The document discusses practical thanatology and perspectives on death and dying. It addresses [1] how humans like Gilgamesh foolishly chase immortality and fail to appreciate life, [2] the differences between sudden and expected death, [3] the stages of dying and bereavement, and [4] the importance of facilitative communication when supporting the dying and their families. The document emphasizes accepting mortality, treasuring the present, and providing compassionate support through the end of life process.

1. Practical Thanatology
Frank Meissner, MD, FACP, FACC, FCCP
US Hospital, Zagreb

2. Gilgamesh, where are you wandering?
The [immortal] life that you are seeking all around you will
not find. When the gods created mankind they fixed
Death for mankind, and held back Life in their own
hands. Now you, Gilgamesh, let your belly be full! Be
happy day and night, of each day make a party, dance in
circles day and night! Let your clothes be sparkling clean,
let your head be clean, wash yourself with water! Attend
to the little one who holds onto your hand, let a wife
delight in your embrace. This is the true task of mankind.
The Epic of Gilgamesh, ca. 1700-1300
B.C.
US Hospital, Zagreb

3. A Humanistic Model of Medicine
SOCIAL
BIOLOGICAL PSYCHOLOGICAL
SPIRITUAL
CULTURE
US Hospital, Zagreb

4. LIKE GILGAMESH, MANY
s Foolishly chase for every second of life
s Fail to treasure the life we have
s Fear the inevitable
s Ignore the ‘perfection’ of the PRESENT
s Deny MORTALITY
US Hospital, Zagreb

5. Sudden death vs Expected Death
s Many say ‘I wish to die sudden’
s Death less fearful than a life of pain &
suffering
s Grief work harder for survivors of
SUDDEN Death
s Epected death can be ‘managed’
s Sudden death must BE endured
US Hospital, Zagreb

6. Anatomy of Dying
s Disbelief/Denial
s Rage/Anger
s Bartering/Negotiation
s Acceptance/Preperation
s General emotional responses NOT a
rigid progression
US Hospital, Zagreb

7. NOT everybody is ON the same wavelength
s Hidden agendas
s Past & secret guilts
s Emotional dysynchrony
s Impossible expectations
s Unrealistic Faith
US Hospital, Zagreb

8. Family Dynamics
s Consensus is VITAL
s Consensus is HARD
s Dying does NOT enoble or transform, IT
amplifies basic personality traits
s Meissner’s 1st Law of Thanatology-
Terminal Cancer does not make
EVERYONE noble
US Hospital, Zagreb

9. Stages of Bereavement
s Shock & Denial
s Depression & Disorganization
s Reorganization, reengagement, and
redefinition
US Hospital, Zagreb

10. Pathological Bereavement
s Delayed grief
s Inhibited grief
s Chronic grief
s Bereavement overload
US Hospital, Zagreb

11. What DO I Say!
s Say what comes naturally
s Say what YOU feel
s Share of yourself
s Give meaning to the death if possible
s Ask for a precious memory of the loved
one
s ACCEPT Intense emotions
US Hospital, Zagreb

12. Facilitative vs Nonfacilitative Communication
s ‘This must be painful for you’ vs ‘I KNOW how
you feel’
s ‘This must be hard to accept’ vs ‘God had a
purpose‘
s ‘Many feel angry at God at these times’ vs
‘Life MUST go on’
s ‘Tell me how you are feeling’ vs ‘Lets not deal
with it now’
s ‘May I help?’ vs ‘He/She lead a full life’
US Hospital, Zagreb

13. Conclusions
s Deal from you Heart not your Head
s Listen, Listen, Listen, Listen
s Accept ‘Scary Emotional Intensity’
s Understand Cultural Differences
US Hospital, Zagreb