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

This is must read for any one who has experienced life and still has questions about the physiology that surrounds death. This book take different disease processes and places them into the actual true life event that has happened, but make you understand the disease and what is does to the body. It is written well and a good fast read, understandable in a language that is not so medical and more lay man terms. I highly encourage this book to the new Nursing Grads that I have worked with, been reading this book for years now as a refresher to help my patient with the dying process.

The first chapter will grab you as Dr.Nuland discusses his first cardiac death. He then moves on to discuss our likely causes of death. From Aids to Cancer the "bones" of his book always contain a human interest story. But then the book bogs down when he starts explaining (in excruating detail) the intricate lives of cells and chemical or surgical intervention.

For example: he delights in tracing the origin of highly technical words from ancient Greek to modern times. Who, but medical students and etymolgy pedants will be interested in reading this.

This is really half a book, one part interesting and one part boring. I can't see a clear "winner".

Nuland writes in a clear, insightful, yet thought provoking manner. He describes in vast detail the cardiovascular system and how it's downfall can lead to death. However, he also provides humanistic insights into relationships with patients and how those feelings relate to death.

We are all going to die, but lately there is a huge fear of death. It is no longer considered partof life, but a failure of medicine. Dr. Nuland, with ample clinical explanations, reminds us that we will al die, explains the main common causes of death, and encourages us to live fully every day, because that is the only way to die well.

How We Die, Reflections on Life's Final Chapter by Sherwin B. Nuland was recommended by a family member. It was very informative and meaningful. The book I purchased was published in 1993. I discovered later that this book had an addendum in 1995. I was disappointed that the seller didn't send the new addition.

I saw this book during my reading 'when breath become air' which i rated 3 star. this one is worse than that. For the record, the author does have some authority over the many diseases, symptoms, organs, etc. I have no doubt about his knowledge as a doctor, clinical one, having much experience than most of us witnessing, feeling, reflecting death. But the book itself is tedious and dry. I wanted to finish it but I failed. The first few chapters are better because it's logically coherent and do explains something helpful. The part about how the heart works is definitely the most interesting part in this book and the only part with a picture illustrating the flow. As the book goes on, less and less details are given, more and more sentimental and superficial philosophical thoughts are presented. Narratives of stories are off the subject and entangled with numerous nouns appeared as abruptly as they can be. I just cannot finish it.

The font used in the paperback edition is very, VERY small; similar to a 7 or 8 computer font. Would need a magnifying class to read it. Returned and ordered the Kindle edition. That way I can adjust the font to a more readable size.

This review is not of the contents, but only of the physical condition of the book. The book came promptly. It was in new condition in the sense of not having been used. However the paper was slightly tan, I suppose dried up somewhat. Perhaps not an ideal storage place.

The title is misleading and disappointing. I expected philosophical thoughts on end of life issues but instead got a boring litany of the diseases that kill us, and we all are aware of heart disease, cancer, etc. I wish I could return a Kindle book. I will erase this one and recommend Atul Gawande's beautiful book, Being Mortal.

I have been meaning to read this title for ages. The new ed is pretty much the book from the 90's.
Nuland can't be anything but what he is - a surgeon and physician. He has trouble distancing himself from the medical end of life, i.e. you are in a hospital and they are going to do everything in their power/your money to keep you alive. There are times when he does stray from htese roots, but always seems to migrate back to them. Mention is made of hospices and the right to die, but only in passing. Assisted suicide is dismissed, as not an option. He only alludes to having a family physician who is willing to ease you through death.
The message I get from him, is that the proper thing is to trust in the AMA even though, they cannot do anything about your certain death, the pain, suffering and costs, it is unfortunate, but just part of the process.
Not a humanistic view of death.

Considering the subject, this isn't the easiest book to read, but it's certainly one of the best. By easiest, I don't mean that it's difficult to understand, it's just very hard hitting, as we all know that we're going to die someday. Dr. Nuland writes about a subject that very few of us want to think or talk about, yet something that 100% of us will face. He does so with compassion and empathy, and yes with even a bit of humor.

Nuland explains in layman's terms the process of dying, and all of the various diseases that will take us there. There are compelling stories of his and other doctors patients interspersed throughout, and we gain a real insight into both the physical as well as the emotional aspect of the dying process.

This is not what I would call a depressing book at all. Rather, it's a factual presentation of the various disease processes that bring us to the end of our lives. It's a factual account of how our bodies work, and how they shut down when no longer capable of sustaining life. It's an important book for all to read, as it explains processes that most are unaware of, and enlightens us on how our bodies function.

I read this book when it first came out over 20 years ago, and decided to read it again. As I approach old age, I thought it would be a good idea to once again learn about the process of death and how society treats those who are in their last years of life.

A lot has changed since this book was first written. End of life choices and end of life care are nothing like they were even 10-15 years ago. Hospice has advanced dramatically over the years, and provides a level of care and philosophy that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, all while attending to their emotional and spiritual needs. While this existed when the book was first in print, it has now reached a level where those in need, can receive not just quality care, but respect and dignity in their final months of life.

I would recommend this book to all medical students, as well as to hospice workers and anyone else who wants to learn more about the last stages of life. This is a superbly written, and important book on a subject that few of us are willing to talk about. 5 stars.

The body get's old. The organs of the body fail. Most people die of the heart attack, stroke, cancer. Fine the body dies. The physical process is described but the interesting contextual questions are not posed or answered. Not a very broad or deep perspective in my opinion.

Not the most pleasant of subjects to address, but sooner or later we will all share the common unpleasant experience. Dr. Nuland takes us through a number of interesting and in some aspects stark realities of how we die and some of the controversies surrounding it. Dr. Nuland covers a fairly wide range of topics one being the somewhat romanticized version of drawing our last breath peacefully surrounded by our loved ones. Most cases in reality he says are nothing of the sort as the long drawn out pain and suffering comes to an end for the individual and shock of the witnessing loved ones. Not a pleasant scene to look forward to. If ones death can be framed that way.

Another aspect he delves into is the doctor and his relentless pursuit of saving the patient, not to mention the tab that is rolled up. Hope against hope we are pushed through the process of every last measure to our needless prolonged suffering in the cause of medicine. To me it seems barbaric but maybe I will have a different opinion at the time, but it is state of the art for now.

The inevitability of death and taxes is real and we must be prepared to face it as best we can. The book sheds light on things we need to consider now before are time has come. It is my hope that as us large group of Baby Boomer heads down this road the laws and ethical considerations of the easy way our will be addressed better. We should have more choice in bringing the end when it is certain. It seems absurd to me that so many are forced to endure the suffering and pain of their demise, yet convicted murderers sentenced to death exit in a dreamlike sleep.

Tenacity cannot be taught! It is a skill indicative of what a physician must be (having ability to impart life or death in seconds) to wield a knife, put in a central line or even slicing skin on humble, poor and forgotten patients in the grips economic hell. Dr. Sherwin Nuland lucidly instructs us in "How We Die."

Liked his term for Heart attack as "failure of a Valentine" which to me is medical poetry. In this book journey Dr. Sherwin Nuland dictates the process of observing a friend in the process of dying and using his tools of kindness, compassion and observation for a humane end.

