Elisabeth Kubler-Ross, who wrote extensively on death and dying, described the five stages of grief: denial, anger, bargaining, depression, and acceptance. In fact, these stages are common among people confronting all sorts of life challenges, from a romantic breakup to a wrenching job loss.
The stages may not progress in order
Those who work with the dying say that most people experience these stages, but they don't make a smooth transition from one stage to another. Instead, most move, in no particular order, from one stage to another and back again over the course of their illness -- and even over the course of a single hour or day. When talking to a loved one about his death, it's a good idea to take these stages into account -- not as a rigid formula, but as a guide to understanding his behavior.
Let him come to accept death in his own way
Your loved one may seem to accept his terminal diagnosis and be planning accordingly. Then one day when you visit him, you find that he's booking hotel rooms for a trip to Italy next summer, even though he has only two months to live. In such cases, it's not advisable to challenge his denial: "Oh, Dad, don't be ridiculous. You heard what Dr. Thompson said!" But neither should you go along with it: "Gee, Dad, that sounds great! Which cities do you plan to visit?" Instead, acknowledge the feelings behind his words. "I know you've always wanted to visit Italy" or "Wouldn't a trip like that be fabulous!" Your loved one is simply coming to terms with his death in his own way, and, unless he's genuinely delusional, will likely quietly give up his travel plans as the reality of his circumstances sinks in.
Try not to take anger personally, and reassure him that he's not alone
You might find that your loved one expresses anger -- at his doctor for not curing his illness, at the nurses in the nursing home for not taking good care of him, at you for simply being in the vicinity. Again, it's most helpful not to argue with your parent -- or to humor him, either. Simply acknowledge his feelings: "I'm sorry you feel that way."
Some people die without ever moving out of the denial stage, refusing to acknowledge death until it's upon them. Others live out their last days in anger, bitterly railing against the miserable fate they've been dealt. Still others sink into a deep depression that makes it difficult to be around them. If your loved one fits any of these descriptions, it's still worth trying to talk to him about his approaching death, even if he's unreceptive, if only to let him know how you feel about him before he's gone.
Dying can be a lonely process. Visits and calls from friends and relatives often begin to taper off as death approaches, more often out of sadness or concern about intruding than indifference, but for the dying person, the result can be the same. Reassure him that you'll be a solid source of support throughout the process, and stick to this commitment. This doesn't mean that you must quit your job or forsake your family. You have a life, and you need to take care of yourself; your siblings or family friends may be able to help, too. At the same time, try to be a consistent, reliable presence in your loved one's life. Be sure to show up when you say you will, and stick around for the tedious moments, as well as the transformative.
I had a client who just passed. One day they asked me, how the nurse knew they were dying. The nurse had said about two weeks. Being the first time to talk with someone about death I wasn't sure what to say. I told them that based on all the medical conditions they had is how the nurse came up with 2 weeks. That their body was tired and all these conditions were causing their organs to work harder. And that they would soon give out, and they would pass on. I would of liked to said I felt the nurse had made a mistake, but I felt she was right. I told my client that the nurse had based it on what she knew about our bodies. After reading this I feel I said what was right. Thanks...
The very advanced alzheimer patient is UNABLE to converse, likewise to understand so the whole section on "talking when it is time to die" cannot apply. Hence my not finding it helpfull.
Thank you for sharing this information with me I find it very helpful.
My mom passed away in February 2010 after over a decade with Alzheimer's. Mom understood early what was happening to her and how it was going to end. She was more worried about us taking care of her in the advanced stages than she was about death. We talked about many issues openly, but it is not easy. I wanted to know what she wanted us to do before she was too sick to tell us. One of the most difficult issues was what decisions to make when she approached the end of life. We got the legal documents in place so we could carry out her wishes, but I am so glad we talked about it 10 years earlier. When mom quit eating and began a rapid decline, the nursing home called to inform me that they were calling an ambulance to take her to hospital for a feeding tube. Over a decade earlier mom told me that we were to let her go when she reached the point of a feeding tube. It was very hard to tell the nursing home not to take her to the hospital, but I was somewhat corforted knowing that I was carrying out her wishes. Talk about the tuff stuff and know how to make the decisions for your loved one when they cannot make them for themselves. Obviously, you need legal documents too, but TALK.
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This article captures so many insights into ways to start what can be a challenging conversation. Another tool that may be considered especially when focusing on advance care planning are "Go Wish" cards. The values card game is an easy way to facilitate conversations with friends and family about what it means to "live well" at the end of your life.
