Monday, January 22, 2018

Review: How We Die: Reflections on Life's Final Chapter by Sherwin B. Nuland

4 stars for How We Die: Reflections on Life's Final Chapter by Sherwin B. Nuland.

All life has a finite span and each species has its own particular longevity.

In this book, Dr. Nuland describes in frank detail the process of dying in its biological and clinical reality, by which life succumbs to disease, violence, accident or old age.

Organised into chapters and sections on the most common disease categories of our time, How We Die covers the cardiac chapters; the sections on aging and Alzheimer’s disease; the trauma and suicide section; the AIDS chapters; the clinical and biological aspects of cancer; and last but not least, the discussion of the doctor-patient relationship.

Amidst the deep desire to understand the nature of dying, the topic on hope is never far away. The deep impression that Dr. Nuland leaves behind on me is his confession on how he tries to give his brother hope - by letting his instincts as a brother overwhelm his judgment as a surgeon who has spent his career treating people with lethal disease - by offering him the opportunity to try the experimental new treatment which only serves to intensify his brother's suffering and rob him of an easier death. Dr. Nuland's brother, Harvey, died of colon cancer in 1990.

In face of the wildly unpredictable process of living, dying and death, it is in our favour to learn as much as we can about our bodies, their strengths, their weaknesses and their ultimate inevitable failings. By doing so, we may/will be better prepared to deal more gracefully with the end. This book is as good a place as any to start.

Publisher: Knopf; 1st edition
Publication date: 25 Jan 1994

*** Notable passage 1 ***

..when the human spirit departs, it takes with it the vital stuffing of life. Then, only the inanimate corpus remains, which is the least of all the things that make us human.

*** Notable passage 2 ***

With what strife and pains we come into the world we know not, but ‘tis commonly no easy matter to get out of it.

~ Religio Medici
Thomas Browne

*** Notable passage 3 ***

Death may be due to a wide variety of diseases and disorders, but in every case the underlying physiological cause is a breakdown in the body’s oxygen cycle.

~ Dr. Milton Helpern
Chief Medical Examiner of New York City, 1954-1974

*** Notable passage 4 ***

Though biomedical science has vastly increased mankind’s average life expectancy, the maximum has not changed in veriflable recorded history.

*** Notable passage 5 ***

When I have a major illness requiring highly specialized treatment, I will seek out a doctor skilled in its provision. But I will not expect of him that he understand my values, my expectations for myself and those I love, my spiritual nature, or my philosophy of life. That is not what he is trained for and that is not what he will be good at. It is not what drives those engines of his excellence.

For those reasons, I will not allow a specialist to decide when to let go. I will choose my own way, or at least make the elements of my own way so clear that the choice, should I be unable, can be made by those who know me best. The conditions of my illness may not permit me to “die well” or with any of the dignity we so optimistically seek, but within the limits of my ability to control, I will not die later than I should simply for the senseless reason that a highly skilled technological physician does not understand who I am.

*** Notable passage 6 ***

The more knowledge we have about the realities of lethal illness, the more sensible we can be about choosing the time to stop or the time to fight on, and the less we expect the kind of death most of us will not have.

For those who die and those who love them, a realistic expectation is the surest path to tranquillity. When we mourn, it should be the loss of love that makes us grieve, not the guilt that we did something wrong.

~ How We Die: Reflections on Life's Final Chapter
Sherwin B. Nuland


A runaway bestseller and National Book Award winner, Sherwin Nuland's How We Die has become the definitive text on perhaps the single most universal human concern: death. This new edition includes an all-embracing and incisive afterword that examines the current state of health care and our relationship with life as it approaches its terminus. It also discusses how we can take control of our own final days and those of our loved ones.

Shewin Nuland's masterful How We Die is even more relevant than when it was first published.

*Blurb from Goodreads*

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