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MANAGING A
LIFE-THREATENING
ILLNESS

College of Agricultural Sciences

Cooperative Extension

Prepared by Barbara W. Davis, associate professor, agricultural and extension education,

Ann Marie Spigelmyer, former graduate student, and Phyllis W. Crabtree, M.S.
Earlier drafts of this publication were reviewed by J. Alfred Jones, M.D., Richard H. Dixon, M.D., and Ellen McCrory, R.N.
This publication is available in alternative media on request.
Issued in furtherance of Cooperative Extension Work, Acts of Congress May 8 and June 30, 1914, in cooperation
with the U.S. Department of Agriculture and the Pennsylvania Legislature. L.F. Hood, Director of Cooperative
Extension, The Pennsylvania State University.
The Pennsylvania State University is committed to the policy that all persons shall have equal access to programs,
facilities, admission, and employment without regard to personal characteristics not related to ability, performance, or
qualifications as determined by University policy or by state or federal authorities. The Pennsylvania State University
does not discriminate against any person because of age, ancestry, color, disability or handicap, national origin, race,
religious creed, sex, sexual orientation, or veteran status. Direct all inquiries regarding the nondiscrimination policy
to the Affirmative Action Director, The Pennsylvania State University, 201 Willard Building, University Park, PA
16802-2801; tel. (814) 863-0471; TDD (814) 865-3175.

R5M395

The Pennsylvania State University 1993

Facing a Life-Threatening Illness ........................................4

Reacting to the Diagnosis ..................................................7
Communicating with Medical Personnel ..............................8
Getting the Help and Care You Need ................................10
Your Rights as a Health Care Consumer ............................12
Taking a Wellness Perspective..........................................13
Getting Support...............................................................15
Other Practical Concerns ..................................................16
Sources of Information and Support .................................17
For Further Reading ........................................................19

.....................................................................................................................................

I N T R O D U C T I O N

f you have a life-threatening

illness, you are not alone. This
publication is written for people
like youpeople with serious
illnesses that have the potential to be fatal.
The following pages discuss:
common reactions to a life-threatening
diagnosis
what to consider when communicating
with medical personnel
your rights as a health care consumer
daily care alternatives
sources of support

Facing a Life-Threatening Illness

kay. Its happened. What

youve been dreading has
occurred. Youve just
been diagnosed with a
life-threatening illness. What happens next? There are many ways to
travel. For example, you may need:
To cry. Thats a perfectly acceptable reaction. Of course, if you are
a man, or a very controlled
woman, you may need permission
to cry. You have it. Go ahead.
Have a good cry. It wont solve
any problems, but it will indicate
that you have accepted the fact
that you are in trouble.
To receive a big hug. Whom do you
know who can hold you and
assure you that you are lovable,
important, and needed? It may be
a spouse or a lover. It may not be.
Choose carefully.
To decide on a plan of attack. Now
that you know the situation, what
are you going to do about it?
Others will help you decide, but
what you want is important. You
have choices.
To do some research. There are
national organizations and support groups for almost every
known disease. Find yours. Get
some information. Learn all you
can about your illness.

To do some brainstorming. Your

family will probably be a part of
this. You may want to attend
meetings of a support group. Talk
with your doctor. Decide whats
right for you. You have the right
to refuse treatment if that is what
you desire. You have the right to
change doctors.
To make a plan. Depending on
what youve decided to do, proper
arrangements must be made.
Many factors need to be considered. Will you need to be away
from your home? Will you need
transportation for treatments? Do
you have small children who will
need babysitters? Are there others
dependent on you? How much
outside help will you need?
To work on your finances. What is
your employment situation? Can
you get a sick leave? Do you have
the necessary insurance to cover
hospitalization? Does your insurance cover care given at home? If
you dont have insurance, consult
with the social worker in the
hospital. Do you have personal
possessions that you can sell to
raise money for your care?
To join a support group. It may be
difficult for you to ask for help,
but its going to be necessary. Put
your pride in your pocket. Accept
all offers of help, and learn to ask
for what isnt offered. If you need