Death is a natural and inevitable conclusion creeping up on the healthy and morbidly compromised patients. This book lays bare many end of life "options" and it's ability to impart clement solutions to a five-letter word that causes most anxiety ubiquitously. Buy, absorb and plan--while off the table and not under the knife.

March 3rd, 2014 83 years old. Prostate Cancer.

His daughter was quoted in USA Today: His daughter said he and his family had talked all the time about his illness and his impending death. She said there were times when he was "very much at peace" and occasional times toward the end when he seemed scared and sad.

"He wasn't scared of death itself, but he loved everything about his world and the people in his world and life," she said. "And he didn't want to leave."

"He told me, 'I'm not scared of dying, but I've built such a beautiful life, and I'm not ready to leave it,'" she said

I guess we could all say that. This book can be a tough read, but it's a good primer on what to expect. RIP, Dr. Nuland

I see on the store I purchased this book in 1998, done so on the recommendation of one of my brothers, around the time he was first diagnosed with an illness he eventually succumbed to a few years later. I was reminded (again) of the book when referred to in "When Breath Becomes Air" as Dr. Nuland had been a lecturer at Yale at the time Breath's author and his wife were there in medical school.

Beautifully and compassionately written, and explained in details that make sense to the non-medical people many of us are, I have used what I learned in this book several times to make sense of what would have seemed utterly senseless. Further, nearly two years ago I found myself unexpectedly in a situation in which I had to make a life and death call in the emergency room, choosing life without hesitation based on what I learned in the book and, in spite of the patient screaming about wanting to die. That person survives today, leading a productive and independent life, grateful for that decision.

This book is well worth the time but consider reading it at home if you're not into sudden public displays of unexpected and overwhelming emotion like I found myself, in the middle seat on a business flight.

In this book the author looks at the different way that people die and the idea of what is seen as a good death. The book starts with some of the most common methods of death such as heart disease and other symptoms of aging. What makes this book especially good is its combination of the mechanical descriptions of what is taking place mixed with personal accounts from the authors long career in medicine.
The idea of a good death is beyond the reach of many of us according to this book and I found this very difficult to read because who among us does not fear dying. But after explaining all the pain, discomfort, embarrassment and grief that accompanies dying Nuland also acknowledge that it is an essential part of life in that we must make room for those that are coming after us. To mean this was a cold but honest truth about existence. I did not find this book to be easy reading but I think that the discomfort that I felt reading is a reflection of how well written it was and the authors skill in explaining a very complicated topic. I found the chapters dealing with H.I.V/AIDS especially interesting and informative.
The book concludes that while in the end most of us wil not be able to have the good death that we would like and that it will be a difficult process for us and out loved ones, death is the conclusion of the much greater story of the life that lead up to it and that is what we should focus on. Death is the final chapter in the book of life for all of us and just like any story it must be appreciated as a whole and not just the conclusion.

Instead of writing a formal review, here is the email I sent to Dr. Nuland upon immediately finishing the book:

Dear Dr. Nuland,

Minutes ago, I completed reading "How We Die"; it is one of the best books I've read...ever.

The most eloquently formed sentences would fail to convey just how brilliantly it was written, and how profound the experience of reading it was. Not only do I no longer experience terror at the thought of death, but I have taken action and created remarkable changes in my life already. I now "get" it- No more fooling around. My charge is to LIVE my best life possible NOW. When it's time to go, it's time to go, and be it by accident or illness, I intend for my last moments to reflect on an awesome existence.

It's funny; with all the self-help books I've read over the years, not one has impelled me to such immediate and noteworthy changes in such a small amount of time as your book. I began reading this book in early December, and by my holiday visit home during the last 10 days of the year, I initiated 3 separate & extremely intimidating yet necessary conversations with my Mother, Father & Aunt that released 10 years of unspoken tension & heavy anxiety. 10 years Dr. Nuland!!!

For the first time in my life, I am not consumed by fear. Not knowing me or my history, I do not expect you to grasp just how earth-shattering that is for me. For the past 30 days, I have LIVED with a thirst and reverence for being alive like never before. So ironic that this should come from a book about death.

Your thoughtfulness & love for humanity in creating this book has impacted me immeasurably. I am misty-eyed. THANK YOU SO MUCH, DR. NULAND.
Ms. Campbell

This was an extremely profound book. I saw it in the stacks at the community college where I was worked as a librarian. Having since retired, I plucked it from the shelves to read.

Other reviewers here have skillfully summarized the contents of a book I believe everyone should read. Though the title may be off-putting to some, the book reports on the physical processes of dying, and his perspective as a physician who has sworn to alleviate suffering and promote wellness. He also talks about how humans have been taught to think about it. A natural process though it is, it is our last act on the planet - to expire, and to make room for others, as the many trillions and billions of life forms that have done the same for us - it is prohibitively frightening to many...and those are the very people who would gain valuable insight to nature itself.

I unfortunately have seen many die earlier than they should have - and I have worked with the dying, and I believe have less of a fear of it than mainstream Americans do. That said, the book makes the reader think about his or her own mortality in ways than might encourage them to look at their existing lifestyle and make healthy changes.

Dr. Nuland has succinctly captured the relatively few ways the human body succumbs to illness and injury, but this book is anything but a depressing read. It is fascinating, and through his descriptions of events from his own life and practice, Dr. Nuland actually gives life to death by addressing it head on, with no euphemisms needed. It's adult talk, for an adult audience. He treats his readers as intelligent world citizens who are interested in his experiences during his life's work.

I walked away understanding the dying process, and the way we perceive death, much more clearly. The one major thing I have taken from this book is our unfortunate ideal to make life itself the ultimate goal, regardless of cost. So many people suffer unnecessarily; why can we as a human race make safe avenues for people to end their own lives *if there is absolutely no possibility of improvement.* Euthanasia figures prominently in one of the chapters, and it is the one that made me think very seriously about how my end will go, when it is time.

Lastly, at book's end, the quoting of the final lines of William Cullen Bryant's "Thanatopsis" (A poem I actually had to memorize as a junior in High school in the 1970's) was absolutely stunning, and beautiful.

I encourage everyone to consider reading this book - you will be a better person, and have a better understanding of life and death having done so.

I wish I had known about this book before my Mother died. I wish I had read it with time to spare, so that I could have understood my Mother's last months.....so that I could have spent the remaining time we had together giving her what she needed......instead of what I so misguidedly thought she needed. I could have avoided times of anger, frustration, tears, and guilt. And I could have learned so much more about my Mother as she prepared to leave. I think of new things to ask her every day........
How We Die is not only about death but it is also very much about life.

