<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2004-02_14/kubler-ross.jpg" hspace="4" vspace="4" /> "Depression, anger, existential questions--"why me?"--and finally, acceptance," is how Army Lt. Col. Alfredo Montalvo, a psychiatric clinical nurse at Brooke Army Hospital, Fort Sam Houston, Texas, describes the emotions of soldiers who have undergone recent amputations. "It isn't that smooth. Sometimes they may jump back to anger, depression. There's good days; there's bad days." When I saw this interview last December on The News Hour, I was intrigued that Lt. Col. Montalvo chose the words he did because they come from Dr. Kubler-Ross's study, On Death and Dying. I believe Kubler-Ross's approach is extremely helpful to someone coping with limb loss. My adoption of it began in the early 1990s when I read a medical journal blurb about criteria life insurance companies used to assess rates. Death of a spouse, loss of limb, death of a child, divorce, and buying a home made the list of life's traumas that companies felt they could charge more for. This was the first time I equated the experience of amputation with grieving. However, once put in such a context, and remembering my own surgeries, I realized I might have coped better if I'd had this perspective. <h1>Helping Your Patients</h1> You may choose Kubler-Ross's approach to help your patients deal with their bereavement. Most will have some knowledge of the five stages involved, and others may find the theory logical and be able to apply it to feelings they had after the death of someone dear. Once people have this new frame to put around their emotions, those emotions won't seem as unexpected or bewildering. Many other aspects of their lives have spun out of control, but they often find that this area, at least, has some pattern and predictability. <h2>The Five Stages of Grieving</h2> Although Dr. Kubler-Ross writes about terminal illness, correlations exist when one is living with limb loss. This is why similar feelings are experienced in both circumstances and can be outlined in certain stages: <b>Denial and Isolation</b>: Disbelief and the need to withdraw are typical initial reactions. Although hard for caregivers to understand, this stage can "function as a buffer" providing time "to mobilize other, less radical defenses." <b>Anger</b>: Rage aimed at whoever is nearby can make new amputees unpleasant to be around. However, you may find this is a stage of increased energy, and you may want to encourage your patients to channel it constructively. <b>Bargaining</b>: Much of this is experienced privately, but it is important to keep in mind that "the bargaining is really an attempt to postpone" and "psychologically, promises may be associated with quiet guilt." <b>Depression</b>: Sadness is felt over the immediate loss of limb and the worries grow of what the "impending losses" may be. You can help by giving realistic encouragement about the expected function the amputee will regain. <b>Acceptance</b>: "The pain has gone; the struggle is over" at this point. Most amputees are never happy that they've lost a limb, but they are now able to think of it without plunging into one of the other stages. Just as Lt. Col. Montalvo said, not all people go through all the stages, nor do the stages necessarily go in order. However, Dr. Kubler-Ross' theory may give you another way to reach out to your patients. <i>Kim Doolan works as clinical coordinator at Allen Orthotics & Prosthetics Inc., Midland, Texas; public relations coordinator at Aesthetic Concerns Prosthetics Inc., Middletown, New York; and volunteers for Hospice.</i>
<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2004-02_14/kubler-ross.jpg" hspace="4" vspace="4" /> "Depression, anger, existential questions--"why me?"--and finally, acceptance," is how Army Lt. Col. Alfredo Montalvo, a psychiatric clinical nurse at Brooke Army Hospital, Fort Sam Houston, Texas, describes the emotions of soldiers who have undergone recent amputations. "It isn't that smooth. Sometimes they may jump back to anger, depression. There's good days; there's bad days." When I saw this interview last December on The News Hour, I was intrigued that Lt. Col. Montalvo chose the words he did because they come from Dr. Kubler-Ross's study, On Death and Dying. I believe Kubler-Ross's approach is extremely helpful to someone coping with limb loss. My adoption of it began in the early 1990s when I read a medical journal blurb about criteria life insurance companies used to assess rates. Death of a spouse, loss of limb, death of a child, divorce, and buying a home made the list of life's traumas that companies felt they could charge more for. This was the first time I equated the experience of amputation with grieving. However, once put in such a context, and remembering my own surgeries, I realized I might have coped better if I'd had this perspective. <h1>Helping Your Patients</h1> You may choose Kubler-Ross's approach to help your patients deal with their bereavement. Most will have some knowledge of the five stages involved, and others may find the theory logical and be able to apply it to feelings they had after the death of someone dear. Once people have this new frame to put around their emotions, those emotions won't seem as unexpected or bewildering. Many other aspects of their lives have spun out of control, but they often find that this area, at least, has some pattern and predictability. <h2>The Five Stages of Grieving</h2> Although Dr. Kubler-Ross writes about terminal illness, correlations exist when one is living with limb loss. This is why similar feelings are experienced in both circumstances and can be outlined in certain stages: <b>Denial and Isolation</b>: Disbelief and the need to withdraw are typical initial reactions. Although hard for caregivers to understand, this stage can "function as a buffer" providing time "to mobilize other, less radical defenses." <b>Anger</b>: Rage aimed at whoever is nearby can make new amputees unpleasant to be around. However, you may find this is a stage of increased energy, and you may want to encourage your patients to channel it constructively. <b>Bargaining</b>: Much of this is experienced privately, but it is important to keep in mind that "the bargaining is really an attempt to postpone" and "psychologically, promises may be associated with quiet guilt." <b>Depression</b>: Sadness is felt over the immediate loss of limb and the worries grow of what the "impending losses" may be. You can help by giving realistic encouragement about the expected function the amputee will regain. <b>Acceptance</b>: "The pain has gone; the struggle is over" at this point. Most amputees are never happy that they've lost a limb, but they are now able to think of it without plunging into one of the other stages. Just as Lt. Col. Montalvo said, not all people go through all the stages, nor do the stages necessarily go in order. However, Dr. Kubler-Ross' theory may give you another way to reach out to your patients. <i>Kim Doolan works as clinical coordinator at Allen Orthotics & Prosthetics Inc., Midland, Texas; public relations coordinator at Aesthetic Concerns Prosthetics Inc., Middletown, New York; and volunteers for Hospice.</i>