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thank you it sure help me a lot,because now i have my aunt and my twinsister the need alot of prayers.unfortunate there are in switzerland.i can call them,but it is not the same when i could be there with them and hold there hands and pray for there comfort.
Everyone dealing with a death and dying issue (which is all of us at some point!), should read this article. I wish medical professionals would read it as well. My background is emergency medicine and there is a LOT of denial about death in that specialty, which often results in expensive, painful procedures that should not have been done. In addition to this article, there is another resource I think would be very helpful for people as they deal with a family member or friend's death. Two books written by Maggie Callanan - the first is "Final Gifts" (also written by Patricia Kelly) and "Final Journey's". Both books are easy reads and filled with information about the dying process. They include many personal stories and examples of what to say and do in this difficult situation. Both books are wonderful resources - packed with years of wisdom. Thanks for a great article.
Clear step by step guidance and information
She also was given MORPHINE , and she never had pain... She was gave this for about 10 days .
I lost my Mom Oct 26 2010 , she went for regular check ups to her Doctor - she kept sleeping a lot and I kept begging for her to go to the ER to get better care , so finally 8 months of sleeping a whole lot, I really beg and finally talked my sister into getting her to the ER, which she didn't want to . Got her to the ER and my sister took her to the restroom and Mom fell to the floor, she was weak .. so we had to have help to get her up and the nurse had took her on back to be check. Once we got back there and the Doctor checked her, he wanted to check her heart , so they did a scan , he said they can not find out what the problem is . They finally had a room for her to be admitted - the next day they ran all kinds of test on her. she had fluid on her lungs - the next day the heart Doctor came in and said her right side of heart has harden and isn't working , so on the forth day , they decide to take her into palliative care with hospice care - which she was not in pain ... she smothered and they drained fluid from her lung. She did so much better after that, then my sister was watching her expressions while Mom was sleeping and he said I think she is in pain, I said no she isn't , Mom said she wasn't having pain , Mom would set and talk all the time in her right mind ( she was 75 ). Well my sister had them to put her on pain medication I got up set , then in a few days they started giving her morphine and Haldol , I was really up set - she took this for over a week, then they gave her steroids injection - I said why are you all doing this, I knew it was to shut her down - I got so sick - to watch my Mom go through this - it was a bad death for her, she was done the way she said she would be done if she went to the hospital, she said they are killing the older people off . I had 3 sister that went against me and they kept giving her medicine - this is a hard thing for me to face in my daily life , the haldol started working and shutting her mind down , the steroids made her so nervouse - she started jerking and shaking , it was awful. Now that she past away , it is so hard for me to talk to the sister, I can not accept them as close as I once did. So, if you are getting ready to face to lose to lose a love one , please take the time to talk them about how to handle their wishes . Mom did talk to me about it, but not in front of other family members. Living Will , everyone needs one. The rest of my life , will be distance with going on as a sister . Can't feel the same again. I wish them a good life ... but my present to them they won't have me as the original Love I once had as a sister love. I was very close to my Mom and to see that medicine shut her down was awful. She was strong minder in her right sense , she had fluid on her lungs that caused her smothering . I believe in letting God take them not man.
In a paradoxical way it was helpful to me. My family who lives in Queensland and I live in Victoria Australia, are far from being my potential carers by their choice. As the previously close relationship with my daughter deteriorated I relieved her from her culturally expected obligation she would comply with when I needed her and won't deny she would be motivated by love how ever in my "loving weakness" I sent her back home to be with her husband they missed each other the relative short period my impending heart surgery she traveled down here to look after me. The surgery been postponed for possibly one or two weeks as more urgent cases needed life saving intervention. I thanked her but said no need to stay and wait she was willing to do, but overhearing their telephone conversation and the winging of her husband missing her and while highly intelligent he did not have an educated heart to discipline himself to tolerate the nuisance of her attending to my needs. So I paid for the second air tickets when she came again a week later. I relieved her as things deteriorated from all the chores expected arou8nd me and or the funeral issues if there was one. She became the meat in the sandwich between me and her husband who newer liked me yet I acted caringly, lovingly towards him and who tolerated my visits and grudgingly accepted me being put up in his office to sleep. I tried to minimize their conflict. The article could be helpful possibly if I sent it to them. But I don't bank on that.- A mixture of mental health and some character issues surfaced with my daughter that concerned me but her sudden decision to escape that she agreed we seek help to repair our conflict gravely concerns me still and saddens as well. The psychogenic impact on my blood pressure is hastening my demise that I try to slow down and fight as I wanted to live as long as I can doing my life's dominant motivating activity: helping others of course including them. This attempt on my part is severely curtailed by them it appears my daughter's self talk and it appears wants nothing to do with me but never ever told me what are her objections no matter how many times I asked, there are some unfinished business between us she is reluctant to face that is essential to do,- her fatally hurt pride and her mother's attitude adds to the mix. I wrote to the mother I want to tie up loose ends I can die any minute but try not to, how ever my health status started to show deterioration the urgency to repair our relationship prompted me to do she replied that I am lying about my condition, also trying to manipulate them to what I wanted (to repair the conflict she did not seem necessary {!} And that the problem is only me, and I need to get help for myself! Is there anybody out there who could characterize that attitude as decent, caring, loving? Am I missing something? She said she has no problems with me and that it is most further from my daughter to want me out of her life...! I would really welcome some responses educating me about what am I doing or not doing is wrong. Loving is often not easy. Sometimes confused with indulging someone. I won't be harping on the unfairness the ingratitude, the passive aggression, the delusions, lack of courage and self deceptions, the Narcissism. Incredible to me still... If I said that I have a good track record with caring and loving, not expecting a song and dance praising me but neither this punitive rejection she would say again that I only want to justify myself to her.- A psychologist on his show said about similar conflict: "not a single good deed should remain unpunished!" The paradox is I am punished most by not allowed to help as before which was considerable, for not being able protecting my daughter from external and internal negative influences as before that were real.