Dr. Nuland encourages the reader to consider how he will face the end of life. For most, the subject is depressing and avoided but inescapable. So, assuming a position as a family physician for the masses, Nuland urges us to consider the topic especially in the event that we encounter the choice between extending our lives and the quality of that extension. Twice, recently, two friends who could have been subjects in Nuland's book demonstrated acceptance of what life had dealt them when their physicians candidly explained the health situation they were facing. One a 65 year old male with leukemia and the other an 82 year old female with traumatic brain injury from a fall. In each case, their primary care physicians described extraordinary medical interventions that might provide Hope but with a lengthy recovery period and no guarantees. In each case, the difficulties involved were plainly described. Independently, they both chose to accept the inevitable; eventually went to hospice; and died, we believe, peacefully. A third friend with lung cancer chose to fight the disease. For 3 years, she sought curative answers from mostly experimental programs. Her struggle was brave but painful for her and her family. Her family and friends rallied around her; provided encouragement and comfort but the inevitable could not be avoided. She struggled mightily and then succumbed to the disease. What we observe is Nuland's belief that what is needed is more family practice physicians who will have intimate knowledge of the patient's history and personal beliefs established through an extended relationship. In the first two examples that relationship existed but in the third the patient was handed over to specialists who were dedicated to solving the Riddle. Nuland suggests that dying in the care of a friend rather than railing against the inevitable in the care of a stranger is something for each of us to consider. Family practice physicians however apparently rank near or at the bottom of the medical hierarchy. Perhaps that needs to be reversed.

There are books that are great because of their literary merit, and there are books that are great for the depth of their subject matter. Nuland's book is both. It takes an unflinching look at death and dying and delivers in great detail a process that we must all go through and yet is so unexplored. The dead and dying are not able to speak for themselves. The living are concerned only with living. There is something tragic about the fact that when we realize how significant death is, when we are dying, we are least able to change our life or let others know what we are going through. Thus Sherwin Nuland's book is a work of great compassion and courage as he relates the experiences and thoughts of those unable to do so, and paint a vivid picture of their suffering as well as their illumination. For those who are dying it is a great gift in giving their experience to the living. For the living, it is a tremendous lesson in how to live.
"The dignity that we seek in dying must be found in the dignity with which we have lived our lives," the author concludes. In a world that is so death avoidant, where anything related to death is seen as morbid and unwelcome, to talk about death can actually liberate us. The only way to prepare for a good death is to live a good life. Death will be hard, no matter what, but the greatest consolation will be knowing that we have lived well. Reflecting about death is necessary; it helps us find meaning in our lives, use our time productively, and focus on what is important. For the dying we should not deprive them of the truth of their circumstance, otherwise we leave them to die alone and deprive them of the final consummation that comes with saying farewell. The great gift of this book is that it teaches us how to think about death when we have so few mentors in this regard.

This book is a series of essays combining both explanations of the physiology of the last moments of life and emotional responses to them. Nuland is a surgeon and medical faculty member at Yale University as well as an author on medical topics. In this book, written for general readers, he examines the topic of death in great detail, both its physiology and personal aspects. He takes up the leading causes of death in turn, including heart disease, old age, Alzheimer's, trauma, suicide, AIDS, and cancer, juxtaposing personal experiences of seeing family members or patients die of these causes with technical descriptions of how their bodies actual stop functioning.

As Nuland notes, death is a taboo subject in modern culture, so many people are unaware of the different faces that death can take. In the past, before people were sequestered in hospitals to spend their final days, death was more familiar. In this book, Nuland explains how each death is unique, some quiet and peaceful, while others are dramatic episodes of final struggle. Nuland's descriptions of the physiology of death and dying are quite informative as well as thought-provoking. Although the book touches on many medical topics, Nuland has written it to be accessible to any general reader, and the book has much worth discussing for book clubs or family reading groups.

In 2013 my Dad died of a massive heart attack without warning. What my Stepmom told me left many questions which led to what ifs which made my regrets worse. For two years I grieved and tried to find answers in books and articles on death in dying only to be left with more questions. A few days before the second year mark I picked this book up as a last attempt for answers. This book describes the physical aspect of death and describes the process our bodies go through when die. When I read the chapter on heart attacks and compared it to what I was told it matched and I was able to guess my Dads final moments. I cried then I felt comforted and at peace. When the day came that marked two years I didn't cry and I am longer a mess. This book is a great read for many reasons for me it was to heal.

A motto on the walls of hundreds of autopsy rooms all over the world can be translated as: "This is the place where death rejoices to come to the aid of life."

"How We Die" is a book where death rejoices to come to the aid of life. Distinguished surgeon Sherwin B. Nuland estimates that only one in five deaths is peaceful, or at least quick. The rest of us are doomed to prolonged suffering before we shuffle off of this mortal coil. However, if we know what our end is going to be like, if the mystery of say, death by cancer is explained to us, we might at least lose our fear of the unknown.

The first time I read this book, I didn't derive any comfort at all from knowing exactly how I might die. But now that I've been through the shadow of cancer, I reread "How We Die" and it didn't frighten me any longer. Dr. Nuland is right. It is better to know, especially since you may need to decide whether you want to be kept alive for as long as possible, no matter what the price in pain, indignity, and loss of function. The author serves as our Virgil, leading us down through the dread circles of terminal disease and accidental death in a graphic, unsentimental fashion. The only time he loses his cool is during his description of young men and women dying of AIDS. "What dignity or meaning can be snatched from such a death will never be known, except by those whose lives have embraced the life just lost."

The worst manner of death, no matter what the cause, seems to be at the hands of physicians who are willing to inflict the most drastic surgeries, chemotherapies, dialysis, and all manner of 21st century medical procedures on patients who have only a short time left to live, or who do not understand the risks and pain of the procedures that are being pressed upon them. Dr. Nuland was guilty of this type of major medical intervention on two patients who were dying, one of them his own brother. "I might have understood that my way of giving Harvey [his brother] the hope he asked for was not only a deception but, given what we knew about the toxicity of the experimental drugs, an almost certain source of added anguish for all of us."

The lessons that Dr. Nuland would like us to learn from "How We Die:"

* Your doctors are likely to want to prolong your life, no matter what the cost. It is up to you to decide whether the cost is worth the few weeks or months of prolonged life. What will your quality of that life be? For example, are you willing to accept a feeding tube, but not a ventilator?

* Fill out that advanced directive to either prohibit or encourage major resuscitative efforts, in case you reach a point where you are no longer able to speak for yourself. I had to answer this question for my mother on her last trip to the emergency room, because she had refused to think about what her end might be like.

* "The greatest dignity to be found in death is the dignity of the life that preceded it." The end itself is likely to be undignified, painful, and a source of anguish to our loved ones.

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.

A motto on the walls of hundreds of autopsy rooms all over the world can be translated as: "This is the place where death rejoices to come to the aid of life."

"How We Die" is a book where death rejoices to come to the aid of life. Distinguished surgeon Sherwin B. Nuland estimates that only one in five deaths is peaceful, or at least quick. The rest of us are doomed to prolonged suffering before we shuffle off of this mortal coil. However, if we know what our end is going to be like, if the mystery of say, death by cancer is explained to us, we might at least lose our fear of the unknown.

The first time I read this book, I didn't derive any comfort at all from knowing exactly how I might die. But now that I've been through the shadow of cancer, I reread "How We Die" and it didn't frighten me any longer. Dr. Nuland is right. It is better to know, especially since you may need to decide whether you want to be kept alive for as long as possible, no matter what the price in pain, indignity, and loss of function. The author serves as our Virgil, leading us down through the dread circles of terminal disease and accidental death in a graphic, unsentimental fashion. The only time he loses his cool is during his description of young men and women dying of AIDS. "What dignity or meaning can be snatched from such a death will never be known, except by those whose lives have embraced the life just lost."

