What "On Death and Dying" Taught Me About Meeting Mortality Quietly at 66

🎧 Listen to the Discussion(two hosts talk through their thoughts on this article)

This is an AI-generated audio overview of this article, created with Google NotebookLM. Two hosts discuss the article together, sharing their own thoughts and commentary — it is not a reading of the article text.

During the five years I spent at medical school, I came across the word "death" more times than I could count — in anatomy textbooks, in pathology reports, in mortality statistics. But it was always someone else's death, a case study, a number. Now, at 66, it has quietly stopped being someone else's business. I read Elisabeth Kübler-Ross's "On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and their Own Families," published in 1969 and famous for describing the psychological stages of the terminally ill — denial, anger, bargaining, depression, and acceptance. Reading it, I found it was less a textbook for professionals and more a letter to anyone on the receiving end of mortality — which is to say, all of us. Here is a personal record of what I actually started doing after reading it.

Not pushing death away, and not staring at it constantly either — just keeping it as a small, steady light. That is the feeling this illustration tries to hold.

Noticing the part of me that assumes I'm exempt

Early in the book, Kübler-Ross names a strange belief she found buried in the unconscious mind of nearly everyone she interviewed.

In our unconscious, we hold the basic conviction that death, for us, is simply impossible. — from "On Death and Dying," "On the Fear of Death"

Why does this belief take hold so easily? Kübler-Ross's answer is that the unconscious has never actually experienced its own death, so it has no material with which to picture it — much as it cannot distinguish a violent wish in a dream from an actual act. Reading this, I recognised myself in the mirror: the will I kept meaning to update, the asset list I kept putting off, not because I doubted the need but because some part of me quietly refused to believe it applied to me. Now I've set one day a year, around my birthday, to review my end-of-life notes and asset list. Not as a grim ritual, but as a way of doing, consciously, what the unconscious keeps avoiding.

Giving myself permission not to stare at death constantly

In the chapter on denial, Kübler-Ross quotes an old saying.

We cannot look at the sun all the time, nor can we look at death all the time. — from "On Death and Dying," "First Stage: Denial and Isolation"

She is careful to frame denial not as weakness but as a healthy defence — because trying to absorb devastating news all at once would break the mind rather than protect it. Just as the eyes need time to adjust to daylight, the mind needs time to adjust to a hard fact. When a health check turns up a number that worries me, I no longer try to resolve it that same day. Instead I make time to have my pulse and general condition read slowly at the acupuncture clinic. Looking at the same body through two different windows — a Western blood test and an Eastern reading of the pulse — keeps me from being swallowed whole by a single figure on a page. You cannot stare at the sun forever, and I have decided the same is true of death: it is allowed to be out of view sometimes.

Looking underneath the anger

In the chapter on anger, a patient referred to only as Dr. G. recalls a moment on a hospital corridor.

Why not me instead of that old man Jones … — from "On Death and Dying," "Second Stage: Anger"

Watching an elderly man shuffle down the street, a man who seemed, by his own harsh judgement, to contribute nothing to the world, Dr. G. found himself thinking: why him, and not me? Kübler-Ross reads this anger not simply as unfairness but as a response to losing control over one's own life. The book also describes a patient, Mr. O., a self-made businessman who raged at being reduced to a hospital bed — until the nursing staff let him choose the times for his own drip changes and bedmaking. His anger subsided almost immediately. The reason, I think, is that anger's root is the loss of control itself; hand back even a small piece of it, and the root is fed. As friends and acquaintances my own age face illness or death more often now, I notice a low-grade irritation in myself that has no obvious target. On those days I make a point of choosing something small I still can control — this week's planting schedule, tonight's dinner. I cannot control the whole of life, but I can control the next hour, and that alone seems to lower the temperature of the anger. Even without dialogue, I believe that simply knowing someone else is looking at the same view is connection enough.

