How We Die: Reflections of Life's Final Chapter

How We Die: Reflections of Life's Final Chapter

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 tak...

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Title:How We Die: Reflections of Life's Final Chapter
Author:Sherwin B. Nuland
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Edition Language:English

How We Die: Reflections of Life's Final Chapter Reviews

  • Richard Kramer

    If you are alive, and might someday die, or know anyone who is alive and might someday

    die, this might be one of those books you have to read. It takes the piss out of heroics,

    and science, and the Dignified Death; it harshly regards the coldness of medical personnel dedicated to solving what

    the author calls the Riddle and ignoring the needs of the person that provides it. He is hard on doctors, and hard on himself. Some books please, some entertain, some disappoint. Few,though, chang

    If you are alive, and might someday die, or know anyone who is alive and might someday

    die, this might be one of those books you have to read. It takes the piss out of heroics,

    and science, and the Dignified Death; it harshly regards the coldness of medical personnel dedicated to solving what

    the author calls the Riddle and ignoring the needs of the person that provides it. He is hard on doctors, and hard on himself. Some books please, some entertain, some disappoint. Few,though, change you, and this is one of them. It came at a time when I needed it, when I was

    in the process of losing a dear family member. It made me value her life more and, also, my own.

  • david

    A beautifully written account by one who has witnessed many deaths, as a retired surgeon, in a hospital setting.

    A scholarly and reflective depiction on the process of quietus.

    Great insight for anyone who is concerned that one day they might die.

  • Jamie Collins

    This book is an attempt by the author, a surgeon, to de-mystify the process of death. He feels that our modern expectation of a "death with dignity" leads to increased suffering when we confront the ugly reality: most people don't experience a peaceful, pain-free death; they don't die at home surrounded by their loved ones; they don't utter profound last words of comfort to those they leave behind.

    He offers detailed, technical descriptions of the most common mechanisms of death, incl

    This book is an attempt by the author, a surgeon, to de-mystify the process of death. He feels that our modern expectation of a "death with dignity" leads to increased suffering when we confront the ugly reality: most people don't experience a peaceful, pain-free death; they don't die at home surrounded by their loved ones; they don't utter profound last words of comfort to those they leave behind.

    He offers detailed, technical descriptions of the most common mechanisms of death, including vivid, disturbing details of the various indignities experienced by the dying. He enhances his narrative with deeply moving stories of the end-of-life experiences of his own patients, friends and family members.

    Alongside the medical details and anecdotes the author waxes philosophical. He talks about the need for the old to die so that the young can prosper. He is appreciative of modern medicine's ability to improve and prolong life, but he expresses concern that a doctor's drive to diagnose and cure can override his duty to provide the most appropriate care when the end of his patient's life becomes inevitable.

    The book was published in 1993 but only seems out of date in the anguished chapter on AIDS.

    I was entranced by the technical details and moved to tears by some of the author's personal stories, but his philosophical musings seemed a bit repetitive after a while. Overall a very good book, 4.5 stars.

  • Abeer Hoque

    On the back of "How We Die" Doris Lessing writes it's a must read for anyone over 50. I say anyone over 35. Because you might still have time then to internalise all the dying lessons Dr. Nuland has to teach, and you're past those forever twenties.

    We've got three score and ten years and most of that could be healthy, but after that, the remainder of our body life is borrowed and breaking down. Towards that end, Dr. Nuland urges us to measure quality of life against mechanical extensions of life

    On the back of "How We Die" Doris Lessing writes it's a must read for anyone over 50. I say anyone over 35. Because you might still have time then to internalise all the dying lessons Dr. Nuland has to teach, and you're past those forever twenties.

    We've got three score and ten years and most of that could be healthy, but after that, the remainder of our body life is borrowed and breaking down. Towards that end, Dr. Nuland urges us to measure quality of life against mechanical extensions of life, value peace of mind over medical miracles (because your surgeon sure as hell won't), and hold our connections with loved ones above everything. Live your life well, he says, because the end will probably not be pretty, and you want the people around you to remember everything else.

    Chapter by morbid chapter, and with intimate compassion and poetry, Dr. Nuland charts the major ways we die, all of which have to do with failures of oxygen supply, one way or another: heart attacks and strokes, old age, suicide, murder, accident, Alzheimers, AIDS and other viruses, cancer. The title alone was enough to give me (and everyone around me) pause, when I pulled the book out in public.

    We should all learn as much as we can about our bodies, their strengths, and their inevitable failings. It will help us deal more gracefully, or at least more knowingly, with the end. This book is as good a place as any to start.

