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Summary: Death comes to all; it's how you live that matters.
Review: Humans are probably the only animals capable of understanding their mortality and envisioning the day of their death. Sherwin B. Nuland shows, however, that while we conceptualize our eventual demise, most people have unrealistic expectations of their death. Misconceptions abound. The expectation of a noble death with loved ones gathered, final farewells, and then eternal slumber forms a common though inaccurate mental image of what many people look forward to in their final moments.There are several themes that permeate Nuland's books. One theme is that death, like birth, is a messy process. Though we may wish for the noble death, more likely we will die slowly from a lack of oxygen in the brain. This, in turn, will result from a failing heart, lungs, or blood vessels. Death does not come easy, and although the final moment is sometime serene and tranquil, months or weeks of painful physical degeneration often precedes it. The second theme in Nuland's book is that death is not only inevitable, it is necessary. While life should be fought for as long as possible, we should all realize that ultimately the battle will be lost. We will die. Nuland takes a dim view of heroic attempts to extend life beyond the point where the body has simply failed and death becomes not only inevitable, but also the proper way for nature to renew herself. Nature uses death to clear the way for new generations, and just as we cannot experience the green buds of spring unless the leaves from last season fall to the ground, the very nature of life demands that when death becomes inevitable we exit the stage for the next generation. Nuland's third point is that the measure of a life is not found so much in how we die, but in how we live and how we are remembered. Few of us can control the way in which we die. For some of us it will be quick, for others death will linger and the process will be slow and painful. Some will find humiliation in the loss of bodily functions or mental facilities. However it comes to anyone of us, death is just a part of our lives and the real meaning in death is in the life remembered. Chapters 1 and 2 focus on the heart, how and why it fails, and what are the consequences in terms of how death is precipitated. These chapters include some personal stories, but are mostly factual in nature. They make fascinating reading for anyone interested in how the body works, as well as those interested in death itself. Chapter 3 is one of the most poignant and describes the author's personal experiences in the life and death of his Grandmother who raised him after his parents died when he was eleven. Nuland is a medical doctor, and he describes the deaths of many people in his book, including the death of his Grandmother and his brother. All these descriptions are stark. There is no attempt to cover up the messiness of death, yet the stories are told with such deep compassion and understanding of the human condition and suffering that they bring a deep upwelling in the soul. Chapter 4 basically outlines Nuland's view that "Among living creatures, to die and leave the stage is the way of nature - old age is the preparation for departure, the gradual easing out of life that makes its ending more palatable not only for the elderly but for those also to whom they leave the world in trust." Chapter 5 describes Alzheimer's disease, and is one of the most interesting chapters in the book. This book includes some of the history of Alzheimer's disease, how the disease manifests itself, and how it kills. Like many other topics in his book, Nuland illustrates the subject by describing the process of degeneration and death due to this disease through his personal experiences with individuals he knew. The sixth chapter, titled "Murder and Scerenity," was difficult for me. It contains a vivid description of the death of a little girl by a knife-wielding maniac. The subject of the chapter is how the body produces chemicals that place it in a type of trance when under tremendous stress. The story of little Katie is very poignant. I hardly ever cry, but I did as I read of the way she died. Interestingly, though, I think that understanding the physiology described in this chapter can be a source of solace even for those who have lost loved ones through violent tragedy. Chapter 7 discusses suicide and euthanasia. Nuland seems to take a dim view of suicide as promoted by some organizations, but he seems to hold open the possibility of doctors taking a more active roll in the final moments of death as patients ask for help in the process. This chapter brought some personal reflection to me, since I'm from Oregon. I voted with the majority of my fellow citizens to allow doctors to help their patients end their suffering (Oregon's law has abundant safeguards and cannot result in euthanasia or death for monetary relief). Ultimately, though, our voices could be rejected. Interestingly, Gordon Smith, a Senator from Oregon, has proven fundamental in overriding the Oregon voters on this issue. Chapters 8 and 9 review the story of aids and how that disease kills it victims, while chapters 10 and 11 describe death by cancer. Chapter 12 summarizes, and leaves the reader contemplating the fact that it's all but certain we will each die by one or more of the processes described in Nuland's book. How we die, and how we will be remembered, however, are entirely up to each of us as individuals
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Summary: A Wise and Gentle Doctor On Death
Review: I came across this book by accident, yet I read it in one sitting. It is a book I believe everyone should read. Dr. Nuland takes the reader on a journey through the physical aspects of life's greatest mystery -- death. One would think that the topic of this book would render the reader sad or anxious. Instead, one finishes with a sense of comfort. Dr. Nuland allows us to see through his eyes (and his patients) what we fear most. By addressing this fear in clear scientific terms, as well as the inherent emotional and spiritual ones, we are allowed to face our fears and come to a calm understanding of what will happen to us all. Dr. Nuland dispels many myths surrounding how we SHOULD die and relates quite simply how we DO die. He discusses the current trends in planned death and explains that death usually is quite out of our control. The fact that it is out of control is what is oddly comforting. What we cannot control, we worry the least about.
I left this wonderful book with a new understanding of my own mortality, as well as the deaths of those who have gone before me. I cannot recommend this book too highly.
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Summary: great read
Review: This is a very well written and informative book that is especially relevant clinicians and aspiring health professionals. Highly recommended.
