Until I Die (1970)

diagnosis at that time i knew the condition was terminal he wasn't supposed to survive for more than 10 days 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 elizabeth 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 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 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 me and to thee but not to me many people are afraid of highways if i'm afraid to use the dalaran 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 it's 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 stolen car there and the police go 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 thee and to me 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 death 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 worst it is 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 not help to die but help to live a human dignified life until they died that is very hard to do in modern hospitals [Music] many times when a person 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 force what we are not teaching and that's not only true for physicians but nursing staff social worker hospital chaplains is that these people have their own very specific needs and most of them don't want to be 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 okay again to talk about next spring 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 is not so horrifying and frightening as our fantasies if we can help them sit and listen to dying 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 eternally 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 stages the patient does when a patient is told that he has a serious illness he first reacts with shock denial no not me we have seen patients maintaining their nile for months and months towards their family and to their physician and then we came in and asked them how sick are you conveying to them that we don't need denial 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 in the open 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 problems sometimes hearings 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 peppy the 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 rub in what this patient is in the process of losing you make him aware that yes two weeks ago i would walk around quick and peppy 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 patient 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 is beginning to knowledge yes me but he adds a little word to it but and the part really means maybe if i'm a good patient or a good christian 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 you don't want to think about it where you feel that you have a certain time and the patient kind of recuperates to mobilize new energies for the final stages when the bargaining time is up and he says yes me but when he drops the butt then he begins to really face yes it's me and the patients then become depressed they regard grief and depression in this period of time of a patient's life is very very normal what do we do when we come into a patient's home 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 who has the courage to face not only that he's losing one loved one but everybody he has ever laughed and everything he has ever left he has to separate himself from is a very sad state of affair 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 to being at home with the family which includes maybe an organ maybe a breast 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 then 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 words 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 is not allowed to grieve search of acceptance is not resignation resignation is kind of a bitter giving up a defeat what's the use acceptance is not the 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 in 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 hardest to reach this stage when we are dealing with the death of a child very very small children naturally have absolutely no concept of death they're only concerned about separation and you try to have the parents and if not both parents at least they're mothering with the children so that they're not alone later on when they are about three four five years old they begin to be very concerned about their body their body image everything has to be intact and so their biggest concern perhaps is at that time surgery or surgical procedures or doing anything that injures 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 and question is 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 leukemia and she went to the doctor and said what is it like when i'm going to die and they 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 and if you don't take your medicine and you talk like this you're a bad girl and you're not going to get well which is a very punitive way of dealing with it and then she asked the hospital chaplain the same question and he looked at her and he said what do you think it's going to be live which is a beautiful answer because it 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 looks at him like the only little girl and looked 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 you use their language and in this way i think you can help them the most in canton in zurich in the hospital they studied drawings of eternally old children with inner brain tumors and one boy drew a picture of a huge huge cannon and in front of the 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 a thing about it the tiny little boy was a stop sign standing in front of the huge studious 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 thrown 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 tin 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 death is something you can't experiment with you can't experience so we in a hospital who have to face death all the time and learn 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 teachers how long have you been helped about the brief period prior to that very briefly in fact i didn't uh wasn't even aware the fact that it was this ill until i collapsed on the street yeah what means this cell how [Music] well on top of uh the malignant growth or uh you have a malignant colon i haven't lived on the right line on the right and you didn't know that until the beginning i knew this i was aware of this but uh i didn't know what else was wrong until i collapsed on the street my legs gave away and i just fell we never ever had to tell a patient that he had a serious illness and he would never even dream of telling a patient he's dying anyway but you can talk about dying all our patients have told us that they were eternally ill near their death and this is irrelevant of the fact that they had been told or not told and this was the basic cause of the paralysis from the hip down how did you take it how were you told that you had the malignancy oh i was aware of the malignancy you were suspected as much how how do people know instinct i don't know i just felt instinctively that this was the case and something bad the other thing that patients always share with us is they would have liked to be told that it's serious but they don't like to be told there's nothing else that can be done if they are told that it's serious they would like to be told with a glimpse of hope even surgery couldn't have done it any good