JC Disciples
On Death and Dying, by Elisabeth Kuebler-Ross, MD
On Death and Dying, a landmark exploration of experiences of terminally ill patients, was written in 1969. Since that time, many of the problems identified by the patients that Dr. Kuebler-Ross interviewed have been corrected. Today, doctors inform their patients of their condition in a careful manner rather than trying to hide the truth from the patient or revealing the facts in a careless way. Nurses have a better understanding of the needs of their dying patients and are better prepared to offer appropriate care. The members of the patient’s family are also given more consideration by the staff. Nonetheless, there are still important lessons to be learned from this now-classic work.
The five stages of grief: denial, anger, bargaining, depression, and acceptance, which were identified by Dr. Kuebler-Ross, are now well known. But by reading her book, I gained a greater awareness of the elements of the stages, particularly the extent to which denial in practiced. Reading the interviews with patients revealed the fleeting moments in which those in denial may lift that veil in very discrete ways. Those who lack experience in talking with the dying can easily miss such moments. Her emphasis on the necessity of depression is also helpful. Rather than a condition to guard against or to fight, this is a necessary phase for the dying to move through in order to reach the place of acceptance from which they can die in peace.
From her interviews with terminally ill patients, Dr. Kuebler-Ross explains those things that are helpful to the dying. In addition to illuminating inappropriate actions by the medical personnel, she also describes ways in which chaplains and clergy also failed to address the needs of the dying. Some of those she observed limited their time with the patients to reading from scripture or prayer books, never inquiring about the actual feelings and needs of the patient. There is a powerful lesson here in ministering to the dying. The important work is to relate with the patient, allowing him to describe his needs and feelings. Then scripture and prayer may be used to address those needs.
Her description of the "therapy of silence" was very impressive. Rather than sitting with a sense of helplessness that nothing else can be done, according to Dr. Kuebler-Ross this silent presence is a real comfort to the dying person and the only care that is truly needed. Furthermore, her description of the moment of death was a soft, peaceful, even beautiful one; it was a comforting portrayal that was devoid of anything fearful.
The role of hope is not to be missed in this process. Those who managed best always retained some degree of hope. Various patients hoped for timely medical developments, divine miracles, or simply the promise of heaven. A sense of hope gives the patient strength as he works through the process of dying.