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Summary: An important and sobering work about a difficult subject
Review: This book by physician Sherwin B. Nuland is both important and sobering. In the first half, Nuland tels from a physician's eye (but with laymen's language) what happens when a person dies from cardiac failure, cancer, "old age", and other maladies. This sets up the two-part argument of the second half: (1) that death is a reality that must be acknowledged and squarely faced; and (2) that much "critical" care given to the terminally ill is the product of the physician's intellectual battle with disease (he names the diagnostician's challenge "The Riddle") and emotional reasoning on the part of both patient and family. His point -- and he makes it extremely well -- is that the dying and their families, while faced with certain grim realities, have choices concerning their final days, and some choices (both premature suicide as advocated by The Hemlock Society, and heroic efforts to prolong life) do little good and great harm. As I read this book, I thought a lot about my aging mother, now in good health, and the wrenching difficulties her final days (or years) will likely bring. Will she (and her family) have the courage to say to the doctors "no more", when the young oncologist or cardiac specialist recommends as a last resort a "promising" but excruciating course of treatment? What if her illness/disease robs her of the powers of reason and decision-making? Those in the "healing" professions should read this book, as well as those -- and I suppose that means all of us -- with elderly or ill family or loved ones. While the subject matter is depressing, Nuland's final arguments are not. Also, my goodness, can this man write!
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Summary: Imminently important read
Review: A moving and detailed compendium of major causes of death, their physical causes and manifestations, and the effects on a victim's life and family. Tragically sad, yet realistic and imminently important, this book is a must-read for anyone who wants the truth about their body, their life, and how the beginning and the middle can affect the end.
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Summary: Extraordinary!!
Review: The author tries to explain experiences related to death both from medical and phylosophical perspective. He explains the major deseases (main causes of death), such as Alzheimer' desease, stroke, aatherosclerosis, cancer and just aging, in very clear and understandable language. But he doesn't stop at explaining what is happening technically with the body, he also proceeds with the desease progress as seen by the patient and other people around him. The author draws not only from his vast experience as a doctor, but also from his personal experience, which makes this book even more powerful. The main point of the book is that author belives we need to know about death to be better prepared to the end. I don't know about this but I just can say that the book left me quite depressed. It's not neccessarily a bad thing but the book is definitely not for everybody. Besides knowing the subject, Sherwin Nuland is a very good writer and this results in very convincing and powerful book. The only point that the author makes that I cannot agree with is that there is no reason to try to change the order of things in the world in regards to aging. The author believes that all attempts to prolong life are meaningless since there is an order in the world where young species replace old and that's how it supposed to be. I find such approach too 'weak' and passive, degrading in a way the purpose of humanity on Earth. Having said this, it does not affect my opinion that this is extraodinary book.
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Summary: Good book, but provokes anxiety
Review: This is a very good book, however, the atmosphere of
helplessness that it creates in the wake of the impending
agony of death makes me feel part of that agony even now,
as I live each minute of my still seemingly healthy life.
Though the book is very truthful and thought provoking
and does not invoke any afterlife myths unlike some other
books on the subject of death and dying, I would not recommend
it to sensitive people since it can increase suicidal
tendencies in our already very stressful world.
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Summary: Amazing book
Review: Well in all truth , this is the first book ive ever read that has more then 100 pages.. And it was able to keep my attention rather well. He describes some of the more well known ways of death such as cancer and homicide , At first I felt this might be a rather boring technical book scince it was the only one in my doctors office.. but the title drew me in. I read and read and read and when I was finaly finished after several visits to the office I was impressed to say the least , he explained in a very easy to understand manner that anyone could grasp even a first time reader. I now love books!
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Summary: Frank yet compassionate book about death & dying.
Review: What actually happens during "clinical death"? Why do we age, and what happens to the body? This National Book Award winner Particularly recommended for anyone in a position to explain these difficult processes to others. This award-winning account describes in frank yet compassionate detail just what most of us are likely to face when the time comes, Sherwin B. Nuland's How We Die combines erudition and eloquence in a refreshingly unsentimental look at the processes of death. A distinguished surgeon and gifted writer, Nuland illuminates the mechanisms of cancer, heart attack, AIDS, and Alzheimer's disease with precision and compassionate awareness. Why read such a book? Taking away the fear of the unknown can bring courage and peace in the face of a difficult time. This book presents unpleasant facts in simple language that anyone can understand. Chapters cover different types of death, making clear the physiological changes and medical choices that go along with each one. It addresses both medical and emotional realities of common conditions such as cancer, heart disease, AIDS, Alzheimer's, severe trauma, and just plain wearing out. (Be prepared to cry, since reading this book may make you experience feelings associated with people you love.) What makes this book such compelling reading is that Nuland brings to this subject all of the depth and breadth of his background AND his deep concern for the human condition. His long career at a high-powered academic medical center (Yale), his knowledge of the history of medicine, of literature and philosophy, and his own personal losses are all woven into his thesis. He is thus highly convincing when he criticizes physicians for becoming seduced by the intellectual challenge of solving "The Riddle" and making recommendations not in the best interests of the patient/family. But the power of the book is in its intensely personal depiction of these events and in the lessons which Nuland draws from his experiences. The message is twofold: very few will "die with dignity" so that (1) it behooves us to lead a productive LIFE of dignity, (2) physicians, patients, and families should behave appropriately to allow nature to take its course instead of treating death as the enemy to be staved off at any cost. Only then will it be possible for us to die in the "best" possible way--in relative comfort, in the company of those we love/who love us. A "must read" for those of us in the baby-boomer generation who, unfortunately, are going to have to deal with a lot of what's covered in this book over the remainder of our lives.
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Summary: Outstanding book
Review: This is an outstanding book. The author is able to explain the medicine in a very clear manner. He clearly has a gift for working with patients. He shares with us the mystery of death, and by doing so, the mystery of life. The book reminds me of how we are all connected by a common biology. I highly recommend it.
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