[...]

[Patient:] I wasn't aware of the prognosis

At that time, I just knew the condition was terminal...

[Dr. Elisabeth Kubler-Ross:] Uh-huh.

[Patient:] and I wasn't supposed to survive

for more than 10 days.

[...]

[Until I Die]

[...]

[Narrator:] When you hear patients talking about dying.

You just have to come to grips with the meaning of death for yourself.

Those of us who work with dying patients

and have taken part in the seminar on death and dying.

Which Dr. Ross began a few years ago.

Are all very much moved by the extraordinary openness,

and humanness, and honesty we find there.

It's very, very hard to deal with your own death

before you have to.

But all of us really ought to.

Because it has something

to do with the quality of life.

That's why Elisabeth Ross is a loved woman.

A truly loved woman.

She has, in a way, made something

which is really natural, all right again.

I think she started us...on a long journey.

[...]

[Dr. Elisabeth Kubler-Ross:] When we talk about the fear of death,

we should remember that most people are not

afraid of falling asleep one day

of old age in bed and just not waking up.

But we are all afraid of a catastrophic death associated

with pain, suffering, violence, and destructiveness.

We know we really can't defend ourselves

physically against the possibility of our death.

So we defend ourselves psychologically.

And that's naturally, the biggest and strongest defense

is to deny that it really exists.

We say oh, it's not going to happen to me.

We say it's going to happen to these and to these,

but not to me.

[Highway traffic]

Many people are afraid of highways.

If I'm afraid to use the [Inaudible],

and I just have to use it.

What do I do?

I'm not driving slow and carefully

because that would give me more time

to think about how frightening it is.

So I deny that its dangerous.

And I put my foot a bit harder on the accelerator.

And I look on the left, and I look on the right.

And I see a stalled car there, and a police car there,

and an accident there.

And each time I see those things,

it kind of confirms in my mind.

Oh, yes it shall happen to these and to these,

but not to me.

And people who use this every day.

And get home safe without an accident.

It confirms to them that they are immortal, that it

shall not happen to them.

This country, especially, is a death-denying society.

And by this, I mean the death and dying are no longer

an acceptable part of life.

In the old days, this came in different ways

than it comes now.

People died at home in familiar surroundings

with loved ones around them.

Now, more than half the people in this country

die in hospitals.

And this makes dying more impersonal, and often more mechanical

and dehumanized than it would be at home.

[...]

The bigger and the better, the more sophisticated

the hospitals are, the rural cities.

We are so trained in medical schools

to cure, to prolong life, to heal.

But we don't stress enough that people also die,

and that the dying person also needs help.

[Caregiver:] Just take a little bit...

[Low talking]

[Dr. Elisabeth Kubler-Ross:] Not help to die,

but help to live a human, dignified life

until they die.

[Clock ticking]

That is very hard to do in modern hospitals.

[...]

[Montage of hospital equipment]

[Respiration device expelling air]

[Clock ticking]

[Dinging bell]

[Machine pulsing]

[...]

[Dr. Elisabeth Kubler-Ross:] Many times when aperson is beyond medical help,

they are put in a different room.

They are left alone.

They are very often isolated and lonely.

And people say, well, what's the use of going in there?

There's nothing much we can do.

The staff feels very uncomfortable

and doesn't know what to talk about.

You can go in and talk about the beautiful weather outside,

the next spring.

But deep down in your soul, you know that this person probably

won't see next spring.

And so it's a farce.

What we are not teaching-- and that's not only true

for physicians, but nursing staff, social workers,

hospital chaplains.  Is that these people have their own

very specific needs.

And most of them don't want to beat around the bush.

They don't want to talk about the jovial, trivial,

superficial things.

But they have very important things

to talk about, namely what it's going to be like.

They want to talk about death and dying.

If only for five minutes.

To bring out an unfinished business,

to raise a question that's on their mind.

And then afterwards, it's OK again

to talk about next spring.

[Inaudible discussions]

How difficult it is

for the members of the helping profession

to be comfortable with those patients.

