By Grant Pick
A generation has passed since the hospice movement surfaced in the United States and Elisabeth Kubler-Ross did her pioneering work on the psychic process of dying. Perhaps our society is finally coming to terms with death. As the baby boomers age, discussion has increased–about the needless prolonging of life through technology, doctors’ improved ability to relieve pain, and the dignified deaths of public figures such as Jacqueline Onassis and Joseph Cardinal Bernardin.
As a decorated army captain and field physician in Vietnam, Bone came up square against the horrors of war. “In Vietnam MASH units there were no clean shots,” he said. “You’d always see triple amputees–two legs and one arm gone, or one arm and two legs. It was pure mutilation. I learned that I hated war, but I also learned about medicine.” It was in Vietnam that he became fascinated with septic shock, the potentially fatal outgrowth of sepsis, the release of bacteria into the bloodstream.
“With my patients I was a good, compassionate physician,” Bone said of himself. “But to a limit. We would make grand rounds, and there I was, the chief doctor, the leader of the team, like [fabled Texas heart surgeon] Michael DeBakey. DeBakey might know each chest–and the physical problems it posed–but he wouldn’t necessarily know each person, and so it was with me. I’d lay out a patient’s treatment plan for the day and then leave the particulars to my interns and residents.”
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That Christmas Day he fell while unpacking books, and blood turned up in his urine. Days later, during a long meeting on campus, he experienced riveting back pain, and when he went to the bathroom his discharge now consisted only of blood and blood clots. An exam revealed a cancerous tumor the size of an orange in his right kidney. A surgeon removed the kidney and an adjoining adrenal gland, and Bone felt the problem had been solved. “I went back to work within a week,” he says. “I thought to myself, I’m cured. I had hoped the tumor had been totally resected. The initial scans were negative. You might as well be an optimist.”
The emotional process of dying is a pathway charted by Kubler-Ross in the late 1960s. For four years the Swiss-trained Kubler-Ross interviewed terminally ill patients at the University of Chicago’s Billings Hospital. Her On Death and Dying, published in 1969, defined dying’s five stages: denial and isolation; rage, envy, and resentment; bargaining, largely with one’s Maker; depression; and finally acceptance, albeit tired and unfeeling. Though Kubler-Ross wrote that the stages “will last for different periods of time and will replace each other or exist at times side by side,” the general impression remains that the phases are to be passed through in sequence.
