Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

that the best possible way we could study death and dying was by asking terminally ill patients to 
be our teachers. We would observe critically ill patients, study their responses and needs, evaluate 
the reactions of the people around them, and get as close to the dying as they would allow us. 
 
We decided to interview a dying patient the following week. We agreed on time and place, and the 
whole project seemed nether simple and uncomplicated. Since the students had no clinical 
experience and no past encounter with terminally ill patients in a hospital, we expected some 
emotional reaction on their part. I was to do the interview while they stood around the bed watching 
and observing. We would then retire to my office and discuss our own reactions and the patient's 
response. We 
 
(p20) 
 
believed that by doing many interviews like this we would get a feeling for the terminally ill and 
their needs which in turn we were ready to gratify if possible. 
 
We had no other preconceived ideas nor did we read any papers or publications on this topic so that 
we might have an open mind and record only what we ourselves were able to notice, both in the 
patient and in ourselves. We also purposely did not study the patient's chart since this too might 
dilute or alter our own observations. We did not want to have any preconceived notion as to how 
the patients might react. We were quite prepared, however, to study all available data after we had 
recorded our own impressions. This, we thought, would sensitize us to the needs of the critically ill, 
would enhance our perceptiveness and, we hoped, desensitize the rather frightened students through 
an increasing number of confrontations with terminally ill patients of different ages and 
backgrounds. 
 
We were well satisfied with our plans and it was not until a few days later that our difficulties 
started. 
 
I set out to ask physicians of different services and wards for permission to interview a terminally 
ill patient of theirs. The reactions were varied, from stunned looks of disbelief to rather abrupt 
changes of topic of conversation; the end result being that I did not get one single chance even to 
get near such a patient. Some doctors "protected" their patients by saying that they were too sick, 
too tired or weak, or not the talking kind; others bluntly refused to take part in such a project. I have 
to add in their defense that they were justified to some degree, as I, had just started my work in this 
hospital and no one had had a chance to know me or my style and type of work. They had no 
Assurance, except from me, that the patients were not to be traumatized, that those who had not 
been told of the seriousness of their illness would not be told. Also, these physicians were not 
aware of my past experience with the dying in other hospitals. 
 
I have added this in order to present their reactions as fairly as I can. These doctors were both very 
defensive when it came to talking about death and dying and also protective of their patients in 
order to avoid a traumatic experience with a yet unknown faculty member who had just joined their 
ranks. It suddenly seemed that there were no dying patients in this huge hospital. M v phone calls 
and personal visits to the wards were all in vain. Some physicians said politely that they would 
think about it, others said they did not wish to expose their patients to such questioning as it might 
tire them too much. A nurse angrily asked in utter disbelief if I enjoyed telling a twenty-year-old 

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man that he had only a couple of weeks to live! She walked away before I could tell her more about 
our plans. 
 
When we finally had a patient, he welcomed me with open arms. He invited me to sit down and it 
was obvious that he was eager to speak. I told him that I did not wish to hear him now but would 
return the next day with my students. I was not sensitive enough to appreciate his communications. 
It was so hard to get one patient, I had to share him with my students. Little did I realize then that 
when such a patient says "Please sit down now," tomorrow may be too late. When we revisited him 
the next day, he was lying back in his pillow, too weak to speak. He made a meager attempt to lift 
his arm and whispered "Thank you for trying"-he died less than an hour later and kept to himself 
what he wanted to share with us and what we so desperately wanted to learn. It was our first and 
most painful lesson, but also the beginning of a seminar which was to start as an experiment and 
ended up to be quite an experience for many. 
 
The students met with me in my office after this encounter. We felt the need to talk about our own 
experience and wanted to share our reactions in order to understand them. This procedure is 
continued until the present day. Technically little has changed in that respect. We still see a 
terminally ill patient once a week. We ask him for permission to tape-record the dialogue and leave 
up to him entirely how long he feels like talking. We have moved from the patient's room to a little 
interviewing room from which ,e can be seen and heard but we do not see the audience. From a 
group of four theology students the class has grown to up to fifty, which necessitated the move to a 
screen window set-up. 
 
When we hear of a patient who may be available for the seminar, we approach him either alone or 
with one of the students 'I'd the referring physician or hospital chaplain, or both. After a brief 
introduction we state the purpose and timing of our visit, clearly and concretely. I tell each patient 
that we have an inter-disciplinary 
 
(P22) 
 
group of hospital personnel eager to learn from the patient. We emphasize that we need to know 
more about the very sick and dying patient. We then pause and await the patient's verbal or 
nonverbal reactions. We do this only after the patient has invited us to talk. A typical dialogue 
follows: 
 
DOCTOR: Hello Mr. X. I am Dr. R. and this is Chaplain N. Do you feel like talking for a little 
while? 
 
PATIENT: Please, by all means, sit down. 
 
DOCTOR: We are here with a peculiar request. Chaplain N. and I are working with a group of 
people from the hospital who are trying to learn more about very sick and dying patients. I wonder 
if you feel up to answering some of our questions? 
 
PATIENT: Why don't you ask and I'll see if I can answer them. DOCTOR: How sick are you? 
 
PATIENT: I am full of metastasis .... 

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