The Five Stages of Death

Have you ever wondered what it would be like to know that you were dying? Would you want to know that the end is coming? When asked, so many of us say, "I'd like to know.There's so many things I want and need to do, so many details to take care of." In a way, it would be great to know. It would give you the chance to clear up unfinished business, find ways to make sure your loved ones would be taken care of and to let them know how much you love them. However, have you really thought about it? Have you thought about how you would really feel, how you would handle it?

Many studies have been done about the feelings a terminally ill patient goes through. Probably the most well-known of these might be from Elizabeth Kubler-Ross' book, "On Death and Dying." In it, she identified five stages that a dying patient experiences: Denial, Anger, Bargaining, Depression, and Acceptance.

When terminally ill is mentioned, most people think of elderly people, but due to the many kinds of illnesses and diseases, a person can be diagnosed as terminal at any age. No matter what age, the patient generally goes through the five stages. As a hospice nurse, I have witnessed varying degrees of these stages in my patients. Following are a few of the reactions I have seen my patients experience:

Denial: "I'm not ready to die" "This can't be true" "I can't be dying" "The doctor made a mistake" "I'm not going to die" "The test are wrong" "The doctor doesn't know for sure" "This can't be happening"

Anger: The anger sets in when you realize that you have no control over dying - it's going to happen. My patients have felt helpless which increases their anger. They take it out on the doctors, nurses and especially loved ones. This, in turn, increases their anger at themselves because they know it is not anyone's fault, but they have to strike out at someone.

Bargaining: Many times I have heard my patients trying to make a deal with God to buy a little more time to: see my grandchild born, watch my son graduate, see my daughter get married, be with my loved ones.

Depression: This sets in when you finally realize that no matter what you do, you are going to die. You start to feel sorry for yourself, sorry for leaving your loved ones alone, sorry for all the things you did or didn't do, sorry for what you are putting everyone through, and sorry that you can no longer enjoy the life you once had.

Acceptance: With any luck, everyone will reach the final stage when you have finally accepted that you have made peace with everyone and everything around you and you are ready to go. Sometimes, this stage comes well before the end and allows you to live out your final days in peace. Sometimes, this stage comes only minutes before the end. I have had patients that have fought a hard battle to live through it all, then tell their family, "It's alright, I'm ready to go now", close their eyes and are gone.