companionship, say so. If you

need time to be alone, say so. For
a time, you are in the cat birds
seat. Take advantage of it.
To rearrange your house. If you stay
at home, will you need a hospital
bed? Will you be able to travel the
stairs? If not, what do you have to
do so that you can live on one
floor? What special equipment
will you need? Can you buy, rent,
or borrow it? If the illness is
prolonged, you may even find it
necessary to move.
To talk with your children or parents.
What and how much do you tell a
child? The answer depends on the
childs age. Explaining a trip to
the hospital is easy, but explaining
that your medications may bring
mood swings is difficult. Talking
with parents is a different issue. If
you have been diagnosed as
having AIDS, what do you say to
your family and your sexual
partner(s)? You may want to take
your own support group with you
for that conversation.
To talk with your clergy person or
rabbi. Some persons, when given a
diagnosis of a serious illness, see it
as a punishment. Some see it as a
test of faith. Some get very angry
with God. Its important to talk
about your feelings. The book
Why Bad Things Happen to Good
People may be of interest to you.

To find a counselor. Some spouses

and significant others are not
able to deal with the incredible
emotion that flows after the kind
of diagnosis you have just been
given. If this is your situation and
you have the money, hire a counselor. If you dont have the money,
call your county mental health
agency. Dont keep on pretending
you didnt hear what the doctor
said. Deal with the problem.
Throw dishes at the wall if it will
help.
To lower your housekeeping standards.
Regardless of what treatment you
choose, you wont be feeling so
energetic as usual; relax. You are
important. Housekeeping tasks
arent.
To value yourself. If part of your
treatment results in the loss of a
body part (mastectomy, hysterectomy, amputation), your selfimage will be at risk. You may be
feeling blue because you are a
drain on the family. Perhaps you
will lose your hair owing to chemotherapy treatment for cancer.
Your own feelings about yourself
will be constantly under attack.
Remember, youre still the person
you were before you became ill.
You are important. Dont ever
forget it.

 To be realistic about the future. A will,

a living will, and a durable power
of attorney are all important for
everyone. A will is important
because, in Pennsylvania, if you
die without one, the state will
decide where your money goes.
A living will lets your family and
your doctors know how you feel
about heroic care in the hospital
and at home. A durable power of
attorney lets you designate another
person to make health care decisions for you, if you become unable
to do so. Its not fun to make these
decisions, but your making them
takes a tremendous burden off the
shoulders of your family and your
doctors.
To be realistic about what others can
offer you in your search for ways to accept your possible death. Particularly
in the United States, death is
neither discussed nor considered
seriously. You may want to see the
time that you are ill as a giftan
opportunity to settle family feuds,
mend relationships, take care of
important details in your life. Dont
be afraid to run up your telephone
bill. And dont be surprised if your
friends and relatives dont want to
talk to you about dying. Most
people are very uncomfortable
talking about the possibility of
death. You may need to go for
professional help if your friends
are too uncomfortable to visit you.

From the beginning of time, civilizations have established rituals and

customs around birth and death. For
the ancients, both were mysteries.
Today, a great deal is known in the
scientific world about each. Usually,
birth is a very joyous, though painful,
occasion. The appearance of a new
life is an occasion for much celebrating. That is accepted.
Death also is part of the cycle. Many
have not accepted that fact. Particularly in the United States, death is
assigned to hospitals and bodies are
assigned to funeral homes. Very few
people die at home. Change, however, is coming. Part of that change
is due to cost, because families cant
afford to keep a terminally ill patient
in a hospital or nursing home. Some
families accept death as a natural
process and value the comfort a
home setting may provide.
Its important to review what you
believe about death, and from that
review decide how youre going to
approach it. To die peacefully is the
ultimate act of living.

ts normal to have a variety

of emotions and thoughts
when youve been diagnosed
as seriously ill. In fact, you
may feel one way one day and completely different the next. You may
go, for example, from feeling angry,
to being depressed, to denying your
illness. The emotions and thoughts
described below are commonly
experienced by people with lifethreatening illnesses, according to
Elisabeth Kbler-Ross.
Denial gives you a buffer between
yourself and unwelcome news. No,
this cant be happening is a normal
reaction, as is listening without really
hearing. These responses give you
time to regain composure and selfcontrol. You may want to isolate
yourself at first. But try to allow
friends and family members to be
supportive by discussing your emotions with them. These people often
have feelings similar to yours. By
talking openly about your illness, you
can help yourself and your friends
and relatives deal with feelings of
denial.
Anger and resentment are apt to
surface, often when denial is no
longer possible. You may feel youve
done nothing to deserve this illness, a
feeling that can compound your
helplessness and frustration. You
may even resent healthy, energetic

visitors, who remind you of losses

you could face. Venting your anger
with a good listener can reduce the
intensity of these feelings.
Bargaining may be tempting. It
occurs when a person agrees to do
something, such as change his or her
behavior, in exchange for something
else. For example, a seriously ill
person might bargain by promising
to go to church every day if made
well enough to attend a special
family gathering. Bargains are usually made in secret, often with God.
You may find yourself wanting to
bargain because youre afraid of the
future or you are in pain.

