On Death and Dying

In contrast to the reactions of the patients themselves, “the hospital staff reacted with great resistance, at times [with] overt hostility, to our seminar” (247). In most instances, “the more training a physician had, the less he was ready to become involved in this type of work” (247). The most receptive doctor had previously been a nurse and was in the practice of caring for the terminally ill.

In Kübler-Ross’s experience, there were generally two categories of physicians who were able to internalize the seminar’s goals and speak candidly about the death process. The first were “the very young in the medical profession who either had experienced the death of a person close to them and worked through this loss or who had attended the seminar over a period of several months”; the second was a smaller grouping of “older physicians, who—we presume this only—grew up a generation ago in an environment which used fewer defense mechanisms and fewer euphemisms, faced death more as a reality” (248-49). On the whole, over 90% of doctors expressed feelings of anxiety or outright hostility when approached by the seminar or the author about participating in the seminar. It is likely that their reactions stem largely from insecurity, since it requires “both courage and humility to sit in a seminar which is attended not only by the nurses, students, and social workers with whom they usually work, but in which they are also exposed to the possibility of hearing a frank opinion about the role they play” (251).

In contrast to the physicians, the nurses were much more evenly split, eliciting much more positive or neutral reactions: “Many nurses felt a great lack of training in this area and had little instruction as to their role in the face of such crisis. They acknowledged their conflicts with more ease than the physicians” (253). Even more open and positive were the hospital chaplains, who were overwhelmingly welcoming of the seminar’s participants: “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” (255).

Patients were almost unanimously accepting of the seminar’s goals, either because they were able to process their experience in a healthy way or felt that they were providing a valuable service, “that their communications might be important, might be meaningful at least to others” (260). Even more surprisingly most “patients who were discharged maintained their contact on their own initiative by phone calls at times of crisis or of important happenings” (261). Kübler-Ross insisted that it was the role of the patients “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” (262). The ultimate lesson learned was that “for the patient death itself is not the problem, but dying is feared because of the accompanying sense of hopelessness, helplessness, and isolation” (268).

Work with the terminally ill is not for everyone; even for those with a natural aptitude, it takes a lot of time and experience. “To work with the dying patient requires a certain maturity which only comes from experience. We have to take a good hard look at our own attitude toward death and dying before we can sit quietly and without anxiety next to a terminally ill patient” (269). Tearing down defensive walls entails giving patients the opportunity to express their emotions and thoughts without judgment or expectation. For one patient, Mr. E., an emotional block caused him to experience somatic symptoms that convinced him he was dying. It was in fact his guilt that caused him to break down physically, as he “was convinced that he had to be punished for all those bad thoughts and that he had to endure much pain and suffering to alleviate his guilt” (272).

The therapeutic benefits of the seminar meetings lasted far beyond the actual meetings, as participants gravitated toward one another. The author relates: “We have noticed patients sitting together in the lobby of the hospital who have been interviewed in the seminar, and they have continued their informal sessions like members of a fraternity” (274). At the end, it is often the good work of those who have surrounded the patient that see the patient off into a peaceful death: “Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever” (276).