How We Die: Reflections of Life's Final Chapter, New Edition

239 Pages·1995·1.26 MB·English

by  Sherwin B. Nuland

Acclaim for Sherwin B. Nuland
“The story comes from a sensitive observer . . . who has seen much, taken much
thought, and written it all down with a superior gift for descriptive narrative. . . .
Nuland’s meditations . . . reflect a pragmatic, measured skepticism permeated by
an intensely human compassion.”
—Washington Post Book World
“Powerfully eloquent . . . a relentlessly frank and graphic description of the ways
human life achieves its terminus.”
—The New York Times
“As powerful and sensitive, and unsparing and unsentimental as anything I have
ever read.”
—Oliver Sacks “Nuland proposes what almost anyone who has been touched by
death will recognize as common sense. . . . [He] never shies away from the
cultural implications of his profession. . . . You cannot read How We Die without
becoming aware of your body, if only . . . to ask it impermissible questions. You
put the book down merely to pick it up again.”
—The New Yorker
“Stunningly frank . . . strips away the fantasy about what happens when the body
stops.”
—Newsweek
“Any reader who is not still convinced of his own mortality . . . is bound to be
altered in some profound way by this book. . . . This is knowledge we all should
have.”
—USA Today
“Nuland combines the clinical eye of a trained physician with . . . emotional and
philosophical reflectiveness.”
—Newsday
About the Author
Sherwin B. Nuland, M.D., is the author of Doctors: The Biography of
Medicine. He teaches surgery and the history of medicine at Yale, and is
also Literary Editor of Connecticut Medicine and Chairman of the Board of
Managers of the Journal of the History of Medicine and Allied Sciences. In
addition to his numerous articles for medical publications, he has written
for The New Yorker, The New Republic, and Discover magazine. His book
The Origins of Anesthesia is a volume in the Classics of Medicine Library.
Dr. Nuland and his family live in Hamden, Connecticut.
Also by Sherwin B. Nuland
The Origins of Anesthesia
Doctors: The Biography of Medicine
Medicines: The Art of Healing
The Face of Mercy
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Epub ISBN: 9781407074689
Version 1.0
www.randomhouse.co.uk
FIRST VINTAGE BOOKS EDITION, JANUARY 1995
Copyright © 1993 by Sherwin B. Nuland
All rights reserved under International and Pan-American Copyright Conventions. Published in the United
States by Vintage Books, a division of Random House, Inc., New York, and simultaneously in Canada by
Random House of Canada Limited, Toronto Originally published in hardcover by Alfred A. Knopf, Inc.,
New York, in 1994.
The Library of Congress has cataloged the Knopf edition as follows: Nuland, Sherwin B.
How we die / Sherwin B. Nuland.
p. cm.
Includes index.
ISBN: 0-679-41461-4
1. Death. I. Title.
BD444.N85 1994
616.07’8—dc20 93-24590
CIP
Vintage ISBN: 0-679-74244-1
7 9 C 8 6
To my brothers,
Harvey Nuland and Vittorio Ferrero
. . . death hath ten thousand several doors
For men to take their exits.
—John Webster, The Duchess of Malfi, 1612
Contents
Acknowledgments
Introduction
I. The Strangled Heart
II. A Valentine—and How It Falls
III. Three Score and Ten
IV. Doors to Death of the Aged
V. Alzheimer’s Disease
VI. Murder and Serenity
VII. Accidents, Suicide, and Euthanasia
VIII. A Story of AIDS
IX. The Life of a Virus and the Death of a Man
X. The Malevolence of Cancer
XI. Hope and the Cancer Patient
XII. The Lessons Learned
Epilogue
Acknowledgments
The eighteenth-century novelist Laurence Sterne once remarked that writing “is
but a different name for conversation.” The content and tone of a book or essay
are determined by the author’s perception of the reader’s anticipated response to
each sentence as it is given form on the page—the reader is always present. The
book you are about to read was conceived with no other plan in mind than that of
conversing with people who want to know what it is like to die. I have tried to
hear how a reader might reply to what is being said. By listening well, I hoped to
be able to address every response as immediately and clearly as possible.
The dialogue in these chapters, however, is only the culmination of other
conversations I have been having most of my life—with my family, my friends,
my colleagues, and above all my patients—with those who have been closest to
me and whose wisdom I have sought in order to come to an understanding of
what our lives, and our deaths, are about. To seek wisdom in another’s words is
much less difficult than to find it in another’s experience. I have looked for it
everywhere I thought it could be discovered. Even when I had no idea I was
learning from one or another of the vast number of men and women whose lives
have entered mine, they were nevertheless teaching me, usually with equal
unawareness of the gift they were bestowing.
Although most learning is thus subtle and unrecognized as such by either its
recipients or its providers, a great deal of it does grow out of the more usual kind
of conversation: direct verbal interchange between two people. In my own case,
the most extensive of those dialogues have gone on intermittently for years or
even decades, while a few have taken place only during the writing of the book.
If “conference [maketh] the ready man” as Francis Bacon claimed, then I have
been made ready for How We Die by countless hours in the company of
extraordinary people.
Several of my fellow members of the Bioethics Committee at the Yale–New
Haven Hospital have again and again sharpened my comprehension of critical
issues faced not only by patients and health professionals but at one time or
another by all of us. I am particularly indebted to Constance Donovan, Thomas
Duffy, Margaret Farley, Robert Levine, Virginia Roddy, and Howard Zonanna.
Together and individually, they have shown me an image of medical ethics that
is as humane (and even spiritual) as it is intellectually disciplined.
Thanks go also to another member of the committee, Alan Mermann, a