Most patients react to the news of their impending death with denial: “No, not me, it cannot be true” (51). Denial is the reaction of most patients for at least some time, and usually toward the beginning of their illness. This initial denial “functions as a buffer after unexpected shocking news, allows the patient to collect himself and, with time, mobilize other, less radical defenses” (52). In the vast majority of cases, it is best to tell the patient the exact nature of their situation as soon as possible. Avoiding the topic of mortality or dancing around the issue doesn’t help. Rather, it mitigates awkwardness for the health care provider. A patient’s denial is soon replaced by at least some level of acceptance.

The author relates the case of a young married woman, mother to two small children, who was diagnosed with terminal liver disease. For almost the entire length of her illness she was in deep denial, convinced in the success of a local faith healer and later convinced by her own delusions that she was going to get better and live a normal life. Toward the end of her illness, she gradually demonstrated awareness of what was happening as she began to waste away.