Letting myself bargain, and putting it to use

The chapter on bargaining places two patients side by side. One is an opera singer whose jaw and face had been disfigured by cancer, ending her career on stage; when her wish to perform once more proved impossible, she asked instead to speak to a class of students about her life, and gave what amounted to an unforgettable performance anyway. The other is a mother who longed to see her elder son married. She struck what was, in effect, a bargain: let me live long enough to attend the wedding, and I will ask for nothing more. The day before the wedding she left hospital looking so well that no one would have guessed she was gravely ill. But when she returned, exhausted, before Kübler-Ross could even say "welcome back," she said:

Don't forget I have another son. — from "On Death and Dying," "Third Stage: Bargaining"

Kübler-Ross notes that not one patient ever actually kept the promise of "nothing more." One wish granted, and already the next one is forming. Bargaining, she writes, is a childlike attachment to reward for good behaviour, set against a self-imposed deadline. Why can no one resist it? I suspect it's because an absolute fate we cannot negotiate with is far harder to bear than one that leaves even a sliver of room to act. Reading this, I realised that my own decades of investing and estate planning follow the same emotional logic. Instead of asking God for a little more time, I have spent years quietly setting aside retirement savings so that a little more security would be there when I needed it. The one asking is different — God, or a future version of myself — but the shape of the deal is the same: I cannot hand over the thing I want right now, so I do this instead, on the understanding that it buys me a measure of time or peace of mind later. Once I saw it that way, I stopped feeling embarrassed about it and started treating it as simply human — better handled by quietly sorting out insurance and paperwork than by anxious hoarding. Most anxiety, I think, grows precisely because we don't clearly know where we actually stand; putting the bargain down on paper, in the form of an asset list or an insurance policy, replaces a vague dread with the concrete fact of what is already covered. Letting the bargaining instinct exist, and channelling it into action rather than denial, has been my practice here.

An illustration of the bargaining stage: an old pocket watch beside a desk calendar with one date circled — the quiet, unspoken deals a patient makes with fate or with God.

Telling two kinds of depression apart

Kübler-Ross divides depression in the terminally ill into two kinds: a reactive depression, rooted in losses already suffered — money, role, independence — and a preparatory depression, which readies a person for losses still to come. About the second kind, she is unusually firm.

One should never tell a patient not to be sad. — from "On Death and Dying," "Fourth Stage: Depression"

Why is cheering someone up the wrong move here? Because preparatory depression is not a symptom to be corrected but necessary work — the slow, deliberate acceptance of what Buddhism calls the suffering of parting from those we love. Being cheered up interrupts that work rather than helping it along. Younger, I thought the kind thing to say to someone grieving was, "It'll be fine." I think differently now: often the more useful thing is simply to sit beside the sadness and let it be sad, without trying to fix it. For me this is one of the small ways I can now hold suffering that I couldn't as a younger man — not rushing the ache of parting toward some tidy resolution, but letting it move at its own pace. As the years ahead bring more occasions to watch friends face illness or loss, knowing the difference between these two kinds of depression will change both what I say to them and how I treat my own low days.

What the rose garden teaches about acceptance

The chapter on acceptance tells the story of a 58-year-old patient, Mrs. W., who had quietly begun to accept her own death — until her husband, unable to accept it himself, pushed for further surgery, throwing her into acute distress. Only once he finally understood and honoured what she actually wanted, and the surgery was called off, did she settle again. Of acceptance itself, Kübler-Ross writes:

Acceptance is almost devoid of feeling. It is as if the pain had gone, the struggle is over, and there comes a time for "the final rest before the long journey," as one patient phrased it. — from "On Death and Dying," "Fifth Stage: Acceptance"

This is not, she is careful to note, a happy stage — it is the quiet that follows a struggle, reached only after passing through denial, anger, bargaining and grief. All of that feeling has, in a sense, already been spent. Every autumn I deadhead the roses in my garden — I grow more than ten varieties of English roses. Leave a spent bloom on the stem and the plant spends its energy setting seed, leaving less strength for next year's buds. Cut it away without regret, and the strength goes where it's needed. This is my own invented comparison, but it feels close to what Mrs. W. wanted in the end: letting go of what has already bloomed is not giving up — it is making room for what comes next.

An illustration of acceptance: a gloved hand deadheading one faded rose, with a young bud swelling behind it — cutting back not to weaken the plant, but to feed the next season.