.....................................................................................................................................

Reacting to the Diagnosis

Depression, stemming from a sense

of loss, is a normal reaction. It is
common as the treatment for a lifethreatening illness progresses. Medical expenses may increase, leading
you to feel depressed because you
think youre a burden on others. One
way to ease sad feelings is to discuss
them openly with a trusted listener.

Because people have individual ways

of dealing with new situations, no
one can tell you how you should be
feeling. An important stage in growth
is to recognize what these feelings
are, accept them, and not judge
them. Feelings are not right or
wrong. They just are, and they will
change.

What did
you just
say?
I have
what?
Doctor, what
does that
mean?
This cant be
happening.

I dont know
how to talk to
my doctor.
I never seem
to get any
answers to my
questions.
Why cant
my doctor
understand
what
Im saying?

.....................................................................................................................................

Communicating with Medical Personnel

hen were sick, we

often go to a nurse or
doctor for reassurance
and care. If we are
seriously ill, we especially depend on
the medical professionals who manage our care: a primary care doctor,
specialists, nutritionists, therapists,
nurses, patient representatives, and
social workers. Your ability to
communicate with these people is
one of the most important factors in
managing your illness.
Communication does not come
easily. It is something you and your
medical team will have to work at.
Barriers to effective communication
include misunderstandings about
word meanings, expectations, and
different points of view.
Simple misunderstandings about
words are often a major barrier to
effective communication. If you dont
understand medical terminology or
self-care instructions, ask for an
explanation. Unless you ask for
clarification, your medical team will
assume that you understand.
What you expect from medical
professionals also can hinder effective communication. If expectations
are not met, you may become disenchanted. For example, doctors differ

in the amount of information they

give their patients. They try to
determine what each patient wants to
know, then provide this information.
If you expected to learn more from
your doctor than he or she is telling
you, its up to you to express
your concerns.
Different points of view can affect
communication. Whats important to
them might not be important to you.
For example, a doctors point of view
may be that you need to know certain information about your illness,
but you might want to be told how
the disease will progress. Discuss
your needs for particular information
with the medical team.
If you have questions about managing your care, make an appointment
to meet with the appropriate medical
professional(s). Before the meeting,
write down your questions and
concerns. Be prepared to take notes,
and consider taking a family member
or friend with you.

Before agreeing to a recommended

treatment plan, ask:
Has the diagnosis been established
without any doubt? Would any
other tests help confirm or further
define the diagnosis?
Is there evidence the treatment will:
1. prolong life?
2. prolong life and limit suffering?
3. just limit suffering?
4. just prolong life?
Is the goal of treatment to cure or
control the disease? If its control,
what symptoms would I have with
and without treatment?
How long will the treatment(s)
last, and how often will follow-up
visits be required?
What lifestyle changes must I
make regarding work, family
relationships, and/or recreation?
If several specialists are involved
with care, who will be coordinating
the overall treatment plan?

What are the names of the drugs

prescribed? What are their interactive effects with other medications?
Are there special foods I should
eat or avoid?
If the illness will persist, how will
it progress? What types of problems can I expect? How well can
symptoms be controlled? What
steps can I take to prepare for the
later stages of the illness?
Will any special equipment need
to be rented (e.g., a hospital bed
for home care)? If so, where can it
be obtained?
What can be done to alleviate any
pain I may feel?
What are the costs? What will
insurance pay for? Are there other
sources of assistance to help
manage the illness?
Are there support groups? If so,
how do I make contact?

What are the benefits and risks of

suggested treatment(s)?
What are the possible side effects
of the treatment(s)? What can I do
to prepare for or limit side effects?

I dont want
to stay in the
hospital, but I
need help with
daily tasks.
What are my
options?

.....................................................................................................................................

