How We Die
by Sherwin B. Nuland
Summary
How We Die is exactly what its title promises, a surgeon's chapter by chapter account of what actually happens to the body in the ways most of us will actually die, heart disease, stroke, Alzheimer's, accident, AIDS, cancer, and the multiple failures of old age, and its unlikely bestseller run proved how hungry readers were for the honesty. Sherwin Nuland had practiced surgery at Yale for thirty years, and he writes the physiology with a clinician's precision, what a coronary occlusion does minute by minute, what sepsis is, why the dying stop eating, but the book's power comes from the stories threaded through the science, patients he treated and family he lost, above all his brother Harvey, whose death from colon cancer Nuland helped manage into exactly the overtreated, hope deformed ending the book exists to warn against. His argument is a correction aimed at his own profession and at the culture it serves: modern medicine has hidden death behind what he calls the riddle, the doctor's compulsion to solve the disease at any cost to the patient, and it has sold the public a fantasy of death with dignity that the biology rarely grants. What dignity is available, Nuland insists, lies in living fully and in dying without the final futile assault, among people who will tell the truth. The book won the 1994 National Book Award for Nonfiction, was a Pulitzer finalist, became a New York Times bestseller, and helped open the American argument about hospice, palliative care, and honest prognosis that has run ever since.
Historical Context & Significance
The book appeared in 1994, as the baby boom generation began burying its parents in intensive care units and the country was quarreling over living wills, assisted dying, and the costs of final month medicine; Nuland's clinical candor gave the debate a vocabulary, and hospice and palliative medicine grew partly in the space he cleared. The 1994 National Book Award honored a book that treated general readers as adults about the one universal subject. Nuland continued as one of medicine's finest essayists, and his much watched TED talk confession of the depression and electroshock treatment he had undergone in the early 1970s deepened the honesty the book had started. Palliative care physicians still assign it, and its chapters get read aloud in the family meetings it was written to make possible.