we went to our local funeral home after seeing how the corp. funeral homes want to sell-sell-sell. Our Local funeral director spent over 3 hrs with my mother and us 4 children going over the mounds of papers and trying to arrange the funeral ma wanted . they were 1/2 the fees of the corp. funeral home.we pre-paid everything flowers, funeral and headstone inscription. it was a relief for all of us.
it gives an outline of what to do
tips and encouragement in understanding the issue
My 93 year old Dad passed away about a month ago, and I never could have discussed death with him! He knew he was dying, mentioned it just once, and never brought it up again, nor did I ever say anything about it to him. Had he said more about it, then I would calmed him down and explained I would be there for him until the very end and that I loved him dearly. Now my mom is doing worse as her dementia has worse symptoms but I can't discuss death with her either...she is so out of it anyway...and wouldn't understand. When she needs hospice I will make all the arrangements to get it for her.
My father has ESRD, is on dialysis 3x a week had chf and is eating less, less responsive and sleeping most the time. he does not want dialysis, but his curent wife who is power of attorney and is having medical problems herslef is forcing him to go to =dialysis and thinks he will get well again. He is at total max assist and can not walk. He was just rushed to emergency on monday with severe UTI that make him unresponsive. I am durable power of attorney if my step mother can not perform duties or chooses not to perform duties. However, she is delegating her authority to her duaghter who is a great person but is not a power of attorney or in AHCD or will. He is being robbed of his dignity and would not want to live this way. I can not bring up end of life issues with his wife or she cuts me off from getting information from rehab or hosipital since i live in san diego and he is in delaware. I am now in Delaware indefinately to make sure my dad has proper care. One other issue is they put my dad's name on the title of my step sister's home so she could refinance because she needed his income and my step mom;s\'s income to qualify for a refinance after she got divorcced. So money is an issue. I feel they will keep him on dialysis until the day he dies so they can collect the 3K a month from his pension. what can i do? My stepmother clearly is not physically able to take care of him, but is mentally competent to make decisions. they just are not what my father would have wanted. Help
My problem is that my husband and adult kids just don't want to talk about the prognosis for my COPD. I NEED to talk 'end of life' issues and they prefer to pretend that the problem is going to go away. I'd love to have them showing enough caring to spend some of this 'closer to the end' time with me, doing things within my ability as a family group. They are like ostriches with their heads stuck in the sand. So...I've made my will, organised my thoughts around a funeral, told my doctor and minister about my feelings around when to say 'enough'. So sad doing this alone.
This can be one of the hardest conversations you ever have. We've found in dealing with our families that it's best to approach the topic from a proactive angle, so that your loved one can find peace with his or her end-of-life arrangements without feeling that they're too immediate. It's best to pre-plan these services so that when the time comes, the family can make sure their loved ones are remembered exactly how they'd like to be remembered. We posted a few tips on finding bereavement resources, which can be a good way to start that conversation.
Good information but under the heading "Your parents Advance Directives" you refer to a link called 5 wishes for a comprehensive and simple advance directive that's good in 40 states. I can't seem to find that link. Am I missing it?
Great information. However, book form Kuler-Ross is outdated, (1997) and she is off base on the stages of grief. A great "free" site for daily encouragement for anyone in grief is "www.griefshare.org". Grief is the hardest work you will ever do, and you must be surrounded by people who love and care about you.