The worst manner of death, no matter what the cause, seems to be at the hands of physicians who are willing to inflict the most drastic surgeries, chemotherapies, dialysis, and all manner of 21st century medical procedures on patients who have only a short time left to live, or who do not understand the risks and pain of the procedures that are being pressed upon them. Dr. Nuland was guilty of this type of major medical intervention on two patients who were dying, one of them his own brother. "I might have understood that my way of giving Harvey [his brother] the hope he asked for was not only a deception but, given what we knew about the toxicity of the experimental drugs, an almost certain source of added anguish for all of us."

The lessons that Dr. Nuland would like us to learn from "How We Die:"

* Your doctors are likely to want to prolong your life, no matter what the cost. It is up to you to decide whether the cost is worth the few weeks or months of prolonged life. What will your quality of that life be? For example, are you willing to accept a feeding tube, but not a ventilator?

* Fill out that advanced directive to either prohibit or encourage major resuscitative efforts, in case you reach a point where you are no longer able to speak for yourself. I had to answer this question for my mother on her last trip to the emergency room, because she had refused to think about what her end might be like.

* "The greatest dignity to be found in death is the dignity of the life that preceded it." The end itself is likely to be undignified, painful, and a source of anguish to our loved ones.

This book should be required reading for anyone contemplating or facing their own death, life's final great adventure.

Probably best read before facing imminent death or the imminent death of a loved one. Read before the "final days," it can give an indication and an appreciation and understanding of what will happen in those final days and hours.

Essentially, the book delivers as promised. It tells what happens to us and to our bodies as we face physical death, how and why our bodies begin to shutdown, but more importantly, how we can react to that inevitable shutdown...

Written with great respect even admiration for the human spirit and the spirtual aspect of life. This is not a religious book, and it takes no position for what happens when we pass beyond the veil, but it does help us understand what it will be like as we approach that veil.

One of the book's strongest points is the author's admission of the mistakes he made in helping his brother prepare for and handle his (the brother's)approaching death. This is a strong and powerful read, but not in the sense that those terms are usually used.

I, for one, am keeping this book instead of passing it on, and should I live to get the ultimate diagnosis that is sure to come for most of us, I will read it again to help prepare for what is about to happen to me physically. I might not like it, but I will know, I will understand and, knowing and understanding, I can deal with it.

A good companion book for the Bible in preparing and thinking about one's final passage. The Bible (or other sacred book) can help you deal with your soul, this book with your body.

Sherwin B. Nuland’s book How We Die is a well-organized piece that I personally believe can apply to everyone. The tone used throughout the book is remarkably frank and easy to understand. The subject matter will apply to every individual at some point in their life, because, as stated in the book, “Whether to anticipate the events of our own final illness or to better comprehend what is happening to a mortally stricken loved one… we are lured by thoughts of life’s ending.” In addition to this being an attentive book, the real-life scenarios are perfectly described and utterly fitting for each chapter. How We Die can affect your writing style, perception of medical care, and appreciation for life.
Sherwin B. Nuland begins this book with a startling introduction into the realities and imminence of death upon every individual. He makes bold statements including the hypothesis that every human being is enchanted and perplexed by the idea of death and, in his own words, “We are irresistibly attracted to the very anxieties we find most terrifying; we are drawn to them by a primitive excitement that arises from flirtation with danger.” The first two chapters include information about heart disease and a personal story of the author’s first patient. Next, Nuland describes the tragedies of alzheimer's disease and the effects on the families of diagnosed patients. The chapters written on murder, suicide, and accidents are some of the best in the book, giving detailed accounts of each with unparalleled clarity. He describes multiple incidents of those items and gives his personal opinion on controversial topics relating to them. Nuland then writes about cancer and begins to close the book with a chapter on hope for inflicted patients. The author ends the book with a recap and a poem written by William Shakespeare.
As stated above, I believe that most individuals will find this book surprisingly interesting and applicable, especially those interested in scientific topics. Loss is a part of life, which means that a book relating to that is relatable to all.
Overall, I would personally rate this book a 7/10. I rate it so high because I believe it applies to many people and is easy to understand. On the other hand, this book includes so much information over such a short period, I didn't retain most of it. Sherwin Nuland makes many profound statements that leave you thinking about them for days after you've read them.
My favorite part of How We Die is the introduction. In the text it says, “Everyone wants to know the details of dying, though few are willing to say so.” This paragraph leaves you unnerved and guides the plot for the rest of the book. On the other hand, in certain parts of the book, the author drags on for a little too long when describing the clinical aspects of each disease. For example, “A vertical front-to-back wall of tissue, called the septum, separates the large space into right and left portions, and transverse sheet at right angles to the septum divides each of those portions into upper and lower parts, making four in all.” This quote shows just a portion of Nuland’s writing, but he continues on for many pages describing the build of the heart and leaves the reader feeling slightly bored. Although, of course, another individual may find that to be the most interesting part of the book.
In conclusion, I found this to be a very interesting book and would recommend to a friend. Though, there were long descriptions, the points Dr. Nuland makes are profound and correctly justified. Death is a difficult topic to discuss, but Sherwin Nuland properly outlines the intricate process and fully discloses the physical and emotional toll on more than just the patient, but also the family.

A detailed clinical deep dive into the mechanics of how we die. Excruciating to read without the purpose of the book in mind. That we need to let go of the fairy tale of"the good death,"and be honest with what can be our opportunity to accept and process this ending can afford us, emotionally and psychologically.
"of the many ways to die alone, the most comfortless and solitary must surely take place when the knowledge of deaths certainty is withheld." (p.243)
An important work, especially for those in hospice, medical or any end of life care.

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.

I've been reading a sobermindedly frank book. It's titled, How We Die, a National Book Award winner by Dr. Sherwin B. Nuland. Already, I sense people skipping on to other things. Why would a deliriously fun-filled guy like me be reading a book like this? You got me. Maybe it's because I want to know how people die. And why not? A person doesn't have to be a morbid ghoul to be curious about that, does he? More specifically, I guess I want to know how I will one day die. Will I be borne aloft on the wings of my guardian angel, accompanied by choirs of cherubim and seraphim--bells joyously pealing in the background? Perhaps my fate will be the other extreme. Maybe I'll plunge through a suddenly opened crack in the earth, fiendishly pitch-forked in the rear all the way down to some fiery terminal of woe. Of course, cracks do open up in the earth on occasion, and people and things do tumble down, but I don't think it has anything to do with deserved retribution. Nevertheless, that possibility seems more likely than the angel and bells scenario.
In his book about death, Dr. Nuland discounts both these romantic exits, glorious or demonic though may be. He takes a much more realistically blunt attitude toward death. Despite the fanciful Victorian perception that death is a somehow uplifting affair, oftentimes cleansing body and soul, his experience as a medical doctor is to the contrary. He has found that the vast majority of us will find the process an agonizing and grim affair. Nuland tells the explicit and none-too-reassuring details of how people die of heart disease, cancer, AIDS, severe trauma, alzheimers, and just plain wearing out. He says that very old people are usually dying of many things--it's just a matter of which disease slams down the coffin lid first. Sure, he says, some of us are lucky enough to proverbially die in our sleep, but that's relatively few. Most of us will feel the torment of death's grip, and it won't be pleasant for either us or our loved ones.
Nuland himself was awakened to the career-long prospects of grim death with one of his first patients as a third-year medical student. Because there was an emergency on the ward, Nuland had unusual autonomy over the admittance of a new patient named McCarty--even all the nurses were busy with the emergency. "McCarty greeted me with a thin forced smile," Nuland says, "but he couldn't have found my presence reassuring." Nuland says he still wonders what McCarty thought of this greenhorn supposedly taking charge of his case. Whatever, McCarty didn't get much time to weigh the pros and cons, because Nuland writes, "As I sat down at his bedside, he suddenly threw his head back and bellowed out a wordless roar that seemed to rise up out of his throat from somewhere deep within his stricken heart. He hit his balled fist with startling force up against the front of his chest in a single synchronous thump, just as his face and neck, in the flash of an instant, turned swollen and purple. His eyes seemed to have pushed themselves forward in one bulging thrust, as though they were trying to leap out of his head. He took one immensely long, gurgling breath, and died." Nuland says an experienced doctor would have known from the glazed eyes and fixed pupils that McCarty was gone, but his innocence wouldn't accept it. Nuland went on to make a mess of things by cutting open McCarty's chest, trying to resuscitate the wriggling heart that was past all help. Finally giving up, Nuland found himself bathed in sweat that was "pouring down my face, and my hands and my short white medical student's coat were drenched with the dark lifeless blood that had oozed out of McCarty's chest incision." He also realized that he was crying and that he had been shouting at McCarty to live.
Not what you'd call entertaining stuff, but nevertheless riveting for those of us not familiar with this territory. So what do I get out of a book like this? The sentiment is old, but so true: Live life to the fullest until I emit that final wordless roar.

