How We Die: Reflections of Life's Final Chapter, New Edition
by Sherwin B. Nuland

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

Book Review: Death comes to all; it's how you live that matters.
Summary: 5 Stars

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

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

New Edition: With a new chapter addressing contemporary issues in end-of-life care

A runaway bestseller and National Book Award winner, Sherwin Nuland's How We Die has become the definitive text on perhaps the single most universal human concern: death.  This new edition includes an all-embracing and incisive afterword that examines the current state of health care and our relationship with life as it approaches its terminus.  It also discusses how we can take control of our own final days and those of our loved ones.

Shewin Nuland's masterful How We Die is even more relevant than when it was first published.

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