  • Paul Corrigan

    I felt compelled to reread HOW WE DIE, starting with the chapters on Cancer, after my wife passed away from an aggressive form of breast cancer. Doctor Nuland is right on when he talks about how the specialists, for whom a disease such as cancer becomes a great riddle to solve, somehow withdraw from the patient's presence when the disease they are trying to interdict cannot be stopped with the assortment of chemo drugs and radiation therapy they have in their tool box. Yes, tool box seems like a

    I felt compelled to reread HOW WE DIE, starting with the chapters on Cancer, after my wife passed away from an aggressive form of breast cancer. Doctor Nuland is right on when he talks about how the specialists, for whom a disease such as cancer becomes a great riddle to solve, somehow withdraw from the patient's presence when the disease they are trying to interdict cannot be stopped with the assortment of chemo drugs and radiation therapy they have in their tool box. Yes, tool box seems like an appropriate metaphor because chemo therapy with the way it devastates the body gives the whole process of treatment a clunky rattling sense to it. Even in the best of treatment centers with the caring technicians, nurses and doctors, the process of getting well is not very pretty, doling out its share of suffering and pain. Doctor Nuland knows this only too well and his sensitive prose explores that point in such treatment when it is best to start exploring other options, such as hospice care. I must say, however, that my wife's oncologists were caring and sensitive, while she was the subject of their attempts to find the right chemo drugs to slow down, and even beat back for a time, the relentless onslaught of an aggressive, triple negative tumor. It was after she was released and returned home, to die shortly after the last treatment at the cancer center, that the oncologists seem to lose interest. Dr. Nuland talks at length about the moment when the specialists pack up their tool kits and it becomes time for the generalists, the GP's and the hospice care nurses and therapists to work their compassion and relieve the pain that the disease has wrought. It is in this arena that Doctor Nuland's humanity and compassion shines through.

  • Jeffrey

    Sherwin Nuland, MD, was a well known and successful surgeon at Yale Medical Center for many years. In this book he begins to describe, literally, the way we die. In detail, he explains how infection and cancer and heart disease ravage the body and cause essential systems to fail. As a physician, I found it interesting, but I did not think I would finish the book if that was all there was to it.

    Then the book began to hold my attention as it developed into an exploration of how people

    Sherwin Nuland, MD, was a well known and successful surgeon at Yale Medical Center for many years. In this book he begins to describe, literally, the way we die. In detail, he explains how infection and cancer and heart disease ravage the body and cause essential systems to fail. As a physician, I found it interesting, but I did not think I would finish the book if that was all there was to it.

    Then the book began to hold my attention as it developed into an exploration of how people deal with dying, a very different question from how we physically die. Dr. Nuland does a beautiful job with Alzheimer's disease using the slow deterioration of a friend as his example. He helps the reader understand not only the disease, but what the disease process does to the family and friends of the one afflicted.

    What was most interesting to me as he made his segue into HIV/AIDS, was how his own values as an old time surgeon began to conflict with evolving codes of ethics, patient and family expectations and modern medical practice. After all, while he trained in the era when the doctor and family could collude to keep the true nature of an illness hidden from a patient, he also was part of a generation of surgeons who saw incredible progress in his field. He repeatedly recognizes that modern medicine can go too far, causing and prolonging suffering when treatment is futile, and yet he tells poignant stories about his own close family in which he cannot stop himself from offering that last sliver of hope even if it means risky surgery or incapacitating chemotherapy.

    He is honest. He admits that sometimes physicians are more interested in solving "The Riddle" of the patient's illness even if diagnostic and treatment efforts are unlikely to help relieve suffering. This type of care and thinking are most often to be found in the academic medical center such as the one in which he worked. Academic physicians have a duty to the patient, but they also have a duty to learn and study. Helping the dying patient to an easy death may not always be their priority.

    But times are changing. The pendulum has swung from the paternalistic physician who could withhold critical information or pursue treatment regardless of the patient's wishes to the empowered patient who can demand treatment even when it is futile or refuse treatment even when it might be life saving. Nuland recognizes the value of the primary care physician to help guide patients through confusing and complicated medical decisions but he only gives this recognition one sentence. He doesn't trust the empowered patient to make correct decisions. He reserves the right to argue, and he admits to using some unfair tactics to get his way. The physician still has power in the relationship.

    As a primary care physician I had to cringe as he put his own brother through dangerous and difficult surgery even though the chance of cure was close to zero. He asks himself why, after the fact, but he has no good answer. He didn't want to admit, given all the tools of modern medicine and his own prowess as a surgeon (he did not do the surgery) that nothing could be done to save him. He did not want to give up hope, so instead he held out false hope.

    This book is very easy to read and understand. Nuland does a great job making complex pathophysiology understandable. Unfortunately he could not get past his own guilt and we spend too much time hearing rationalizations for his aggressive (think academic surgeon) treatment of some of his patients.

    I recommend the book for those interested in how the body works, or doesn't, and how people think about and react to illness and dying. The section on Alzheimer's disease is excellent and beautifully written. The book also gives insight into the mind of the academic surgeon.

    And, should you ever be in a life threatening situation where difficult decisions have to be made, if time permits I would also recommend a conversation with your primary care physician. It is good to get more than one opinion.

