Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

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a patient is in a crisis, when he is dying, when his family has difficulty in accepting the news, or 
when the treatment team wishes to have him play the role of the mediator. During the first year I 
did this work without the assistance of the clergy. Their presence has changed the seminar a great 
deal. The first year was incredibly difficult for many reasons. 
 
Neither my work nor I were known and thus met with much understandable resistance and 
reluctance aside from the difficulties inherent in this undertaking. I had no resources nor did I know 
the staff well enough to know whom to approach and whom to avoid. It required hundreds of miles 
of walking through the hospital and by trial and error finding out the hard way who was 
approachable and who was not. If it had not been for the overwhelmingly good response from the 
patients, I might have long ago given up. 
 
It was at the end of a fruitless search that I ended up in the chaplain's office one night, exhausted, 
frustrated, and looking for help. The hospital chaplain then shared with me his own problems with 
these patients, his own frustrations, and need to have some help, and we joined forces from then on. 
He had a list of the critically ill available and had previous contact with many of the seriously ill 
patients; thus the search ended and it became a matter of choosing the most needy. 
 
Among all of the many chaplains, ministers, and rabbis and priests who have attended the seminar, 
I have seen few who avoided the issue or who showed as much hostility or displaced anger as I 
have seen among other members of the helping professions. What amazed me, however, was the 
number of clergy É who felt quite comfortable using a prayer book or a chapter out :j of the Bible 
as the sole communication between them and the patients, thus avoiding listening to their needs and 
being exposed to questions they might be unable or unwilling to answer. 
 
Many of them had visited innumerable very sick people but began for the first time, in the seminar, 
really to deal with the question of death and dying. They were very occupied with funeral 
procedures and their role during and after the funeral but had great difficulties in actually dealing 
with the dying person himself. They often used the doctor's orders "not to tell" or the ever 
 
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existing presence of a family member as an excuse for not really communicating with the 
terminally ill patients. It was in the course of repeated encounters that they began to understand 
their own reluctance in facing the conflicts and thus their use of the Bible, the relative, or the 
doctor's orders as an excuse or rationalization for their lack of involvement. 
 
The most touching and instructive change in attitude, perhaps, was presented by one of our 
theology students who had attended, the classes regularly and who seemed deeply involved in this 
work. One afternoon he came to my office and asked for a meeting alone. He had gone through a 
week of utter agony and confrontation with the possibility of his own death. He had developed 
enlarged lymph glands and was asked to have a biopsy taken in order to evaluate the possibility of a 
malignancy. He attended the next seminar and shared with the group the stages of shock, dismay, 
and disbelief he had gone through-the days of anger, depression, and hope, alternating with utter 

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anxiety and fear. He vividly compared his attempts to cope with the crisis with the dignity and 
pride he had seen in our patients. He described the comfort of his wife's understanding and shared 
with us the reactions of his young children who overheard some of their discussions. He was able to 
talk about it in a very real sense and made us aware of the difference between being an observer 
and being the patient himself. 
 
This man will never use empty words when he meets a terminally ill patient. His attitude has not 
changed because of the seminar but because he himself had to face the possibility of his own death 
at a time when he just learned how to cope with the impending death of those in his care. 
 
We have learned from the staff that the resistance to such an undertaking is tremendous, the 
displaced hostility and anger hard to accept at times, but these attitudes can be changed. Once the 
group understood the reasons for their defensiveness and learned to face the conflicts and analyzed 
them, they were able to contribute not only to the patient's well-being but also to the growth and 
understanding of the other participants. Where the obstacle and fear is great, the need is equally 
great. It may be for this reason that the fruit of our work tastes so much better 
 
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now because it took so much` hard soil to dig and so much care to plant the ground. 
 
Students' Reactions 
 
Most of our students entered the course not knowing what to expect exactly or because they heard 
from others certain aspects appealing to them. Most of them felt that they had to face "real patients" 
before having the responsibility of their care. They knew that the interviews would be conducted 
behind a one-way mirror and that it served for many students as a "getting used to" process before 
they would have to sit and face an actual patient. 
 
A great many of the students (so we learned later during the discussion) signed up because of some 
unresolved conflicts in their own life regarding the death of a loved or ambivalent figure, and a few 
came because they wanted to learn interviewing techniques. Most of them said they came in order 
to learn more about the complex problems of dying; only a few of them really meant it. Many a 
student came to the first interview quite self-confident, only to leave the room before the end of the 
interview. Many students had to make several attempts before they were able to sit through both 
interview and discussion, and then they were still shaken up when a patient requested to have the 
session in the audience room rather than behind the mirror. 
 
It took three or more sessions until they became comfortable discussing their own reactions and 
feelings in front of the group, and many of them discussed their responses long after the day was 
over. There was one student who constantly picked up some minor details of the interview, 
challenging an argument among the group until other participants wondered if that, too, was 
perhaps his way of avoiding the real issue, namely, the patient's impending death. Others were able 
to talk only about the medical-technical problems and management and became quite 
uncomfortable when the social worker mentioned the agony of the young husband and the small 
children. When a nurse spoke up and questioned the rationale of certain procedures and tests, the 

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