How We Die: Reflections on Life's Final Chapter
When I found out that my 80 year old grandmother had advanced cancer and was choosing not to treat it... I found myself suddenly afraid for her because I was uncomfortable with the fact that I didn't know what would happen to her at the end. I didn't know anyone with cancer who chose not to remove it or treat it with chemo.

I bought this book because it gave me exactly what I wanted to know and didn't try to beat around the bush about the bodily processes that happen when we die.

At first I was only interested in finding out about cancer, but I found myself reading the book from cover to cover.

It is so wonderful to find someone who is willing to give the facts on this subject! It gave me great comfort because I knew what was coming and didn't have to fear the unknown... When my grandmother's disease progressed, I was ready. She passed on 09/02/2008.

Dr. Nuland has paid the price to achieve not only medical skills but a uniquely learned voice--his erudition and education makes this work a classic of philosophy. I was fascinated from start to finish by his interweaving of modern science and time-honored insights. He highlights the fact that the advance of science cannot bring comfort by itself but must be used with wisdom and an understanding of the purpose of life.

The book is an argument that mankind's time on earth is naturally limited and that the efforts of science to extend life sometimes miss the point. Dr. Nuland does not even spare himself in criticizing some of the excesses of modern medicine. Quite simply, he argues that there is a fate worse than death itself--that often the additional time purchased by science comes at a fearful cost.

However, Dr. Nuland is no Luddite--he does acknowledge the improvements that medical science has provided. But in discussing death by way of various case histories and personal experiences, Dr. Nuland hopes that we come to appreciate that death has a purpose and importance that when understood will lessen our fear and increase our appreciation for the gift of life. We are all alike subject to death and whether by a random accident, untimely disease or simply old age, the results are the same and must be confronted by all.

After reading "How We Die", I must warn potential readers that if you are anywhere in the neighborhood of depression, anxiety, or morbid fascination with death, you might want to skip this one. I have been a nurse for 30 years and have seen a lot of death, both at the bedsides of my patients and at those in my personal life, and have fortunately been spared the agonizing scenarios experienced by the author. And to say that there is no peaceful passing or possible dignity in death and that we all ultimately die gasping and grasping at the last vestiges of breath is a hard read indeed. Dr. Nuland details the various manners and mechanisms by which we die, including cardiac arrest, accidents, murder, suicide, euthanasia, Alzheimer's, AIDS, cancer, and old age, and although his writing is stellar, learned and lyrical, his reality is brutal. Yes, we all know we are born dying, that aging and degeneration, fate or illness and disease will be our inevitable demise, but Lord have mercy, Doctor, yours is a tough dose of medicine.

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!

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

Doctor Nuland's book, How We Die, is an important and reflective work on an even more important topic. Death is something that Americans have increasingly been able to shield from their eyes, as more deaths take place in hospitals surrounded by specialists rather than at home or in a hospice. How We Die chronicles these changes in dying, and serves as a basis for suggestions on how death could be made a more dignified experience.
Nuland uses different ways Americans die - heart disease, cancer, trauma, etc. - to start each of the chapters. He then covers both the medical details of death by that particular disease and also specific ethical issues concerned with the treatment of that illness. Also included in each chapter are remembrances of specific cases in which Nuland treated that illness; and many of these reflections are brave and poignant.
This book served as the starting point for a discussion in my bioethics class concerning the topic of death and dying. As a general rule, I think it would be a useful exercise to read this book with a group of some sort, to assist in sorting out the highly emotional issues.

I thoroughly enjoyed author Sherwin B. Nuland's writing style--to me it was sheer poetry. This fantastic book shines the spotlight on the most common, true causes of death, describing what our bodies go thru as age creeps up on us. I was sorry to see the book end. Delightful!

This is not a book of philosophy so much as a thoroughly readable book that explains how various parts of the body, including the cells and organs of it, age and ultimately fail. It also makes apparent that other simpler organisms are in a more anomolous position, dividing indefinately into separate organisms, making the original cell virtually immortal. One interesting example of cellular immortality is the on going life of cancerous tissue preserved in a culture medium for decades after the death of the person from whom it was removed. The ambiguous concept of death is also discussed as our society grows more technologically able to prolong the dying process without acheiving a guality of life for that individual. The ethical issues that have arisen are discussed thoroughly not only from the perspective of death in the United States, but from that of other countries with other cultures and legal standards regarding the dying. An excellant book on a difficult subject.

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.

In his book "How We Die" Sherwin B. Nuland describes how the U.S. Government in its annual "Advance Report of Final Mortality Statistics" neatly tabulates all the deaths by cause. And nowhere in the report is "old age" listed as a cause. In fact, this attitude is echoed by the World Health Organization - it is illegal to die of old age. There are many other wonderful facts and descriptions in this book. Now that it is 12 years old, I'm not sure if the statistics need to be updated but I would guess that how we die changes very little over the years.

Nuland, a practicing surgeon, has detailed the major causes of death - from sudden heart attacks to more lingering strokes to the very lengthy dying process of Alzheimer's. He describes the physiology, the pathology of disease in its relentless attack on the human body and how, despite all the advances of medical science, the disease always wins.

The descriptions aren't pretty. Nuland pops our bubble that dying can be done with dignity. But somehow, knowing the possibilities takes away some of the fear and dread. The stories are told sensitively as one would expect from a medical practitioner who has had some years of experience but also as one would expect from a brother or son or friend. Some of the more poignant descriptions are very personal.

Now that 80% of our deaths in America occur in the hospital, we need a book like this to remind us of the reality of death and to help us cope with that reality.

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.