Getting the Help and Care You Need

Are home
health care
services covered
by
insurance?

hile you may need to

spend some time in the
hospital, home health
care and hospice programs can provide valuable assistance and may be needed if you can
be at home. If home care is not
possible, but you dont need hospital
care, nursing homes offer living
arrangements with varied levels of
assistance.
Determining the best health care
option for you depends on your
available financial resources and
other supportive means, and on your
exact medical condition. Certain
daily care services are covered by
insurance policies, Medicare, and
other health benefits. These services
vary by company and medical condition, so review your benefits to
determine exactly what is covered
and to what extent.
When making daily care arrangements, be aware that different types
of organizations can provide this
care. Some, for example, are nonprofit, meaning they perform their
services for fees intended to cover
expenses only. Others are for-profit,
meaning they are interested in making a profit from their fees. Some
agencies are approved by government regulatory bodies, while others

10

are not. Ask for the credentials of the

agencies youre considering, to make
sure they meet your standards.
Home health care includes a broad
range of medical, nursing, and
therapy services. These often include
other services, such as homemaking
or transportation, which can help
you manage the problems of a lifethreatening illness within the comfort
and security of your own environment.
The goal of home health care is to
help people function as independently as possible. Home health care
is available from various community
and private agencies. To locate these
home care providers, check your
telephone book for listings of human
services in your area. Their services
range from complex medical treatments to assistance with personal
care.
Nursing homes offer three basic
types of careskilled care, intermediate care, and custodial care. Individuals in skilled care require the
continuous services of a registered
nurse. Those in intermediate care
need regular, but not continuous,
nursing care along with personal
care assistance. People who need
help only with personal care receive
custodial care. Be sure to check
costs.

Hospice care is offered to seriously ill

individuals and their families when
an illness is considered no longer
curable and when the person has a
limited life expectancy measured in
months rather than years. These
programs operate under three basic
principles:

Hospice care can be offered in your

home, with a hospital as a backup
facility if needed. This type of care is
usually not appropriate when an
illness is newly diagnosed, unless it is
so far advanced when discovered
that you do not want to receive
active treatment.

care for the seriously ill is coordinated by a medical team,

the patient can spend his or her
days in less distress by a reduction
or elimination of pain and symptoms,
the family is consoled at the time
of death and during bereavement.

11

If Im in a
hospital, can
my medical
team order
treatments
without my
permission?
How should a
home health
caregiver
treat my
property?
If I choose to
live in a
nursing home,
may I receive
any visitor
I want?

.....................................................................................................................................

Your Rights as a Health Care Consumer

he rights of health care

consumers are protected
under certain federal and
state laws. For example,
youre entitled to receive complete
information about your illness and its
prognosis, and you may withhold that
information from others if you wish.
Youre also entitled to know about
any procedures or treatments that
may be planned, to know how much
these may cost, and to accept or refuse
further treatment.
In 1980, the Pennsylvania Department of Health designated minimum
provisions for a Patients Bill of Rights
and required all hospitals in the state
to establish their own rights for patients (which include the minimum
state provisions). Hospitals are required to inform individuals of these
rights, either by displaying them
prominently with additional copies
available upon request or by providing them with a copy upon admission.
Nursing home residents also have
important rights. These include equal
access to care, freedom to choose a
physician, confidentiality, participating in decisions about ones care,
refusal of care, the right to be informed of charges, unrestricted visitation, privacy, and protection of personal funds. Residents also are entitled to voice their complaints. If
youre considering nursing home care,
ask the facility for a copy of its residents rights.
12

In 1987 Congress passed legislation

outlining the rights of home health
care recipients. All home health
agencies are required to share these
rights in writing with their clients.
Home care consumers are entitled to
be notified in writing of their rights
and obligations before any treatment
is started.
Providers of home health care are
obligated to protect and promote the
rights of their clients. If you receive
home care, youre entitled to:
have your property treated with
respect
not be discriminated against
be informed about your care and
any changes in it
participate in the planning of your
care
know your clinical records will be
kept confidential
be advised of how much Medicare
and other sources can be expected
to pay for services rendered
an investigation of any complaint
regarding treatment or lack of
respect for property
For more information regarding
home health care agencies or to
pursue a complaint against an
agency, you may call the Pennsylvania toll-free home health hotline at
1-800-222-0989.