And I think if we can help people

to realize that we are all finite

and that death can be a very comfortable part of life.

And that it's not as horrifying and frightening as our fantasies.

If we can help them sit and listen to their own patients,

it doesn't only help the dying patient,

but it helps the person who is comfortable doing that.

We have talked with more than 400 terminally ill patients

in order to find out what their real needs are

and how we can best help them.

We found out that most patients go

through five stages in coming to terms with the fact

that they are dying.

And often, their families and sometimes even the medical staff

go through the same stage as the patient does.

[...]

When the patient is told that he has a serious illness,

he first reacts with shock and denial.

"No, not me."

We have seen patients maintaining their denial

for months and months to their family,

and to their physicians.  And then they came in

and asked them, how sick are you?

Conveying to them that we don't need denial.

And they said, I'm full of cancer.

Many, many times we have seen patients who said,

I know I have cancer but my family doesn't know.

And the doctor says, I know he has cancer,

but the patient doesn't know.

And the family says, I know he has cancer, but don't tell him.

And usually, we ask the patient to convey to the family

that he knows and that it's much better to talk about it frankly

and openly, rather than to waste all the little remaining energy

in playing a game.

[...]

When the patient can no longer say no, not me.

His next question is usually, why me?

And the patient gets angry and he questions

why this is happening to him.

He's angry at the people.

He's angry at God.

He raises his voice.

He becomes very, very difficult management problem sometimes,

Calls for the nurse all the time.

He complains to the family about their visiting.

Whatever you do is no good.

We find that the more happy, and more energetic, and in a way,

the more effective you are.

The more you get this patient's anger.

They are angry at what you represent.

If you come in full of life, energy, functioning.

You are being what this patient is in the process of losing.

[...]

You make him aware that yes, two weeks ago,

I would walk around quick and happy like this.

I was able to work.

I was able to go home to fix dinner for my children.

I was able to do this and that.

And look at me now.

And they are angry about all the things they

are in the process of losing.

And they are angry at you only because you remind them

of all the things that they were able to do.

What we found most helpful to do with those patients is not

to make them feel guilty and kind of convey to them

that they are bad patients.

But to kind of put yourself into

the patient's shoes for a moment.

And say, you know, I think I would be angry too.

Get it out.  Get it off your chest.

I think it's a perfectly normal human reaction.

And if you can get it off, maybe it helps you a little bit.

[...]

Then the person usually becomes less apprehensive.

Less difficult to manage, and to handle, and to tolerate.

And he enters what we call the stage of bargaining.

The bargaining, he's beginning to acknowledge, yes, me.

But he adds a little word to it "but."

And the "but" really means ...maybe if I'm

a good patient, or a good person, or I promise something.

Maybe I can live a little bit longer.

And I think everybody needs this kind of truth.

Needs a little time of temporary peace.

Where they don't want to think about it.

Where they feel that you have a certain time.

And the patient can recuperates to mobilize new energy

for the final stages.

When the bargaining time is up and he says, yes, me, but--

When he drops the "but."

Then he begins to really face, yes, it's me.

[...]

And the patients then become depressed.

So we've got grief and depression

in this period of time of a patient's life.

It's very, very normal.

What do we do when we come into a patient's room,

a patient who cries?

Especially if it's a man?

Our tendency is to come in and try to cheer them up, and say,

oh, isn't it a lovely day outside, and cheer up,

it's not so bad.

For a patient to have the courage

to face not only that he's losing one loved one.

But everybody he has ever lost,

and everything he has ever lost.

He has to separate himself from.

It's a very sad state of affairs.

And he should be allowed to express this grief.

He has to mourn not only the things he has already lost,

which includes probably the job, and the income.

And just being at home with the family.

Which includes maybe an organ, maybe abreast, maybe a limb.

But he goes then, through the preparatory grief.

That means he's beginning to separate himself

from this earth.

And that shows, in a practical way,

in that he asks for all the friends

to come and visit him once more.

Than he would like to see his children once more.

And then at the very end, he only

needs one or two people who are comfortable

and who can sit in what we call

the silence that goes beyond earth.