This book tells you what to expect, from the perspectives of the patient, the family and loved ones, the doctor, and the laboratory technician. Fully informative and a good reference book. I read the part about Alzheimer's disease, which has afflicted my sister. While the news was not good, it is my nature to prepare and there is no better way to get this type of information.

Nuland opens by describing his initial, unexpected close-up encounter with death. On his first day as a medical resident, he was sent to help a patient calling for assistance, when no other medical personnel were available. He went to the patient's bedside, and the dying process he witnessed changed his thoughts about life, death, and dying.

Nuland describes many similar situations faced by individuals who witnessed the death of a friend or loved one. His insights are delivered scientifically, but with the utmost compassion. What I'd give to hear this man lecture!

Don't imagine that this book will leave you sad or uneasy. Read the book laying aside preconceptions and squeamish feelings. Knowing the science and understanding what happens in the body during the dying process will leave the reader enlightened and thankful that the humans -- an maybe other living creatures -- have their own "protective" powers. These "kick in" at the time of death so that the experience is as bearable and painless as possible. The description of Katy's mother watching her daughter die illuminates this point in particular.

A good cliche applies: this book is a "must read" for those interested in death and dying.

This book names and explains the most common ways in which one will die. My favorite quote from the book is "good health guarantee's nothing". By this the author means that you have no control over when and how you will die. A person in tip top physical shape could be killed by a natural disaster, a murderer, a freak accident, disease or could become very old and die a very slow and agonizing death. While an obese person may get colon cancer and wind up dying with a smile on his face.
All of the chapters of the book with the exception of chapter 8 is five star material. I enjoyed studying chapter 2 and learned a great deal about how the heart operates and exactly what happens when people get heart disease. I found the story in chapter 3 about the author's grandmother slowly deteriorating over the years and dying particularly poignant. He wrote about what was going on with her and explained why different things were happening. This made me reflect on what will eventually happen to me as I grow older (if I make it that far). I also found chapter 5 on Alzheimer's equally poignant. He wrote about how a woman's life changed after realizing that her husband had Alzheimer's. Reading about what the woman had to go through with her husband may bring tears to your eyes. There are other parts of the book which are just as sad, but the chapters on Alzheimer's and on the author's grandmother affected me the most.
In chapter 8 on AIDS, the author quotes the bible and seems to lose his objectivity to a certain extent by becoming emotional. As a muslim, I disagree with god ever being without sight or hearing as the author prefers to conclude with AIDS. If the natural order of things is not necessarily the will of god, then who or what is the natural order of things?
Enough books quote the bible, I will leave with a quote from the Qur'aan (english translation)
29:57 "Everyone shall taste the death. Then unto Us (god) you shall be returned."
Since everyone will die and be returned to his or her creator, everyone should prepare for that moment. "How We Die" is good preparation but is not the final word.

I still don't know how to approach the subject of death. I consider myself fearless in many respects, but death has always instilled in me a sense of terror for the unknown. Little did I know that I am not alone. The near hysterical celebration of life and the shielding away of all things anathema to life in recent times could be partly to blame.

This is about the book, "How We Die", by Sherwin Nuland, published in 1995, and how it affected me. There are times when while reading the book, I had to put it down because the clarity with which it describes the process of dying causes my heart to pound so strongly that I worry I might have a heart attack. How ironic and headline grabbing it would be to find the book on the lap of a dead man on his commute home. I had to read the encouraging reader reviews at the store.com to find the courage to continue reading, albeit a few pages at a time.

Sherwin Nuland finished medical school and so learned in the classroom every disease that kills us. As a surgeon, he saw patients under his care slip all the way through to the other side. According to his book, the hospital today is among society's central institutions, and so the public's view of death -- like no other time in history -- has been obstructed by the swinging emergency room double-doors, the hospital curtains, and the intensive care units leaving the masses ignorant of the inevitable that lies before each and every one of them.

The book describes how as soon as the heart stops beating, the body shrinks within minutes because blood no longer gets pumped into the face, fingers, toes, etc., and the skin's color turns into a deathly hue of pale blue. The pupils enlarge and the eyes become glazed that there is no mistaking one is now looking into the eyes of a corpse -- even for one who hasn't laid eyes on one before.

For a patient, diagnosis of a terminal illness marks the beginning of a lack of meaning for the word "hope", when discomfort, pain, and indignity lasting for weeks, months, and even years will begin to dominate that patient's final chapter on life. And all this, compounded by the constant, vexing feeling of what may lie beyond does not make the journey any easier. Attempts by doctors using the latest advances in medicine, along with experimental drugs that cause more side effects than anything else, will often add more suffering in exchange for the minimal gain of postponing the eventuality, making one question their worthiness, well-intentioned though they may be.

And this is when I turn to faith.

All religions speak of eternal life. That our soul or spirit or consciousness -- call it what you will -- continues to live after our bodies die is perhaps the most important requirement that any church must have a firm stand on. And with no visible proof from its spiritual leaders, a church's congregation can be rejoicing all day long about life and its blessings, but be left hanging dry when death comes knocking.

Nuland's book suggests that an individual's one goal in life -- a fleeting anecdote in the greater scheme of human existence -- should be how one wishes to be remembered, and constantly work towards that goal with the knowledge that death comes when it comes. The book stops short of spirituality, perhaps because, understandably, the world is divided when it comes to religion. But the book places great importance on spirituality as one of the viable sources of dignity for a patient during the final moments.

This is how I measure religion. Roughly speaking, science delves in life, religion, in death. I wish for my religion to guide me into living a meaningful life, such that I will have contributed to the betterment of life on earth, as others have done so before me. My chosen religion -- any religion -- must be there when my time comes. Because chances are, in this day and age of computers and high-tech health monitoring equipment, I will not be holding the hand of my loved one when I depart. That is all I ask.

I wish for my religion to preach about detachment from earthly possessions, indifference toward material things, humility, an almost-forbiddance of grieving in funerals, and place importance on the work of doctors. I wish for the saintly quiet and the pervading somber atmosphere that one would think is a requirement for meditating. But above all, I wish for my religion to know and instill in its teachings an underlying, common theme: death. Because for one's religion to know its place and to be so focused in preparing its followers, lighting the way for something that no one has come back from to say definitively what it's like, is perhaps the greatest blessing one can have.

For all intents and purposes, death is goodbye. I take comfort in the thought that the people I leave behind share in me the faith that I will not go my way alone.

I recommend the book to everyone.

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.

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.

How We Die was a brave attempt to look clearly at the inevitability of death and account for the manner in which it reaches so many of us in the modern world. It's relatively unsentimental and at the time of original publication contained current knowledge about biomedical phenomenon - not all of which were properly understood by the author at the time of writing.

The book provides a context for thinking about one's own end - we must all come to it sooner or later, and contemporary society leaves us uniquely unprepared for our final days. We live in such a culture of "now" and youth-orientation that the vast majority of people simply turn away from the idea that they too must die one day. Consequently, far too many end up dying by increments, wired up to machines and intubated with drips and catheters, suffering from the ravages of neurological decay and the unpleasantness of bed sores. The modern way of death is nothing if not ghastly.