  • Toph

    It's hard not to compare this to Kalanithi's

    . Like Kalanithi, Nuland is a surgeon who has written a book exploring themes/ideas surrounding death. Nuland's account is a lot less personal; for one, he didn't experience dying as he wrote the text. His inspiration for writing was not his own mortality but rather the result of decades upon decades of watching his own patients suffer through the so-called "hidden" process of dying. Nuland explores the more common ways that most Am

    It's hard not to compare this to Kalanithi's

    . Like Kalanithi, Nuland is a surgeon who has written a book exploring themes/ideas surrounding death. Nuland's account is a lot less personal; for one, he didn't experience dying as he wrote the text. His inspiration for writing was not his own mortality but rather the result of decades upon decades of watching his own patients suffer through the so-called "hidden" process of dying. Nuland explores the more common ways that most Americans die in his account, explaining the many possible processes of dying in scientific terms while also weaving in his personal experience and insight.

    One thing I really liked was how Nuland pointed out how attitudes toward death have changed with the advents of modern medicine, how physicians today focus more on achieving victory in indivudalized cases rather than accepting death as inevitable. Not that this is necessarily a bad thing, but an consequence of this is that death has become more concealed from society, so to speak. Since we have the technology to stave off death longer and longer, physicians and society in general have a need to "hide" the process of dying in the cases where they fail to slow it, decreasing the frequency of their visits to patients once it's clear that they don't have much time left. This is a pretty stark contrast to the 19th century, where it was the norm for people to drop dead like flies, often in the comforts of their own homes. Doctors then focused more on helping patients die in a comfortable, dignified manner rather than try to combat death in the first place. Most people today still want their long-term dying process to be dignified, but Nuland points out that this often isn't the case, relating a memory where a man with Alzheimer's had to be cleaned of his own feces the year he died.

    Nuland's conclusion that we try to have the best death possible by living the best life possible might seem unsatisfactory, but this is ultimately the most that anyone can hope for in the wildly unpredictable process of death.

    4.5 stars. Guess Mom forcing me to read books about death is paying off.

  • Dan

    Excerpt From

    How We Die

    Sherwin B. Nuland

    This book is full of difficult subject matter on end of life causes and it won the National Book Award for Non-Fiction some 25 years ago.

    Although this read feels dated today, since both cancer treatments and treatment of HIV have progressed significantly, the conclusions about awareness of end of life decisions and hospice are still spot on.

    The author, Stewart Nuland, who has since passed away from prostrate cancer was the head of the Yale Medical School. He suffered from mental depression. I don’t know if he wrote this book in a dark place but although it is science based, it is also brutally frank about the pain and discomfort that most dying patients face in their last days and months.

    4 stars. Very informative book that is both enlightening and sobering. Best read when in the right place emotionally.

  • Paul Bryant

    When I log on to my Goodreads home page I always see many notices saying things like

    Brainiac the Magnificent is now friends with Death By Radiation

    Is This Catching? is now friends with My Mother Has Turned Blue

    Tiny Little Aardvark is now friends with The Biker who Eats Babies

    The Seventeenth Beatle is now friends with Barkybarkywoofwoof

    But really, that's got nothing whatsover to do with how we die. At least, I don't think so. Unless thes

    When I log on to my Goodreads home page I always see many notices saying things like

    Brainiac the Magnificent is now friends with Death By Radiation

    Is This Catching? is now friends with My Mother Has Turned Blue

    Tiny Little Aardvark is now friends with The Biker who Eats Babies

    The Seventeenth Beatle is now friends with Barkybarkywoofwoof

    But really, that's got nothing whatsover to do with how we die. At least, I don't think so. Unless these are all the names of angels.

    As regards the book itself, since I sold my copy via Amazon to some geezer in Salt Lake City years ago, I can't remember much about it, so I'm just kind of busking here. This is a bad review. Talking just to be talking, you know. Because I'm reading some long books right now & it'll be ages before I can say anything about those.

    But that makes me wonder.

    Because, how we die

    is .... we suddenly stop responding to messages... stop adding books ... never finish another "currently reading".... no, it's too awful to contemplate. Our partners (if book geeks actually have partners) would never bother logging into our GR account and posting "It is with deep regret that we announce the passing of Barkybarkywoofwoof from cirrhosis of the liver with complications, no flowers please".

    Man visits his doctor. Doctor says "I've got some bad news, and I'm afraid I've got some even worse news." Guys says "Okay, I'll have the even worse news first." Doctor says "Okay, you have terminal cancer. The other news is that you also have Alzheimer's." Guy takes a deep breath and says "Okay - well, at least I haven't got terminal cancer."

  • Larry Bassett

    My Dad is ninety-three. I bought this book to share with him some time ago as we have been grappling with the Inevitably of Death for some time now. He is relatively healthy and he has always counted on living at least until ninety-six, the age his father died. But this past year his sharp mind has begun to notice his body lagging somewhat. He likes to have his “four wheeler” to help him get around and dozes more frequently sitting in his chair. “Maybe I won’t make it to ninety-six,” he says.

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