, Professor of Medicine, New York University School of Medicine, New York, NY
Arthur W. Feinberg, MD
One of the special extras of a long career in medicine is the opportunity to see major changes in the way we view certain illnesses and certain attitudes. Who, for example, would have thought that peptic ulcer disease was caused by a bacterium and not by the stress and strain of daily life? Who could have envisioned the development of the science of genetics, sparked by the discovery of the double-helical structure of DNA? And none of us could have foreseen the changes in our attitudes toward those who were soon to die.
As a medical student and young house officer, I was taught that dying patients were not to be reminded of their approaching fate but, instead, were to be lied to in order to maintain hope. The lies we manufactured were ingenious, though difficult to remember. We were sure that dying patients did not wish to face the truth about their illnesses. And so we built a wall of silence with the cooperation of families, doctors, and nurses, and?we thought?the patients themselves.
All this started to change in the 1950s and 1960s, predominantly thanks to the actions of Dr Elizabeth K?bler-Ross, a psychiatrist who was born in Switzerland and came to the United States after World War II. Working at the University of Chicago, she noted that terminally ill patients were sent to a special ward where they were segregated and isolated. She started talking to these ill people and was amazed to discover that they desperately wanted to talk and, if anything, felt estranged from their families, who refused to discuss the approaching death.
Dr K?bler-Ross embarked on extensive interviews with these people, and her work was discussed in Life magazine. She was swamped with requests for lectures, and her approach to the dying patient was discussed throughout the country and the world. Her book, On Death and Dying, is still in print some 40 years later. It was in that book that she wrote of the five stages terminally ill patients often went through?denial, anger, bargaining, depression, and, finally, acceptance.
The attitudes about medicine in this country and throughout the world have changed. The growth of the hospice movement, the development of palliative care programs in many hospitals, and, above all, the dialogue between a concerned physician and a needy patient were all fostered and strengthened by the work of Dr K?bler-Ross.
In more recent years she became increasingly intrigued by death, and especially by the possibility of life after death. This tended to lessen her reputation in medical circles, but she persisted in studying this subject. Dr K?bler-Ross died in August 2004, at the age of 78. Her life is a wonderful example of the power a single individual has to turn things around. She had an idea, pursued it, and never gave up. For this, thousands of patients and medicine at large are in her debt.