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April 9, 2014

“How We Die”

by Anne Paddock

We rarely go gentle into that good night.

Several weeks ago while listening to “Fresh Air” on NPR, the topic was Sherwin Nuland – a surgeon, writer, and educator who died on March 3, 2014 at 83 years old. Nuland was the author of How We Die, an informative and groundbreaking book that describes death in both its clinical and biological terms in such a way that the reader doesn’t have to have a medical degree to understand the process. Published in 1994, How We Die won the National Book Award and was a finalist for the Pulitzer Prize. 

Unknown-6At the time the book was written, the prevailing treatment for terminally ill patients was to use all means possible to extend life even if those treatments also caused additional suffering. Nuland attributes this behavior to a cultural conviction among doctors that should an error occur in the treatment of a patient, “it must always be on the side of doing more rather than less.” Exposing the myth of “dying with dignity,” Nuland started a national debate about end-of-life, palliative, and hospice care that continues to this day. At the core of this discussion is how we all hold on to hope which should be redefined to mean “hope that your life had meaning to those who loved or cared about you” and not hope as in “a miraculous cure will occur.”

Reading How We Die was a lesson in which I learned the answers to questions often wondered but never asked. What really is cancer and how does it kill? What is a heart attack? Can there be serenity at death? How do patients move from denial to hope to acceptance? What happens as we age because I really can’t imagine this happening to me?

Never have I learned so much from a book. Divided into 12 chapters, How We Die explains heart disease, aging, trauma, suicide, AIDS, and cancer, in an easy to understand way that tells the reader it all comes down to oxygen, or rather the loss of oxygen. Heart valves are blocked, organs are smothered, tissues are starved…all these things happen with heart disease, cancer, illness, and trauma but

If we were to name the universal factor in all death, whether cellular or planetary, it would certainly be loss of oxygen. 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 oxygen’s cycle.

Sherwin Nuland was also well-known for his personal struggles. After enduring a difficult childhood, Nuland went on to NYU and then the Yale School of Medicine where he earned his medical degree and completed a residency in surgery. His career soared at Yale but his first marriage was profoundly unhappy and caustic, which contributed to a deep depression that led him to be hospitalized for months in the early 1970’s. In a Ted Talk in 2001 entitled How Electroshock Therapy Changed Me, Nuland talks about this period of his life and how electroshock therapy brought him back and allowed him to have a second chance at being a surgeon, husband, father, writer, and educator. The degree of personal disclosure is immense but only fitting for a man who believed that only by talking about the details could we best deal with our fears.

When it is accepted that there are clearly defined limits to life, then life will be seen to have a symmetry as well.

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