Taking a Wellness Perspective

ellness is made up of
many parts. Now that
you know youre a
high-risk person, its
more important than ever to assume
responsibility for your own wellbeing. Its important to think about
the overall quality of your life:
Maintain relationships that are
important to you.
Be safety conscious (including
examining yourself for physical
problems, using food safety practices, taking safety precautions in
the home to prevent falls).
Continue interests that you can
manage, those that add something
special to each week.
Exercise to maintain mobility and
reduce stress. Find an exercise
routine that suits you. You may
begin by walking to the corner
every other day. Build up distance
and frequency slowly. Use the
time outdoors to enjoy natures
diversity.
If necessary, seek help through
stress management and/or spiritual counseling. Management of
stress is often helped by yoga and
special classes in deep breathing.

More than ever, the quality of your

life is important now.
Eating a variety of foods in moderation is of great benefit. For assistance, refer to the revised USDA
Dietary Guidelines, available
through the Penn State Cooperative
Extension office in your county. You
are unique and may have special
dietary needs.
If youre on chemotherapy, for
example, there are some foods you
may not be able to eat. If you have
kidney disease, your protein intake
may be limited. If you have diabetes,
your food choices and eating pattern
will need to change. If you have
heart disease, your fat intake should
be reduced.
A patient often feels resentment
when he or she is warned, You need
to lose some weight. Yet being
overweight is a risk factor for many
diseases. Its easy to take medications
but difficult to change a lifestyle. Its
your choice. How badly do you want
to live? Almost every other week
brings new evidence from nutritional
research on the importance of diet
and health. Your doctor or dietitian
can recommend, but its up to you to
decide. Make changes one step at a
time. It took years to get into your
current condition. It wont change
overnight. If you cant or wont
change your lifestyle, be prepared to
face the consequences.

13

You may want to explore the relatively new field of psychoimmune

therapy. Psychologists are working
with patients on the interractions
among body, mind, and soul. How
we think and what we believe can
affect our wellness. This is a new but
fascinating field of medicine. Dr.
Bernie Siegel, for example, has done

14

some interesting work with cancer

patients in this area. The role of
meditation in healing has been
explored by O. C. Simonton and
colleagues (see For Further Reading). The role of prayer in healing
has been part of many cultures for
centuries.

oping with the unknown

can be a challenge for anyone. When the unknown
is a life-threatening illness,
coping can become extremely
difficult.
Throughout your illness, you will
need the support of your friends and
family members. Beyond this, many
communities have specific support
groups made up of people who have
the same illness as you, family members of those with the same illness,
surviving family members of those
who have had the disease, and
trained counselors.
Support groups hold either openended sessions, where you can attend
as many meetings as you find helpful,
or time-limited sessions, where the
same group members agree to meet
together for a fixed number of sessions. The basic goal of any support
group is to help individuals learn
more about dealing with illnessrelated problems.
Some people feel uncomfortable
sharing their situation in a group
setting. For them its easier to talk
one-on-one with a close family
member or friend, a member of their
medical team, or a trained listener
such as a clergy person, social
worker, or psychologist.

To be most helpful, the person you

talk to should be comfortable with
your illness. Finding this person or
group may take time. Dont be
discouraged if family members and
friends shy away from illness-related
conversations. These people are
coming to terms with the seriousness
of your illness just as you are, and
with time, they will probably be able
to talk with you.
Everyone can benefit from the
support of a family member or
friend. For this to happen, however,
you must be open to it. Allow others
to help. Let them listen while you
open up about your feelings, questions, and fears. If youre tired of
discussing your condition, you might
want to look through an old scrapbook. You may even want to label
loose family photos and organize
them in an album. Reminiscing can
bring back good memories; and
laughter can be the best medicine,
when you can laugh without feeling
angry.
You may find it helpful to keep a
diary or log where you can express
your concerns and your triumphs.
While a document like this cannot
replace the support of another person, it does give you an outlet to
open up and to vent frustrations.

.....................................................................................................................................

Getting Support

15

Whom can
I talk to?
Where can
I go for
support?

Why should I
organize my
personal
affairs?

.....................................................................................................................................

Other Practical Concerns

If I decide to
do so, are there
any guidelines
to follow?

t may be frightening to know

you could become dependent
on others, even temporarily.
Because of this, you might be
tempted to delay thinking about and
resolving certain practical issues. But
discussing these issues now can give
you a greater sense of control over
your life, and it may eliminate many
problems later.
There are steps you can take to
organize your personal affairs. These
include organizing personal records,
considering an advance directive for
health care, preparing to transfer
property, and preplanning final
arrangements. These steps are outlined in the Penn State Cooperative
Extension publication Getting Your
Affairs in Order (forthcoming).

