(Here are some excerpts from my book The Why Files that I hope will be helpful.)

Elisabeth Kubler-Ross, the author of On Death and Dying, believes that the terminally ill—and their families and friends—pass through five stages in [leading up to the] death: denial, anger, bargaining, depression and acceptance.

Not everyone agrees with the order of phases, and some believe people may repeat some phases, but most agree these five feelings are experienced by both the patient, family/friends, and medical staff.

Denial

[This] stage is important. It not only helps the medical staff to carry on with their other responsibilities, but it gives the patient some emotional insulation to make plans and contact family and friends.

Anger

Another phase Kubler-Ross describes is anger.

Anger at the medical staff: "Why didn't they detect it earlier?" "Why isn't the medicine working?" "Why wasn't the operation a success?"

Anger at God: "Why did You allow me to get this disease? "Why won't—or don't—You heal me?" One thing my wife, as a minister, does is tell people it's okay to be angry with God. The Psalmists seemed to be angry with God—"Why don't You do something?"most of the time.

This intense anger can spill over onto family and friends. Lynn Caine in her book Widow talks about the "craziness" of blaming her husband for dying. How dare him die and "cop out" on his responsibilities to her and their children!

Anger is a normal emotion as we deal with our own death or the death or a loved one. Realize that the patient is losing every earthly thing. He or she has a right to be angry, so allow them to express it—and don't take it personally.

Bargaining

Family members may pray "God, if you'll let my grandmother live, I'll go to church more often. I'll even put more in the offering plate. And here's an offer you can't refuse: How 'bout if I become a missionary? You name it, I'll do it."

The patient may pray, "God, just let me make it through the holidays."

But God rarely responds to this version of "Let's Make a Deal." It's not that He doesn't care about our hurts and fears. It's just that He knows, the best thing He can do is go through life's difficulties with us, not—poof! —make all our problems go away. [See Why? xxx]

Depression

It is depressing to think about one's losses such as health and mobility. In a hospital bed—tethered to an IV pole—one can't play basketball, go out for pizza, swim, walk in the park, or do thousands of things he or she once enjoyed. The realization creeps in that there may be many more things that will be missed: graduating from high school, going to college, getting married, having children—the lists continues to grow in one's mind.

Kubler-Ross refers to this as "preparatory grief." The patient and family begin to grieve the loss even before the death.

Although depressed people are depressing to be around, they need our love and company. J. Kerby Anderson, in his excellent book Life, Death & Beyond, writes:

When a patient is expressing himself on an emotional level, he does not need logical arguments. He needs compassion and assurance on the emotional level. Conversely, when he is seeking advice about his personal affairs, he does not need emotional statements like "Don't worry, everything will be all right." He needs helpful advice about finances or other affairs.

Dying patients often come to a point of accepting their impending deaths with courage and a real lack of fear. They've worked through the denial, anger, bargaining, and depression—often through counseling and support groups. (Organizations such as the American Cancer Society and the Muscular Dystrophy Association sponsor such groups through their local agencies.)

Dame Cicely Saunders, the founder of the hospice movement, writes "You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die." Dying patients . . . will often withdraw and not feel like having visitors. This isn't a sign that they no longer love and care for you, but is part of the process of breaking ties with this physical world.

"You can pretty well bet," Tina [an ICU explains], "if they tell you they're going to die, they probably will. Others will say 'I don't think I'm going to make it through the night' or 'I'm prepared. I'm going to meet God.' They have a sense that death is near—unless it's a sudden death like an accident or sudden stroke."

Charlene [another ICU nurse] has the reputation of being the one on whose shift people die. "A lot of nurses pray, 'God, don't let 'em die on my shift,' but I let them. When they say, 'I'm gonna die,' I don't say, 'You gotta hang in there.' I just hold their hand and say, 'That's okay, I'm here for you. Your family's here for you.'"

© Copyright 1993 James N. Watkins

Related site: Dealing with death and grief



Leave a comment, tell a friend, send me money . . .

Email your comments to jim@jameswatkins.com.

And if this page was helpful, please . . .
    a) save it as a favorite at delicious.com
    b) subscribe to the RSS feed
    c) recommend it to digg.com and StumbleUpon.com and
    d) tell a friend:

Your name:
Your email:
Friend's name:
Friend's email:

And if this page was really helpful, please . . .
    e) please consider a donation to our sponsor XarisCom.

You can donate securely with any major credit card through PayPal. Thanks!

Legal stuff and warnings

Copyright © James Watkins. All text and graphics on my sites, unless otherwise noted, are copyrighted © in my name, James N. Watkins, and are protected by United States copyright law and international copyright law under the Berne Convention. Please visit the press room for information on reprinting any text or graphics. Thanks!

WARNING: Reader assumes full responsibility for the proper and prescribed use of this site. For external use only. Discontinue if rash, redness, irritation, or swelling develops. If swallowed, do not induce vomiting. Side-effects may include drowsiness or mild to severe agitation. Do not read while consuming alcohol or operating heavy machinery. Keep away from open flame. Do not store above 451 degrees. Do not use near or place in water. Void where prohibited, taxed or licensed. Any medical information provided is for general educational use only and should not be used as a substitute for professional medical advice. Views expressed are those of the author and do not necessarily represent those of any other person—real or fictitious, living or dead—using the name James N. Watkins.