On Death and Dying

Over 20 years ago, after graduating from medical school and becoming a physician, I chose not to go into clinical practice. It was an uncommon path compared to most of my peers. I had two major concerns at the time. One was whether I could be the kind of doctor patients could trust with their lives despite my physical limitations. The other was a fear, born from my own experiences of illness, that I might become numb to others’ pain. So, I temporarily veered away from clinical medicine.

After some trial and error, I came to the conclusion that if I were to live as a physician, facing patients was an inevitable rite of passage.

In 2013, I began my internship at the National Medical Center. This was followed by four years of surgical residency. During those years in operating rooms, hospital wards, and emergency departments, I witnessed countless deaths. Observing how patients approached the end of life taught me that every person carries a unique story. I came to enjoy listening to those stories. Being able to encounter lives I hadn’t lived, even vicariously, felt like a rare gift.

Around that time, I started this blog as a place to organize book reviews. Before long, I found myself wanting to someday document the one-of-a-kind life stories of ordinary people nearing death. That desire remains on my bucket list to this day.

So, it felt natural for memories of that time to resurface as I read On Death and Dying by Elisabeth Kübler-Ross, a book based on interviews with hundreds of terminally ill patients. I already knew its core message. In Korean medical schools, the Five Stages of Grief introduced in this book are often memorized under the acronym DABDA—Denial, Anger, Bargaining, Depression, Acceptance.

Although I’ve written many reflections on the topic of death, I had always felt uneasy about never having properly read On Death and Dying, the very foundation of modern thanatology. If I was to continue writing about death, I wanted to broaden my perspective by standing on the shoulders of giants. Just as with the other classics I’ve written about on this blog, I realized that this book holds much more than can be captured by the abbreviation DABDA. It’s like summarizing The Old Man and the Sea as simply a story about an old man catching a marlin only to return with its skeleton after sharks devour it—there’s much more beneath the surface.

While reading, I discovered three especially memorable insights I hadn’t known before.

First, the book is largely composed of interviews with terminally ill patients and their families. This made reading it quite difficult—not because it was emotionally overwhelming, but because understanding the complex psychology of terminal patients through translated text was a challenge. The author herself admits that the nuances of emotion visible in live interviews couldn’t be fully captured in writing. So I often paused mid-page, closed my eyes, and tried to imagine the actual atmosphere of these conversations and the tone of the speakers. It wasn’t easy, and there were times I considered giving up on the book. In the end, it took me quite a while to finish reading it.

Second, the stages of grief—Denial, Anger, Bargaining, Depression, and Acceptance—don’t always occur in that order. Sometimes they appear in a different sequence, or even simultaneously. Each terminally ill patient has a unique background: family dynamics, upbringing, religion, the process of diagnosis, and the medical staff they encounter. These factors influence patients in unpredictable ways. That’s why the author emphasizes listening to each patient with genuine attention.

Here’s a fascinating fact I discovered: after reading the book, I used AI tools to analyze the interview transcripts quantitatively. The terminally ill patients collectively spoke around 6,700 words—more than the 6,500 words spoken by the interviewers, including doctors and clergy. The author practiced what she preached. This made me reflect on how well I truly listen to the people I meet.

Lastly, there was one more surprising discovery: hope. Not as a sixth stage of grief, but as something that permeates the entire process. This isn’t poetic license. The author explicitly defines the period from Denial to death as the realm of hope in a visual chart. She writes, “All the patients we encountered never gave up hope, and we must remember that.”

On Death and Dying was first published in 1969. Over half a century has passed, and the world has changed dramatically. Medicine has also advanced. For instance, Hodgkin’s lymphoma, which many of the book’s patients had, now has a high cure rate if diagnosed early. In recent years, artificial intelligence has become integrated into everyday life, ushering in a fundamentally different era. Still, some things remain unchanged. Caring for patients continues to be a human role. Most experts agree that caregiving is one of the few professions AI cannot replace.

But is that really true?

Until recently, the consensus was that while AI might displace some jobs, it would be limited to repetitive tasks. Creative work was believed—hoped—to be beyond its reach. Yet now we’re seeing AI write more creatively than humans, draw, compose music, and even make films. People are growing increasingly reliant on these tools, much like how we follow navigation systems without questioning the route.

Still, many believe that empathy will remain uniquely human. But even that belief might soon be proven naïve. Already, many people use ChatGPT for everyday emotional support. AI is capturing hearts with empathy that rivals—if not exceeds—human understanding. The one domain we assumed AI could never conquer—empathy—might already be slipping from our grasp. As I read On Death and Dying, I couldn’t help but feel that it also illustrates the “death and dying” of the human role itself. I hope I’m wrong.

The true value of this book isn’t just in its theoretical contribution to medical history. The author’s sincere, attentive interviews with dying patients may be the book’s most important message. This isn’t a book to read once and shelve. It deserves to stay close, as a reference for life—both for the people I’ll meet, and for myself.