Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

the last will, and arrange for the care-temporary or permanent-of children left without a parent. 
Aside from these practical matters, the family often needs a mediator as demonstrated in the 
interview of Mr. H. (in Chapter VI). 
 
The dying patient's problems come to an end, but the family's problems go on. Many of these 
problems can be decreased by discussing them before the death of a family member. The tendency 
is, unfortunately, to hide the feelings from the patient, to attempt to keep a smiling face and a front 
of make-believe cheerfulness which has to break down sooner or later. We have interviewed a 
terminally ill husband who said, "I know I have only a short time to live, but don't tell my wife, she 
could not take it." When we spoke to the visiting wife in a casual encounter, she volunteered almost 
the same words. She knew and he knew, but neither had the courage to share it with the other-and 
this after thirty years of marriage! It was the young chaplain who was able to encourage them to 
share their awareness, while he remained in the room at the patient's request. Both were greatly 
relieved that they no longer had to play a deceitful game and proceeded to make arrangements 
which either one alone was unable to do. Later they were able to smile about their "childish game," 
as they themselves called it, and were wondering who knew it first and how long it would have 
taken them without help from outside. 
 
I think the dying person can be of great help to his relatives in helping them meet his death. He can 
do this in different ways. One of the ways is naturally to share some of his thoughts and feelings 
with the members of the family in order to help them do the same. If he is able to work through his 
own grief and show his family by his example how one can die with equanimity, they will 
remember his strength and bear their own sorrow with more dignity. 
 
Guilt is perhaps the most painful companion of death. When an illness is diagnosed as a potentially 
fatal one, the family members often ask themselves if they are to be blamed for it. "If I had only 
sent him to a doctor earlier" or "I should have noticed 
 
the change earlier and encouraged him to seek help" are frequent statements made by wives of 
terminally ill patients. Needless to say, a friend of the family, a family physician, or chaplain can be 
of great help to such a woman by relieving her of her unrealistic reproach and by assuring her that 
she probably did everything possible to obtain help. I do not feel, however, that it is enough to say, 
"Don't feel guilty, because you are not guilty." By listening to such wives carefully and attentively, 
we can often elicit the more realistic reason for their guilt. Relatives are often guilt ridden because 
of very real angry wishes toward the dead person. And who, in anger, has not at times wished 
someone would disappear, go away, or even dared to say, "Drop dead"? The man in our interview 
in Chapter XII is a good example of this. He had good reasons to be angry at his wife, who deserted 
him to live instead with her brother, whom he regarded as a Nazi. She walked out on our Jewish 
patient and raised his only son as a Christian. She died while he was absent and the patient blamed 
her for this too. Unfortunately there was no chance ever to express all this unresolved anger and the 
man was grief-stricken and guilty to the extent that he himself became quite sick. 
 
A high percentage of widowers and widows seen in clinics and by private physicians present 
themselves with somatic symptoms as a result of the failure to work through their grief and guilt. If 
they had been helped before the death of their partner to bridge the gulf between themselves and 
the dying one, half of the battle would have been won. It is understandable that people are reluctant 
to talk freely about death and dying, especially if death suddenly becomes a personal thing which 

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affects us, has somehow come close to our own doorstep. The few people who have experienced 
the crisis of impending death have found that communication is only difficult the first time and 
becomes simpler with gained experience. Instead of increasing alienation and isolation the couple 
find themselves communicating in more meaningful and deeper senses and may find a closeness 
and understanding that only suffering can bring. 
 
Another example of lack of communication between the dying and the family is the example of 
Mrs. F. 
 
(P144) 
 
Mrs. F. was a terminally ill and severely debilitated Negro woman who lay in her bed for weeks, 
motionless. Looking at her dark-skinned body in those white bed sheets reminded me in a 
gruesome way of tree roots. Due to her crippling disease, it-was hard to define the outline of her 
body or her features. Her daughter, who had been living with her all her life, sat equally motionless 
and speechless next to her mother. It was the nursing staff who asked us for help, not for the patient 
but for the daughter, for whom they were rightfully concerned. They watched how she spent more 
hours every week at her mother's bedside. She had stopped working and finally spent practically 
day and night silently with her dying mother. The nurses might have worried less had they not 
sensed the peculiar dichotomy between the ever increasing presence and the complete lack of 
communication. The patient had had a stroke recently and was unable to speak; she was also unable 
to move any limbs, and it was presumed that her mind was no longer functioning. The daughter just 
sat there in silence, never said a word to the mother, never gave her a verbal or nonverbal gesture of 
care or affection-except for her mute presence. 
 
We entered the room to ask the daughter, who was in her late thirties and single, to come and join 
us for a brief discussion. What we hoped to achieve was some understanding of her increasing 
presence, which also meant an increasing detachment from the outside world. The nurses were 
concerned about her reaction after her mother's death but found her as uncommunicative as her 
mother, though for different reasons. I don't know what made me turn to the mother before I left the 
room with the daughter. Maybe I felt I was depriving her of a visitor; maybe it was just an old habit 
of mine to keep my patients informed of what was going on. I told her that I was taking her 
daughter away for a while because we were concerned about her well-being once she was alone. 
The patient looked at me and I understood two things: First, she was fully aware what was going on 
in her environment, in spite of her apparent inability to communicate; the second, and unforgettable 
lesson, was never to classify anybody as a so-called vegetable even if they appear to be non-
reactive to many stimuli. 
 
We had a long talk with the daughter, who had given up her job, her few acquaintances, and almost 
her apartment in order to spend as much time as possible with her dying mother. She had not given 
any thought to what would happen if she 
 
died. She felt obliged to stay in the hospital room almost day and night and actually had had only 
about three hours of sleep a night during the preceding couple of weeks. She began to wonder 
whether she made herself so tired to prevent her from thinking. She dreaded the idea of leaving the 
room out of fear that her mother might die. She had never talked with her mother about those things, 
though the mother had been ill for a long time and able to talk until recently. At the end of the 

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