The silent companionship of a loved one.

Who can just sit and hold your hand, or touch your hair,

or just be with you.

Without words.

A patient cannot reach this if he's not allowed to grieve.

[...]

State of acceptance is not resignation.

Resignation is kind of a deeper giving up, the defeat,

what's the use?

Acceptance is not a happy stage.

But it's a feeling of, I have finished

my unfinished business.  I have done my best.

I would like to lie back on my pillows now,

and I'm ready for the last journey.

If that's how people conceive of it.

If you can help them through this, at the very end,

they have much less physical pain.

They are at peace inside and outside.

[...]

The family and the patient himself,

when they reach the stage of acceptance of death together,

it's really a kind of a victory.

But it's hard to reach the stage when you are dealing

with the death of a child.

Very, very small children naturally

have absolutely no concept of death.

They are only concerned about separation.

And you try to have the parents, and if not both parents

at least their mother, in with the children

so that they are not alone.

[Children's voices in background]

Later on when they are about three, four, five years old.

they begin to be very concerned about their body,

[Children's voices in background]

their body image.  Everything has to be intact.

And so their biggest concern, perhaps,

is at that time, [Inaudible] of surgical procedures

or doing anything that changes their body

and they have to talk about it.

And so we talk about that, if that's relevant to them

and if that issue has questions raised by the child.

The most important thing, perhaps,

is that we listen to them.

And when they ask a question, that we don't tell them lies.

We had a seven-year-old who was in the hospital with a terminal illness, leukemia,

and she went to the doctors and said,

"What is it like what I'm going to die?"

And he said, "Oh, I hear my page."

And he left.

And then she asked the nurse, and the nurse said,

"You're a bad girl, don't talk like this."

"You take your medicine, you get well."

You see, what this means is if you take your medicine,

you will live and be well.

But if you don't take your medicine,

if you talk like this, you're a bad girl

and you're not going to get well.

This is a very primitive way of dealing with it.

And then she asked a hospital chaplain the same question.

And he looked at her and he said,

"What do you think it's going to be like?"

This is a beautiful answer because it says many things.

It says most important of all, yes, it may happen.

But what do you think it's going to be like?

And she looked at him like only a little girl can look at you, and she said,

"One of these days I'm going to fall asleep,

and when I wake up, I'm with Jesus and my little sister."

That simple.

So children too, they know when they're dying.

They have their own concept, depending on their age.

And they can convey this to you

if you can see it and hear it,

and then use their language.

And in this way, I think you can help them the most.

[Children's outdoor laughter]

In [inaudible] in Zurich, in the hospital,

they study drawings of terminally ill children

with inoperable brain tumors.

And one boy drew a picture of a huge, huge cannon.

And in front of that barrel was a tiny little boy,

the diameter of the barrel with a stop sign in his hand.

And what this represents beautifully

is our concept of death is a huge, destructive, powerful force

that hits us from the outside.

We can't do anything about it.

The tiny little boy with a stop sign standing

in front of the hugest cannon for this tiny little boy.

What you could tell to such a child,

is it must be terrible to feel so tiny,

and this thing here is so big.

When this boy was able to talk about it,

the next picture he made was a beautiful bird

flying up into the sky.

And everything was drawn in black and white

except for his wing, which had a little touch of gold

on the edge of the wing.

And when asked what this was, he said,

but naturally, this is the peace bird flying up into the sky

with a little bit of sunshine on my wing.

And that was the day he died.

[Shadow cast on ground of a child on a swing]

Death is something you can't experiment with,

you can't experience.

So we in the hospital, who have to face death all the time

and we have to deal with it,

realize that the only way you can get the feeling of what it's like

is to ask seriously-ill patients themselves to be our teacher.

[Background group chatter]

[Dr. Elisabeth Kubler-Ross:] How long have you been ill?

[Machine beeping]

[Patient:] Oh...

[Dr. Elisabeth Kubler-Ross:] About?

[Patient:] A brief period

prior to that, very brief.

I didn't, I wasn't aware of the fact that I was this ill