couldn't have helped yes but then he gave me uh some out by uh telling me that uh cobalt radiation would uh could control it if it was affected with me how has your morale been since january oh fine what are you gonna do i mean you can't go crawl in the corner and beat your head against the wall and cry and pull your hair out i wish to be like you one day if i would have something like that well i can't think of any other attitude yeah i wouldn't know how else to approach it you who may test played at all mr uh atkins oh yes he's been a terrific companion he's with me constantly he went home for 24 hours and i thought i was lost i hadn't talking to myself in fact my fingers over and over again yeah he's been quite a terrific companion isn't that beautiful certainly it's lovely to watch what would you say in the world yeah i think mr atkins has a similar illness without uh i think that's pretty much what brought us together uh singing for each other knowing that we're both had terminal cases and does a shot of whiskey help once in a while yes i wish i could get them more often that'll be taken care of thank you that's interesting i didn't tell him what the biopsy results were i came and told him that we had the biopsy result we were transferring him to our word for treatment as he was he told me i said malignant yeah and he said yes i mean he wasn't actually what he said well he said it wasn't benign wasn't it [Music] so he helped you really talk about it well i have since learned that many uh residents are interns now i understand too much doctors try to face away from the subject or to a discussion of the subject really cool do you know why yes i don't understand it's frightening for them you see as a position you're trained to cure them to treat and it's very hard sometimes to face when you can't kill somebody anymore when dr levine suggested to take biopsy certainly go ahead because i felt extremely secure in his hands still do now that shows how important it is to have confidence in your doctor emotionally terrific terrific there are many interns and many residents that uh still don't see this value they don't know no it's very hard to teach them you said that you knew quite a while that you were returning or patient yes what does dying mean to you i know the same i mean everyone has to do it do you have a special image about it is it just end no just so it isn't a miserable and uh yeah i told dr levine i wouldn't want to lay in agony for a long period of time yeah is there anything afterwards nothing that i fear nothing nothing that you look forward to either no thank you was it not too long to handle oh no [Music] careless character to begin with and i hope that some of the things will help perhaps with relieving if i hear you right it's a little bit of risky good companionship but not to be alone i think you're a strong underwise man good luck to you before we go into details what was your gut reaction to this man do you remember what we talked about last time what i mean by gut reaction how do you feel towards this patient here not up here i feel great admiration you admire him what else what the hell i thought he was too accepting of it i was suspicious you were suspicious of him i felt that he was using lovely words to conceal his real feelings with [Music] he was disguising it was kind of denial denial i want as many as possible and i'll tell you afterwards why that's up here that's an interpretation of a diagnosis how do you feel here it's very hard but you have to learn to do that because it's what you feel here that the patient picks up and that eventually helps in a relationship but it doesn't help you what the hell i think before he spoke i felt very disturbed i wanted to cry but after hearing him i felt strengthened myself and he felt resignation i picked that up from him who else had the government i felt like i wanted i wanted to get close to him and he wouldn't let me like they were saying i was talking i couldn't how did that make you feel it sort of made me angry he himself said it was a defense mechanism and i think he showed great fortitude in facing his situation the way his way in one word you see the reason why i asked all this is that you admired him you end with him you picked him you were sad with him um oh the whole range of katri was the different people here what we tried to learn though from them is what he was willing to share with us it's not that you know everything but that you're comfortable sometimes to say i don't know so you're willing to listen to your patients and if you are assigned to such a man and if you don't learn what your gut reaction is to a patient what this patient does to me you'll never quite know why you don't take it off right and it's a great art to elicit not only the patient's needs but your own needs to end your own feelings because those two not up here but those two gut reactions will eventually result in either a very meaningful relationship or not a minimum relationship about a year ago we had a 35 year old black single girl who came to her hospital with the hope of getting treatment here she was diagnosed having serious kidney disease there are two programs here for indigent people both of them turned her down and she came back to her hospital knowing that she had a short time to live and that made it even more difficult because we knew that in our society we have means and ways of prolonging her life that she couldn't afford it the staff then who could not accept this they regarded her as a beautiful person and they could not accept that this young woman had to die she came to her seminar and at the end she very calmly you know i know i'm going to die very soon when i die it's just like going to be transplanted from this garden to the next garden and i think my gut reaction at that time was that easy and she looked at me and she said no it's not that easy there is something that bothers me that i can't put my finger on it and she couldn't do it nothing partially perhaps because there was a teaching seminar so a few days later and i had a strong urge to see her and when i went to visit her she had the same urgent needs did what we call to finish unfinished business so we sat together like two children searching in the dark for something we had lost but not quite knowing what it was and all she could say is i'm bad and bad and bad and we searched together and finally she was able to say you know i've been calling god for help when seemed so bad but i didn't call him when things were all right what you say to that doctor was and i told her that children do this all the time when they hurt they go to mother and when they're okay they go their own merry way and she looked with a happy peaceful smile and she said you know what you're saying is that this is human and i noticed my head and she was lying back in her pillows very peacefully and then she did something that no other patient ever did before or wrapped with she looked at me and she said what is your concept of death doctor and i looked at her surprise and then it dawned on me you know we always think it shall happen to me and to be but not to me and then i caught my breath and i looked at her face with this beautiful face and i said peace and i really meant it and she looked back at me with this beautiful smile and she said i'm going very peacefully now from this garden to the next garden [Music] [Music] [Music] [Music] you