16

Sources of Information and Support

American Cancer Society

90 Park Avenue
New York, NY 10017

The American Cancer Society is a

voluntary organization that offers a
variety of patient services, including
publications, videos, and sponsorship
of the support programs Reach for
Recovery, I Can Cope, and I Can
Surmount. The ACS also is involved
in cancer education and research.
ACS local units are organized to
cover all counties in Pennsylvania.
Limited financial services are available to cancer patients. The ACS
hotline number in Pennsylvania is
800-227-2345.
American Diabetes Association
Diabetes Information Service Center
1660 Duke Street
Alexandria, VA 22314
(703) 549-1500

The American Diabetes Association

provides classes, lectures, and selfhelp groups that meet throughout the
country. To find out about Diabetes
Forecast and various activities in your
area, check your telephone book or
call the National Service Center at
800-ADA-DISC.

American Heart Association

American Heart Association National
Center
7272 Greenville Avenue
Dallas, TX 75231
(214) 373-6300

The mission of the American Heart

Association is to reduce disability and
death from cardiovascular diseases and
stroke. Skilled volunteers in 25 offices
throughout Pennsylvania offer educational and community service programs at schools, work sites, and other
community locations. To make contact
with the office closest to you, check
your telephone book or contact the
closest American Heart Association
district office. These are located in
Wilkes-Barre, Williamsport, Erie,
Lancaster, and Pittsburgh.
Cancer Information Service
The National Cancer Institute
Bethesda, MD 20892
(800) 422-6237

The National Cancer Institute is an

agency of the National Institutes of
Health, U.S. Department of Health
and Human Services. Its Cancer
Information Service, open 7 days a
week, is staffed by trained persons
who can answer your questions regarding cancer, medical facilities,
home care assistance programs, financial aid, emotional counseling, and
other services. They also can send you
relevant information about specific
types of cancer.
17

Choice In Dying, Incorporated

250 West 57th Street
New York, NY 10107
(212) 366-5540

Make-a-Wish Foundation of America

Suite 205
4601 North 16th Street
Phoenix, AZ 85016

Choice In Dying, Inc., is the national

council for the right to die. This
nonprofit educational organization
distributes information on advance
medical directives, provides psychological and legal counseling, and
makes referrals to local organizations.

The Make-a-Wish Foundation of

America works closely with families
of terminally ill children (up to age
18). It works with families to cover
expenses and to arrange for granting
a childs special wish, which will
provide encouragement, respite, and
special memories.

Leukemia Society of America, Inc.

600 Third Avenue
New York, NY 10016
(212) 573-8484

The Leukemia Society of America,

Inc., offers supplemental financial
assistance and consultation for cancer
patients with leukemia and related
disorders.

18

For Further Reading

American Diabetes Association

(1987). Adults: Diabetes and You.
Alexandria, VA. Diabetes Information Service Center.
Bartlett, J. G., & Finkbeiner, A. K.
(1991). The Guide to Living With
HIV Infection. Baltimore: Johns
Hopkins University Press.
Cousins, N. (1979). Anatomy of an
Illness as Perceived by the Patient,
Reflections on Healing and Regeneration. New York: Norton.
Hermann, J. F., Wojtkowiak, R. N.,
Houts, P. S., and Kahn, S. B.
(1988). Helping People Cope: A Guide
for Families Facing Cancer. Harrisburg, PA: Pennsylvania Department of Health.

National Cancer Institute. (1986).

Taking Time: Support for People with
Cancer and the People Who Care
About Them. Bethesda, MD: Public
Health Service, U.S. Department
of Health and Human Services.
Siegel, B. S. (1986). Love, Medicine,
and Miracles. New York: Harper &
Row.
Siegel, B. S. (1989). Peace, Love, and
Healing. New York: Harper &
Row.
Simonton, O. C., MatthewsSimonton, S., & Creighton, J.
(1978). Getting Well Again. Los
Angeles: Houghton Mifflin.

Kbler-Ross, E. (1978). To Live Until

We Say Goodbye. Englewood Cliffs,
NJ: Prentice-Hall.
Kbler-Ross, E. (1982). Working It
Through. New York: Macmillan.
Kbler-Ross, E. (1987). Aids: The
Ultimate Challenge. New York:
Macmillan.
Kushner, H. S. (1983). When Bad
Things Happen to Good People. New
York: Avon.
Langone, J. (1988). Aids: The Facts.
Boston: Little, Brown & Co.

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