denial in her patients. If they do not wish to talk about it, she 
certainly respects their reticence. She emphasizes the importance of the doctor who can sit and 
listen. She confirms that most of her patients then take the opportunity to tell her (more often than 
the other way around) that they knew what was happening, resentment and fear being almost 
nonexistent at the end. "More important still," she says, "the staff who has chosen to do such work 
should have had the opportunity to think deeply about it and to find their satisfaction in a different 
sphere from the usual aims and activities of hospitals. If they themselves believe in and really enjoy 
such work, they will help the patient more by their attitude than by any words." 
 
Hinton was equally impressed by the insight and awareness the terminally ill patients demonstrated 
and the courage they showed in facing their death, which almost always came quietly. I give these 
two examples because I think they reflect as much about these authors' attitudes as they say about 
the reactions of their patients. 
 
Among our staff we have found two subgroups of physicians who were able to listen and talk 
calmly about cancer, impending death, or the diagnosis of a usually fatal illness. They were the 
very young in the medical profession who either had experienced the death of a person close to 
them and worked through this loss or who had attended the seminar over a period of several months; 

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