On death and Dying – Elisabeth Kübler-Ross


Today I would like to share a very precious reading of mine. As I’m thinking about how to continue to help people (as I used to do as a medical doctor), but without doing the equivalence, I’m reading a lot of things on dying, living with a cancer or other critical illness.

The first time I went back to my library after my last 2 months in France, I found that very famous book for me: On Death and Dying. It’s famous because I learned during my medical studies the different steps of grief, which come from that book. But I never read the book itself. So today I’m proud to tell you that I read it in its original version!!

On Death and Dying

Elisabeth Kübler-Ross was a psychiatrist, born in Switzerland. She worked in France and in Poland, during a typhoid fever epidemic. She also discovered black butterflies drawn by children in Majdanek concentration camp … After all these special life experiences, she moved to the USA where she became a psychiatrist, and dedicated her research to dying patients, and later dying children.

This book is the first that she wrote, while working in Chicago. She explains the seminar that took place at the hospital, initially with 4 theology students. The principle was to interview a critically sick person, in front of a one way mirror. Behind the mirror, at first 4 students but soon up to 50 people, nurses, medical students, theology students … What impressed me is that I’m not sure that those interviews given in 1965 would be so different today. The only difference would be that no patient would remain without knowing his diagnosis from the doctor himself. At that time, so many patients would only be informed by their family of the severity of the disease … So that’s definitely some progress of the last 40 years.

But the 5 steps of grief are still so true. At first it’s denial and isolation. « That’s not possible! » usually quite short, but sometimes pathologically long. Then comes the anger: « Why me? » People can be angry at their doctor, their nurse. The important thing for caring staff is to remember that this anger is not against them in particular, but against « the entire world » for being sick. And that’s a lesson that every new generation has to learn, that I learned a few times with patients…
The third stage is bargaining: people try to ask « nicely » to try to get something. To God, to their doctor… They try to stay functioning until a child’s wedding for example.
When bargaining cannot be positively answered comes the fourth stage, the depression stage. People are sad, realizing the different losses in life (work, physical appearance …) preceding the loss of life itself. It’s a difficult stage to go through, because often there are some conflicts about how to deal with spouse, with children…

Eventually, when those conflicts are dealt with, the patient enters the last step, aka acceptance. The patient gets detached from his family, is less hungry. That’s the final stage of grief and dying. Not everybody is able to attain that stage, depending on the ability of his entourage to let him go…

Those stages, I did learn during my medical studies. But what I didn’t learn really (or at least what I didn’t remember) is to give hope at every stage. Not false hope, but Hope. At least respect the patients’ hope, such as the discovery of a new treatment (rarely on time…). And I admit this is a hard thing to do in every day life as a thoracic oncologist… And that’s what I would like to work on in the future.

This book is not just a dissertation about the different stages, it’s most of all a collection of patients’ testimonies about dying, and about life. I would recommend this book to every health care student, but also to everybody who has to take care of a sick person (does that mean quite everybody?). This book is very touching…

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