Nuland's folksy outlook leads him to overlook a number of important points, however. In his chapter regarding the phenomenon of endorphine release during periods of trauma he muses on evolution in a totally misguided way; a similar error occurs when he considers the reports of near-death experiences (the so-called "tunnel of light" phenomenon). In these, and in several other instances, he simply doesn't think through the issues clearly and so we are presented with at best a vagueness of ideas and at worst a muddle. And when he's recounting near-death experiences it doesn't seem to occur to him to wonder if there are causal elements underlying the fact that the majority of people studied don't in fact report such experiences at all.

Likewise his attitude to self-ending (suicide) is also muddled, a consequence of his lack of intellectual rigor. There are definitely strong positions to be taken on either side of the argument, but the author seems to turn away from the logic of his own book in favor, once again, of vagueness and evasion based on nothing more than personal discomfort.

So in short this is a book worth reading but it's far from the final word. It would be great if someone could update it to include more recent scientific knowledge and at the same time bring greater clarity of thought to the various philosophical (and biological) issues that are raised within its pages.

What a simply amazing and compassionate book about death and dying. None of us wants to think about how or when we will die. For those of you who fear death, reading this book will help to ease many of your fears.

We often wonder just what a person feels or thinks about during the dying process and this book helps to answer alot of questions. It also addresses the question about just how long we should prolong a person's life.

I wish I had read this book before my mom died a few years ago. I was with her in the nursing home on her deathbed and I was left with so many questions that needed to be answered. This book would have been a great comfort.

After experiencing mom's struggle with Alzheimer's and being with her at the moment of death I started to prepare some type of document containing my final wishes. Before I read this marvelous book I had purchased a brilliant new publication by Renata Marie Vestevich called, "Grant Me My Final Wish: A personal journal to simplify life's inevitable journey." Ms. Vestevich has created a beautifully bound journal which will act as a person's ethical will. She gently guides the reader through the process of making their final wishes known. Inside the journal are places for you to leave behind your most precious photos as well as your most treasured memories. Long after you are gone your loved ones will be able to remember you through this beautiful journal. Use this journal along with this book to guide you through the process of having to one day, too, make that final journey. Prepare yourself now and rest assured when it is time for you to leave this earth that you will have made your wishes known as well as having left behind a living legacy for those you love.

My wife's uncle recently passed away from a stage 4 lung cancer - from diagnosis to death was about 4 1/2 months. Had the family read this excellent book, I would hope their anguish would have been less, the patient would not have undergone unnecessary treatment, in this case, radiation that made him uncomfortable, and lastly, the truth about his condition and prognosis would have been offered upfront. Instead they decided to reside in the 51st state, the state of denial. Many people just don't want to discuss it, don't want to learn much about it, and then they talk about a 'dignified death'. This is no dignity in deception, for the patient or the family, and ignorance in this day and age is a poor defense. In many cases in this book, the illnesses that ravage the human body are not pretty, but the author presents them in terms lay people can understand, so the end should not be a surprise. Most importantly to me, 'hope' is not false, and options re: treatment are open to patient and family alike. Lastly, goodbyes and rememberances can be made while the patient remains lucid and capable of comprehension. Dr. Nuland deserves great credit for this work -

This is a very easy read that gives basic background information, as well as personal accounts from the author's days as a practicing MD, on each of the diseases covered.

"How We Die" gives a rare glimps into little known facts about diseases which plague us today. The book also includes interesting facts, such as the origin of disease names but also gives insight into progression/pathology and a short history of each topic covered.

Even if you have limited scientific/medical training, you should be able to follow the author easily. If you do have a medical background, "How We Die" offers enough detail you shouldn't be bored.

There are already many good reviews so -although the subject may be one about which we try not to think too much or often- I will only suggest reading the following books, more or less related to the matter, in addition to Nuland's interesting work: a) "A Social History of Dying" by Allan Kellehear; b) "The loneliness of Dying" by Norbert Elias; and c) chapter 11th of "The Waning of the Middle Ages" by Johan Huizinga.

I believe this is a must read book for doctors and patients alike. While not cozy and comforting, it presents the facts in a wholly acceptable and honest manner.

I read this after both of my parents passed away from cancer 10 months apart in an attempt to make some sense of what they endured both mentally and medically. This book provided the answers and a great measure of righteous anger at the attending physicians and their attitudes that somehow they could cure the uncureable right up until the very last moment, depriving everyone of the necessary time to say the things that needed to be said.

This book will tell you that you, as the patient, must seek the truth about your illness as it isn't always handed to you by your physician. For the physician, it teaches how to tell the truth without destroying the time left to terminal patients.

HOW WE DIE came into my life when I needed it most--as I faced the impending passing of my mother. Dr. Nuland's words were not only medical and accurate, they were also comforting. We need to know how to die, how to prepare for it, and how to recover from it. We live in a culture where dying is hidden away in hospitals and our lack of experience leaves us absolutely terrified. HOW WE DIE calms our fears, and even though words cannot take away the shock and sorrow of death, this book brings much needed and timely solace.

Although great science books like those of Darwin and Freud profoundly influence society, not all influential science books are great. Surgeon Sherwin Nuland has drawn attention to the topic of death and dying in a format that is accessible to a large audience, and could lead to more informed debate about euthenasia and other end-of-life issues. Nuland informs the reader about the mechanisms of death in some depth, reducing the mystery and horror of the topic to the point that it can be dealt with rationally. The problem with the book is thematic uneveness. After the promising first chapter I expected to be forced into a cold hard look at that from which I usually hide my eyes. But Dr. Nuland is a charmingly emotional and empathetic fellow who can bear to look into the abyss only sporadically. For example, he spares no details in cataloging the effects of cancer on the organs, but then lapses into the literary in his comparison of tumor cells to unruly teenagers. Like everyone else he has dealt with deaths of his patients, friends and family with protective emotional constructs that pop up with increasing frequency as the book progresses. His description of the dying AIDS patient's loving support group was downright gooey. Dr. Nuland also strays from his main theme and into public policy, where he is not convincing. He identifies human villians in Medicine's approach to dying; the specialists who won't give up when the cause is lost. He wants to "encourage" med students through discouraging policies not to specialize (note that Nuland is a specialist). This, I suppose, will protect patients from doctors who are technically qualified to try too hard. Nuland's advocacy positions are cheery news to HMO's that want to reduce the cost of end-of-life care.

Though I haven't picked up Nuland's book in several years, the recent circus surrounding Terri Schiavo's plight led me to track down any discussion of it.

It ought to be a primer for anyone asserting his or herself into the actual decision-making process with regard to how Ms. Schiavo is handled from this point forward -- if for no other reason, to not only dispel the myths about "painful starvation," but to shed light on the horrendous reality she has suffered for almost 15 years.

If Nuland had an opportunity to evaluate the Schiavo case, surely he'd consider a sequel.

If only.

The author begins with a graphic description of a horrifically invasive procedure he performed on a heart attack victim when he was an intern, then for chapter after chapter goes into way, way too much clinical detail on mechanisms of breakdown in organs and body systems. This approaches dying on a level that I found to actually be detached and distanced from what may be experienced by a dying person and those close to them. If you read any of it, I would recommend skipping to the last chapter, where among other things the author discusses the mindset of doctors that strongly inclines them to keep trying any and every treatment and procedure, even in disregard of their patients' wishes and/or best interests -- although he doesn't touch on the additional boost this kind of attitude is given by the health care industry's view of a dying person as a closing window of opportunity for profit. There must be better, or at least less clinical, books about dying out there.