Flowers still open behind barbed wire — living today while holding onto hope

In the chapter on hope, Kübler-Ross quotes a poem written in 1944 by a child held at the Terezín concentration camp, from which only around a hundred of the roughly fifteen thousand children imprisoned there ever emerged alive.

The barbed wire imprisons the blooming flowers too — yet they open. So I too shall never simply die. — from "On Death and Dying," "Hope"

What holds every terminally ill patient together, she writes, is not denial or anger or bargaining themselves, but the hope that keeps reshaping itself underneath them. Why does hope alone never quite vanish? Because hope, unlike a cure, doesn't need to be won all at once — it can live in units as small as hearing a bird outside the window, or exchanging one more sentence with someone you love. A long healthy life may have less to do with adding years on a chart than with keeping one small piece of hope available each day. This book gives no clean answer to what life is, what happiness is, or what any of us was put here for. But what Mr. W. finally learned was that goodness is not holding someone in the shape you wish for them, but listening to what they actually want. There is probably no escape from the grief of parting from those we love. What I can do is let the sadness move through instead of damming it, turn the urge to bargain into action, notice the craving for control underneath my anger, let go of what has already bloomed without regret so the next season has room to grow, and keep tending the small, flower-sized hopes that open even behind barbed wire. That, more than any answer to where life comes from or where it goes, is my own practice for living today — with some real enjoyment, and a little wonder — even without knowing the destination. Now that I notice memory and focus slipping a little more than they used to, the act of writing this down before I forget it has itself become one form of hope.

The book discussed here:

Elisabeth Kübler-Ross, "On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and their Own Families"

(As an Amazon Associate I earn from qualifying purchases.)

---

The world Elisabeth Kübler-Ross lived in

An illustration of the Swiss countryside near Zurich where Elisabeth Kübler-Ross was born — one of triplets, dangerously underweight at birth. No one in this quiet valley could have known she would spend her life at the bedsides of the dying.

Elisabeth Kübler-Ross (1926–2004) was born in Zurich, Switzerland, one of a set of triplets weighing barely 900 grams each; doctors gave the three sisters little chance of survival. Raised in a devout Catholic household, she faced her father's firm opposition to medical school, but funded her own studies and graduated from the University of Zurich medical school in 1957, at 31. She married Manny Ross, an American student she had met in medical school, and emigrated with him to the United States in 1958. Training in New York, she was struck by how carelessly dying patients were treated — left to face death alone, rarely spoken to honestly about what was happening to them. As a lecturer in psychiatry at the University of Chicago's Billings Hospital, she began an unconventional seminar in which medical students interviewed terminally ill patients directly, in their own words. That seminar became the foundation of this book, published in 1969.

Part of her outlook, it is said, traces back to an earlier experience. Before moving to the United States, she visited the former Majdanek concentration camp in Poland, where she found the barracks walls scratched with countless butterflies — carved by children who knew they would soon be sent to the gas chambers. Why butterflies, and not something darker? That question is thought to have planted the seed of the work she would spend her life on: listening closely to what is actually happening inside someone who is dying. In the same late-1960s period as this book, in Britain, Dr. Cicely Saunders was founding the modern hospice movement, built around pain relief and the preservation of a patient's dignity, and opened St Christopher's Hospice in London in 1967. That the same question — how do we actually accompany someone who is dying? — rose to the surface of medicine on both sides of the Atlantic at nearly the same moment feels less like coincidence than a measure of how thoroughly medicine had been looking away from death until then.

Her later years, I think, do not undercut this book so much as deepen its humanity. In 1995 she suffered a stroke that left her partially paralysed and largely confined to bed for the rest of her life. By several accounts, she did not move smoothly into the acceptance she had spent decades describing in others; she is said to have shown frustration and confusion of her own. That the woman who mapped these stages had to walk back through denial and anger when facing her own death does not weaken the book — if anything, it is proof, offered by the author's own body, that the five stages were never meant to be a tidy staircase, but a real and uneven road that everyone, including their own author, walks unevenly. She died in August 2004 at her home in Scottsdale, Arizona, at 78, with her family at her side.