How We Die: Reflections on Life's Final Chapter

I have a friend who has gone through chemo to cure cancer. The chemo has damaged his veins causing his body to not get enough oxygen which has caused severe high blood pressure. Prayers and Thank you for these authors who explain the dynamics behind the symptoms. mj Alpine OR

This is a sane and sensible treatment of a most painful subject. Nuland is not only a physician and writer, he is a compassionate human being and an educator. He aims in this work to teach us how to prepare for the inevitable, how to better understand how to deal with death when it comes. As he understands it there is a tendency to romanticize the final moments, to imagine the end of the drama is a kind of bedside scene in which family and friends gather to say farewell to one who peacefully slips off. Nuland would disabuse us of that notion and teach that Death is ordinarily more messy prolonged and complicated than we would like. And that it often comes only through the deprivation of the dignity of the suffering patient. He emphasizes that our human goal should be not to focus overmuch on the death of the person, but rather on their life and its remembrance. He examines the major causes of death, Old Age, Cancer, Heart Disease, Trauma, Aids, Alzheimers. He gives us moving case - histories one of his own grandmother's passing from the world, the other of a young child suddenly killed. He underlines the point that no matter how healthy the person thinks they are they can never know when and how Death will come. No one has a guarantee of an easy way out. He does not really touch upon any religious or spiritual consolation. And though he indicates that he did say the Jewish prayer of mourning Kaddish for his mother he gives no indication that he believes in an afterlife. "If there is a God," he says, "He is present as much in the creation of each of us as He was at the creation of the earth". He again would have us focus on life. And so he warns against those who would struggle at any and all costs to artificially extend life through heroic measures i.e. he urges an acceptance of Death as inevitable and necessary. He on the other side he is in general against giving patients' the right to take their own lives. This work may tell some more than they ever want to know about death, and may help others better prepare for it. The late William Saroyan on his deathbed was seen shaking his head. When he was asked what it is , he said," I knew everybody had to die , but in my case I thought they would make an exception' They did not. For each and every one of us one of the most chilling facts of life is that we too will not be an exception. And as I write this I write it with a certain fear and a prayer to God for help.

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 h

I'm not sure what made me read "How We Die". It just appeared on my reader's radar a couple of years ago. First let me say that what I came away with was a profound sense of the awesomeness of human life and death, especially the awesomeness of physical death. The author explains in careful and graphic detail what happens to the body's systems under various scenarios that eventually result in the inevitable death of the body. Strangely, this information was more embracing and empowering than depressing and sad. Somehow, the knowledge of WHAT really happens when we die frees me to move on to HOW I feel about it and how I can deal with it. For me, the book stripped much of the power from various traditional, political, religous, legal, societal, and familial interpretations of this event, and allowed me to start to think it through for myself. Long after I finished the book, I found myself reflecting on the information presented by the author, and more importantly, digging deeply into my own psyche and soul to uncover what I really feel and believe. When my father died last year, I felt able to observe and participate in the process with less fear and dread, and more of a sense of power than if I had never read the book. While the events and circumstance of his illness and eventual death were extremely sad and difficult, I credit this book (and the mental and emotional effort I put into reading and reflecting on it) with allowing me to accept the fact that my father was going to die, and to deal with everything that had to be dealt with. Thank you, Dr. Nuland.