Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

 
to sit and share some of the fears, fantasies, wishes she thinks of during those lonely hours? Maybe 
it is this alone, a little attention a little "occupational therapy," a break in the monotony of things, a 
little color to the whiteness of the hospital wall, that this seminar offers to these patients. Suddenly 
they are all dressed up, put in a wheelchair, asked if their response can be tape-recorded, and aware 
that a group of interested people are watching. It may just be this attention that helps and that 
brings a little sunshine, meaning, and perhaps hope into the life of the terminally ill patient. 
 
Probably the best measure of the patient's acceptance and appreciation of this type of work is the 
fact that they all welcomed us during the remainder of their hospitalization during which time the 
dialogue continued. The majority of patients who were discharged maintained their contact on their 
own initiative by phone calls at times of crisis or of important happenings. Mrs. W. called me to 
share with me her feelings of great relief that her physicians Drs. K. and P. had called on her at 
home to check about her well-being. Her wish to share the good news with us is perhaps an 
indication of the closeness and intimacy of such an informal but meaningful relationship. She said, 
"If I were on my death bed and I would see either one of them, I am sure I would die smiling!" This 
shows how meaningful such relationships can become and how little expressions of care can 
become the most important communications. 
 
Dr. B. was described in similar terms by Mr. E. who said, "I was so desperate about the lack of 
human care, I was ready to sign out. The interns came all day long and stuck me in my veins. They 
did not care if the bed and the pajamas were a mess. Then one day Dr. B. came and before I knew it 
he pulled a needle out. I did not even feel it, he did it so tenderly. Then he put a bandage on-this 
never happened before-and told me which way to pull it off, so it wouldn't hurt!" Mr. E. (a young 
father of three small children who had acute leukemia) said that this was the most meaningful thing 
that happened to him during his ordeal. 
 
The patients respond often with almost exaggerated appreciation to someone who cares and who 
takes a little time out. They are deprived of such kindnesses in a busy world of gadgets and 
numbers and it is not surprising, then, that a little touch of humanity elicits such an overwhelming 
response. 
 
In a time of uncertainty, of the hydrogen bomb, of the big rush and the masses, the little small, 
personal gift may again become meaningful. The gift is on both sides: from the patient in the form 
of the help, inspiration, and encouragement he may give to others with a similar predicament; from 
us in the form of our care, our time, and our wish to share with others what they have taught us at 
the end of their lives. 
 
The last reason perhaps for patients' good response is the need of the dying person to leave 
something behind, to give a little gift, to create an illusion of immortality perhaps. We acknowledge 
our appreciation for their sharing with us their thoughts about this taboo topic, we tell them that 
their role is to teach us, to help those who follow them later on, thus creating an idea that something 
will live perhaps after their death, an idea, a seminar in which their suggestions, their fantasies, 
their thoughts continue to live, to be discussed, become immortal in a little way. 
 

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A communication has been established by the dying patient who attempts to separate himself from 
human relationships in order to face the last separation with the fewest possible ties, yet is unable to 
do this without help from an outsider who shares some of these conflicts with him. 
 
We are talking about death-the subject of social repression-in a frank, uncomplicated manner, thus 
opening the door for a wide variety of discussions, allowing complete denial if this seems to be 
necessary or open talk about the patient's fears and concerns if the patient so chooses. The fact that 
we don't use denial, that we are willing to use the words death and dying, is perhaps the most 
welcomed communication for many of our patients. 
 
If we attempt to summarize briefly what these patients have taught us, the outstanding fact, to my 
mind, is that they are all aware of the seriousness of their illness whether they are told or not. They 
do not always share this knowledge with their doctor or next of kin. The reason for this is that it is 
painful to think of such a reality, and any implicit or explicit message not to talk 
 
(P234) 
 
about it is usually perceived by the patient and-for the moment -gladly accepted. There came a time, 
however, when all of our patients had a need to share some of their concerns, to lift the mask, to 
face reality, and to take care of vital matters while there was still time. They welcomed a 
breakthrough in their defenses, they appreciated our willingness to talk with them about their 
impending death acid unfinished tasks. They wished to share with an understanding person some of 
their feelings, especially the ones of anger, rage, envy, guilt, and isolation. They clearly indicated 
that they used denial when the doctor or family member expected denial because of their 
dependency on them and them need to maintain a relationship. 
 
The patients did not mind so much when the staff did not confront them with the facts directly, but 
they resented being treated like children and not being considered. when important decisions were 
made. They all sensed a change in attitude and behavior when the diagnosis of a malignancy was 
made and became aware of the seriousness of their condition because of the changed behavior of 
the people in their environment. In other words, those who were not told explicitly knew it anyway 
from the implicit messages or altered behavior of relatives or staff. Those who were told explicitly 
appreciated the opportunity almost unanimously except for those who were told either crudely in 
hallways and without preparation or follow-up, or in a manner that left no hope. 
 
All of our patients reacted to the bad news in almost identical ways, which is typical not only of the 
news of fatal illness but seems to be a human reaction to great and unexpected stress: namely, with 
shock and disbelief. Denial was used by most of our patients and lasted from a few seconds to 
many months as some of our included interview examples reveal. This denial is never a total denial. 
After the denial, anger and rage predominated. It expressed itself in a multitude of ways as an envy 
of those who were able to live and function. This anger was partially justified and enforced by the 
reactions of staff and family, at times almost irrational and a repetition of earlier experiences, as the 
example of Sister I. shows. When the environment was able to tolerate this anger without taking it 
personally, the patient was greatly helped 
 
(P236) 
 

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