Update: OK, although I haven't read it yet, it very much looks as though the better book I and other reviewers here were hoping for may be BEING MORTAL: MEDICINE AND WHAT MATTERS IN THE END by Atul Gawande.

This book not only medically explains the process of death and the decay of various diseases on the human body but gives small stories of patients through the doctor's eyes. Interesting and fascinating read and intriguing thoughts on death and dying. I recommend to anyone. A fuller understanding of how the human body dies and the process of death.

I am sure that many will enjoy this book. I thought it would be a more spiritual view of life and dying but it was very clinical. I am not a physician so it didn't help me understand the whole concept. We all die but I wanted read some anecdotes; some things people have experienced as they came to the end. Too dry for me.

I read this book shortly after my mother-in-law died of the complications that started as bone cancer in the early '90s. While I wasn't totally emotionally invested in her passing, she died in our house while my husband and I were present. I had always been afraid of death and this book took away my fear and replaced it with knowledge. Put another way, Dr. Nuland's book quelled some of my deepest seated fears and replaced them with an almost calm perspective on death and dying. I found this book and its philosophies to be uplifting, as well as realistic and pragmatic. I especially think I benefitted from his description of how death used to be a natural part of life and that modern society's way of hiding it has made the fear of the unknown worse than it has to be. I recommend this book to everyone who has a fear of death. I also recommend it to those who have lost someone to its throes. Death isn't pretty; I can vouch for that, but it is part of the cycle that begins with birth and is as natural as the sun going down each day. I wish I could thank Dr. Nuland personally for writing this book. I couldn't afford to purchase it then, but it will become part of my library of treasured books now.

I wanted 'TO KNOW'. While my dad was dying of cancer, I desperately attempted to get doctor after doctor to tell me about various aspects of his illness. Not once did I get an answer. After reading this book, in a lot of ways, now, I know.
(My only critism being that some of the phrasing and sentence structures made the book awkward to read at times.)

I cannot say enough good things about this book. It's one of my favorite books of all time. Of course, I'm a bit odd in that I find medical topics and CSI-type stuff fascinating. Beautifully weaves a variety of information in a logical style to explain everyday things such as why some older people have swollen ankles and what it says about their overall health. Perfect for anyone who likes problem-solving, diagnosing illnesses, and learning unusual tidbits along the way...

Nuland won the National Book Award for this frank and sometimes disturbing reflection on death. And while this is challenging material, especially for anyone who has nursed the terminally ill or suffered a grievous loss, How We Die ultimately puts death in its place, robbing it of some of its mystery.

Dr. Nuland provides a very through, comprehensive and enlightening description of a very taboo topic. He has used terms and descriptive language that is understandable by people who don't understand the medical lingo.
Unlike some of the other books I have read on the topic, this books explains the issues of interest in scientific form, that are easily understable and cover a wider range of topics than the ordinary topics affiliated with this taboo topic.
I wouldn't hesitate to recommend this book to anyone who is interested to be more enlightened and open-minded.

How We Die is a moving and unaffected book about one's dying. Dr. Nuland attempts to answer in uncommonly moving observations
what it looks like, what it feels like on life's final journey. Interestingly, upon reading the insightful descriptive stories, I believe the reader will look at life in a very different way.
I found Dr. Nuland to have the rare ability to explain the "hard to explain" status of dying in an easy, readable format. The seriousness of death was dealt with in a compassionate way and Dr. Nuland softened the message.

How We Die should be in every physicians and health care professionals library. The book is very readable and thoughtfully written. This book eases the fear of dying and discusses the many ways in how we die. Dr. Nuland approaches this difficult subject with great compassion and honesty.

I thought the book was excellently written, although somewhat unnerving. It clinically describes what happens to the body when one dies from various causes. The desciption of cancer was particularly eye opening. The author's vocabulary was awesome. The main reason that one should read the book is so that knowing what is happening to you, you can make more informed decisions. There are times when you need to ask for help and/or there is a time when you have reached the point of diminishing returns and should consider giving up the journey. The author asserts the point "There is no death with diginity." The dignity belongs to the well person and how they lived their lives.

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.

The subject of our own mortality is difficult to consider. However, this book allows the reader to contemplate all aspects of the end of life. The author's sensitivity and insight are like having someone to hold your hand as you undertake an unwelcome journey.

Offers insight into what is unknown and therefore frightening about the end of life. I wish I had read it before my mother's death last November. It also helped me form decisions about what "a good death" will be for me.

Health care workers should read this book. The author clearly has achived his goal of persuading the reader to be better at empathizing , comforting and loving those who are dying or in the throes of ilness.

This the only author who maintains that muscle cramps from exercise kill muscle cells, just like heart attacks kill heart muscle cells. I did not find confirmation anywhere else. So he's probably wrong.

While I liked this book, I'll admit that this isn't something I'd have picked up on my own, nor is it something I'd really recommend to people at large.

One of my favorite things about the book has to be how accessible Nuland makes the subject and writing. It's written to inform the average person without being self-congratulatory at his achievements or being overly dumbed down.

However at times the book could be a little dry and I occasionally felt my attention drifting in ways that had nothing to do with it being an assigned reading. There are parts to this book where you'll find yourself being incredibly fascinated by the history and knowledge in the book, but other parts where it's just kind of tedious.

If you're into end of life studies then this will be a great book to pick up. For everyone else this will be a library read.

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!

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.

Technical informations, personal experiences, history and philosophy put the reader face to face with the end of life aspects. Informations that will help take decisions when death is near.
The magnifying glass over physiology let the reader think about many others aspects of life.

Death always wins in the end no matter what. Knowing that we're dying gives us an opportunity to leave whole as opposed to living with false hope. A great read for anyone who's going to die; which is all of us.

Interesting although dated, this overview takes a paternalistic look at major groupings of the reasons why the human body gives out.

I thought the AIDS chapter (which was good for its time) could be updated as well as the one dealing with cancer.

I also wish there were references listed at the end of each chapter (or grouping) for readers to go for more detailed information if they were interested.

We all know of the various conditions that cause our death, heart, AIDS, cancer, murder, stroke. and euthanasia , the title I assumed I would be told of the body functions that fail and how they cause our death. The book is just a lot of words to occupy the pages to compile and form a book.
Useless

[...]

I got this book from Thriftbooks.com for $4 plus free shipping. It is supposed to be used, but looks to never have been opened. Hardback. If you are like me, you appreciate all bargains. Another is WOOT Deal of the day.

Bye bye

This book is a collection of ghoulish and voyeuristic accounts of human death. It strips the dying process down to the biological mechanics and then decorates them with flowery and dramatic language which demonstrates the depth of the author's narcissism and histrionics. It denies dignity in death and dying and only detracts from the field of palliative medicine and hospice. If you want to feel more hopeless about the dying process while being entertained by the cheap parlor tricks of a charlatan this book is for you.

Prepare yourself for a collection of voyeuristic anecdotal accounts of the dying experience. This book is void of any commendable consequence. I could not even offer it as a donation to a charitable organization. The book has been discreetly relegated to the trash bin beneath the putrifying garbage. There it will remain until next Tuesday, trash pickup day.