Dr. Sherwin B. Nuland died on Monday, March 3, 2014, at his home in Hamden, Connecticut. He was 83. The cause of his death was prostate cancer.
I had never heard of Dr. Nuland until news of his death was reported in the main section of The New York Times. I don’t as a rule make a practice of reading obituaries, so I might never have learned about this man if he had not been important enough in his field for the Times editors to take him out of the obituary section and place him in the news. They did it because after he had retired as a surgeon at Yale-New Haven Hospital and as clinical professor of surgery at Yale University, where he also taught bioethics and medical history — he wrote a celebrated book. It is called How We Die.
How We Die won the National Book Award for nonfiction in 1994 and was a finalist for the Pulitzer Prize in nonfiction in 1995. It has sold 500,000 copies worldwide, and continues to sell. At a time when the goal of medicine is to prolong life as long as possible by means of aggressive treatments that usually intensify and prolong the suffering of patients while depriving them of an easier death, Dr. Nuland’s goal was to demythologize death, to make it less frightening, and to encourage the dying to make decisions regarding their care with more reasonable expectations.
In July I will be 83. Having nearly arrived at that age, this description of the book was necessarily of interest to me — of sufficient interest that I pulled my ostrich head from the sand long enough order it from Amazon. Not having yet received it and read it, or read as much of it as I can bear, I now fall back on the obituary itself to tell you more of what’s in it. [It appeared in print on March 5, 2014 on page A20 of the New York edition of the Times.]
To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.
‘I have not seen much dignity in the process by which we die,’ he wrote. ‘The quest to achieve true dignity fails when our bodies fail.’ [Italics added.]
In ‘How We Die,’ published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital….. The issue [of physician-assisted suicide] has only intensified since the book was published, and has been discussed and debated in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy.
‘The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” he wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.’
Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, ‘How We Die’ was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.
In chiding physicians, Dr. Nuland pointed the finger at himself, confessing that on more than one occasion he persuaded dying patients to accept aggressive treatments….One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.
Looking back on that episode, Dr. Nuland wrote that he had mistakenly tried to give his brother hope, failing to acknowledge that disease, not death, was the true nemesis. [Italics added.]
…. In its concluding chapter, Dr. Nuland confessed that he, like many of his readers, desired a death without suffering ‘surrounded by the people and the things I love,’ though he hastened to add that his odds were slim. This brought him to a final question.
‘And so, if the classic image of dying with dignity must be modified or even discarded,’ he wrote, ‘what is to be salvaged of our hope for the final memories we leave to those who love us? The dignity we seek in dying must be found in the dignity with which we have lived our lives.’
Dr. Nuland’s death was reported by his daughter, Amelia Nuland. She added that he himself had said he was not ready for his own death. “He told me,” she said, ” ‘I’m not scared of dying, but I’ve built such a beautiful life, and I’m not ready to leave it.’ ”
If you want to know more of what’s in Dr. Nuland’s book without buying it yourself, let me know, so I can revisit this painful (but ultimately unavoidable) subject another time — after I’ve read it, or at least some of it.
Getting old isn’t always a blog-ful of laughs.