The Whisper of Death

Psychotherapy with a dying Vietnam veteran is described. In spite of a severe heart condition and HIV-positive diagnosis, the outspoken and provocative patient reverts to heroin and cocaine use early in the treatment. This causes a heart attack and interruption of treatment. The therapist maintains empathy, a solid bond is forged, and the patient returns, but under constrained circumstances. A turning point is reached, both in the treatment and in this final phase of the patient’s life, with major life improvements ensuing. At death the patient leaves word to thank the therapist. This case exemplifies how the approach of death lends urgency to positive forces appropriate to life’s final developmental stage, and how end-oflife therapy bolsters those forces.