Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

the other, smaller group were older physicians, who-we presume this only-grew up a generation 
ago in an environment which used fewer defense mechanisms and fewer euphemisms, faced death 
more as a reality, and trained doctors in the care of the terminally ill. They were trained in the old 
school of humanitarianism and are successful now as physicians in a more scientific world of 
medicine. They are the doctors who tell their patients about the seriousness of their illness without 
taking away all hope. These physicians have been helpful and supportive both to their patients and 
to our seminar. We have had less contact with them, not only because they are the exceptions but 
also because their patients were comfortable and rarely required a referral. 
 
Approximately nine out of ten physicians reacted with discomfort, annoyance, or overt or covert 
hostility when approached for their permission to talk to one of their patients. While some of them 
used the patient's poor physical or emotional health as a reason for their reluctance, others flatly 
denied having any terminally ill patients under their care. Some expressed anger when their patients 
asked to talk to us, as if it reflected their inability to cope with them. While only a few flatly 
refused, the great majority regarded it as a special favor to us when they finally allowed an 
interview. It has only changed slowly to a situation in which they are coming to ask us to see one of 
their patients. 
 
Mrs P. is an example of the turmoil that such a seminar can cause among physicians. She was 
greatly disturbed about many aspects of her hospitalization. She felt in great need to express her 
concerns and desperately tried to find out who her doctor was. She happened to be hospitalized at 
the end of June when there is a big turnover of hospital staff and hardly came to know her "crew" 
when they left to be replaced by another group of young doctors. One of the newcomers, who had 
previously attended the seminar, noticed her dismay, but he was unable to spend any time with her 
as he was busily trying to get to know his new supervisors, his new ward and duties. When I 
approached him with the request to interview Mrs. P., he quickly consented. A few hours after the 
seminar, his new supervisor, a resident, cornered me in a busy hallway and angrily and loudly 
reproached me for seeing this lady, adding that "this is the fourth patient in a row that you have 
taken from my ward." He did not feel the least embarrassed about bringing out his complaints in 
front of visitors and patients; it did not bother him either to talk quite disrespectfully to a senior 
member of the faculty. He was clearly enraged about the implication and about the fact that other 
members of his team quickly gave permission without asking him first. 
 
He did not wonder why so many of his patients had difficulties in coping with their illness, why his 
team avoided asking him, and why it was impossible for his patients ever to bring up such concerns. 
The same physician told his interns later on that they were henceforth not allowed to talk to any of 
their patients about the serious aspect of their illness nor were they allowed to have them talk to us. 
In the same meeting he mentioned the respect and admiration he had for the seminar and for our 
work with the terminally ill-but he himself wanted no part in it and that included his patients, most 
of whom had an incurable illness. 
 
Another physician called the moment I entered my office after an especially moving interview. I 
had half a dozen visiting priests and nursing supervisors in my office when a loud voice yelled 
through the telephone and said something to the effect of, "How do you have the nerve to talk to 
Mrs. K. about dying when she does not even know how sick she is and may go home once more?" 
When I finally came to my senses, I explained to him the content of our interview, namely, that this 
woman asked to talk to someone who was not involved in her immediate treatment. She wanted to 

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share with someone in the hospital that she knew that her days. were numbered. She was not yet 
able to acknowledge this in its full meaning. She asked us to reassure her that her own physician 
(the one I had on the telephone!) would somehow give her a cue when her end was near and that he 
would not play a hiding game with her until it was too late. She had the greatest confidence in him 
and was very uncomfortable that she had not been able to convey to him her awareness of the 
seriousness of her condition. 
 
When this doctor heard what we were actually doing (which was in great contrast to his 
suppositions!), he became more curious than angry and finally consented to listen to the tape of 
Mrs. K.'s interview, which was actually a plea from his own patient to him. 
 
The visiting clergy could not have gotten a better learning experience than the actual interruption 
by this angered doctor, who showed them the displaced effect that such a seminar can provoke. 
 
Early in my work with dying patients I observed the desperate 
 
(P222) 
 
need of the hospital staff to deny the existence of terminally ill patients on their ward. In another 
hospital I once spent hours looking for a patient capable to be interviewed, only to be told that there 
was no one fatally ill and able to talk. On my walk through the ward I saw an old man reading a 
paper with the headline "Old soldiers never die." He looked seriously ill and I asked him if it did 
not scare him to "read about that." He looked at me with anger and disgust, telling me that I must 
be one of those physicians who can only care for a patient as long as he is well but when it comes 
to dying, then we all shy away from them. This was my man! I told him about my seminar on death 
and dying (*) and my wish to interview someone in front of the students in order to teach them not 
to shy away from these patients. He happily agreed to come, and gave us one of the most 
unforgettable interviews I have ever attended. 
 
In general, the physicians have been the most reluctant in joining us in this work, by referrals at 
first and then by attending the seminar. Those who have done either have contributed a great deal, 
and once they joined they usually continued to do so in increasing involvement. It may take both 
courage and humility to sit in a seminar which is attended not only by the nurses, students, and 
social workers with whom they usually work, but in which they are also exposed to the possibility 
of hearing a frank opinion about the role they play in the reality or fantasy of their patients. Those 
who are fearful of hearing how others see them will naturally be reluctant to attend such a meeting 
aside from the fact that we are talking about a topic which is usually taboo and not talked about 
with patients and staff publicly. Those who have come to such seminars have always been amazed 
how much they can learn from the patient and the opinion and observations of others and have 
come to appreciate it as an unusual learning experience which gave them both insight as well as 
encouragement in pursuing their work. 
 
It is the first step which is the most difficult with physicians. Once they opened the door, listened to 
what we were actually doing (rather than speculating on what we might be doing), or 
 
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