Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
More than two decades ago, University of Chicago psychiatrist Elisabeth Kübler-Ross, MD, identified various stages that people who are dying may experience. Their families quite often experience the same emotions. The stages do not necessarily progress in the order listed. Furthermore, the dying person, and those who love him or her, may go back and forth among some or all of these stages. Knowledge of these stages may help us understand the dying person's reactions—and our own.
Denial: It is almost impossible to believe that our own or a loved one's illness will result in death. We call for a second opinion (generally a good idea) in the hope that a mistake has been made. Sometimes the denial is not of the illness but of its lethality ("maybe everybody else, but not me!").
Anger: Once past denial, anger often sets in. The anger may be specific or diffuse: anger at the doctor for making the diagnosis or not making it soon enough; anger at a spouse for "arguing so much that I just had to smoke, and now look, I have lung cancer, and it's your fault"; anger for not taking better care of oneself; anger at healthy people because "they'll see many more sunsets and spring days and Christmas Eves, and I won't"; and, especially if the individual has tried to lead a "good life," anger at God for "not keeping His part of the bargain." The ill person, or his or her family, eventually may decide that anger accomplishes nothing, and the anger may fade.
Bargaining: Promises are frequently made to others, in the hope that giving voice to them guarantees their fulfillment. The promise might be to be here for a bar mitzvah, the birth of a grandchild, or the graduation of a daughter from medical school. An attempt often is made to strike a bargain with the One who
is thought to have ultimate control over life and death. We tell God that "I
will change my life, or give to mission work, or reach out to try and help
people more." Sometimes, the bargain is for a reprieve—for life free of disease.
Other times, it is a limited bargain: "Please just give me enough time to..."
Depression: When it becomes clear that bargaining will not change the inevitable, depression may set in. Two types of depression may be experienced. The first is over things we used to do that can no longer be accomplished: dancing, duck hunting, lifting the kids onto our shoulders, and making love. This is the pain of what used to be but will not be again. The other face of depression is over things that never will be—for
us: family Christmas dinners, vacations at the beach, knowing the kind of
person a child or grandchild will become. All these things will happen but without us.
Acceptance: The stage of acceptance may be reached at some point before death. Acceptance is not a happy time or a sad time. It just is.
Anticipatory grief: The family of a terminally ill person often experiences anticipatory grief. As its name implies, this is a grief reaction that occurs in anticipation of an impending loss and is the process by which family and friends come to terms with the potential loss of someone significant. Anticipatory grief has many dimensions, including anger, guilt, anxiety, irritability, sadness, feelings of loss, and a decreased ability to perform usual tasks. The most effective response to anticipatory grief is to acknowledge it openly and to talk about it.
As these stages come and go, there is, for most people—irrespective of religious beliefs or absence of same—a search to fulfill a universal need: to find meaning in life.
