Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

 
(Another patient may say, "Do you really want to talk to an old and dying woman? You are young 
and healthy!") 
 
Others are not so receptive at first. They start complaining about their pain, their discomfort, their 
anger, until they are in the midst of sharing their agony. We then remind them that this is exactly 
what we wanted the others to hear and would they consider repeating the same a little time later. 
 
When the patient agrees, the doctor has granted permission, and arrangements have been made, the 
patient is brought personally by us to the interviewing room. Very few of them walk, most are in 
wheelchairs, a few have to be carried on a stretcher. Where infusions and transfusions are necessary, 
they are brought along. Relatives have not been included, though they have occasionally been 
interviewed following the dialogue with the patient. Our interviews keep in mind that no one 
present has much if any background information on the patient. We usually rephrase the purpose of 
the interview on our way to the interviewing room during which time we emphasize the patient's 
right to stop the session at any moment for any reason of his own. We again describe the mirror on 
the wall which makes it possible for the audience to see and hear us and this allows the patient a 
moment of privacy with us which is often used to alleviate last minute concerns and fears. 
 
Once in the interviewing room the conversation flows easily and quickly, starting with general 
information and going on to very personal concerns as shown in actual recorded interviews, a few 
of which are presented in this book. 
 
Following each session the patient is first brought back to his room after which the seminar 
continues. No patient is kept waiting in the hallways. When the interviewer has returned to the 
classroom he joins the audience and together we discuss the event. Our own spontaneous reactions 
are brought to light, no matter how appropriate or irrational. We discuss our different responses, 
both emotional and intellectual. We discuss the patient's response to different interviewers and 
different questions and approaches and finally attempt a psychodynamic understanding of his 
communications. We study his strengths and weaknesses as well as ours in the management of this 
given person and conclude by recommending certain approaches that we hope will make the 
patient's final days or weeks more comfortable. 
 
None of our patients has died during the interview. Survival ranged from twelve hours to several 
months. Many of our more recent patients are still alive and many of the very critically ill patients 
have had a remission and have gone home once more. Several of them have had no relapse and are 
doing well. I emphasize this since we are talking about dying with patients who are not actually 
dying in the classical sense of the word. We are talking with many if not most of them about this 
event because it is something that they have faced because of the occurrence of a usually fatal 
illness-our intervention may take place at any time between the making of the diagnosis until just 
before death. 
 
The discussion serves many purposes, as we have found out by experience. It has been most helpful 
in making the students aware of the necessity of considering death as a real possibility, not only for 
others but also for themselves. It has proven to be a meaningful way of desensitization, which 
comes slowly and painfully. Many a student appearing for the first time has left before the 

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interview was over. Some were finally able to sit through a whole session but were unable to 
express their opinions 
 
 (P24) 
 
in the discussion. Some of them have displaced all their anger and rage onto other participants or 
the interviewer, at times onto the patients. The last has occasionally happened when a patient 
apparently faced death with calmness and equanimity while the student was highly upset by the 
encounter. The discussion then revealed that the student thought the patient was unrealistic or even 
faking, because it was inconceivable to him that anyone could face such a crisis with so much 
dignity. 
 
Other participants began to identify with the patients, especially if they were of the same age and 
had to deal with these conflicts in the discussion-and long afterwards. As those in the group began 
to know each other and realized that nothing was taboo, the discussions became a sort of group 
therapy for the participants, with many frank confrontations, mutual support, and at times painful 
discoveries and insights. Little did the patients realize the impact and long-lasting effects many of 
the communications had on a great variety and number of students. 
 
Two years after the creation of this seminar, it became an accredited course for the medical school 
and the theological seminary. It is also attended by many visiting physicians, by nurses and nurses' 
aids, orderlies, social workers, priests and rabbis, by inhalation therapists and occupational 
therapists, but only rarely by faculty members of our own hospital. The medical and theology 
students who take it as a formal credit course are also attending a theoretical session, which deals 
with theory, philosophical, moral, ethical, and religious questions, and which is alternately held by 
the author and the hospital chaplain. 
 
All interviews are tape-recorded and remain available to students and teachers. At the end of each 
quarter each student writes a paper on a subject of his own choice. These papers will be presented 
in a future publication; they range from very personal workings-through of concepts and fears of 
death to highly philosophical, religious, or sociological papers dealing with death and dying. 
 
In order to ensure confidentiality, a checklist is made of all those attending, and names and 
identifying data are altered on all transcribed recordings. 
 
From an informal get-together of four students, a seminar has grown within two years which is 
attended by as many as fifty 
 
people consisting of members of all the helping professions. Originally it took an average of ten 
hours a week to get permission from a doctor to ask a patient to be interviewed; now we are rarely 
forced to search for a patient. We are getting referrals from physicians, nurses, social workers, and 
most encouragingly, perhaps, from patients who have attended the seminar and have shared their 
experience with other terminally ill patients who then ask to attend, at times to do us a service, at 
other times in order to be heard. 
 
The Dying As Teachers 
 

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