How We Die: Reflections of Life's Final Chapter
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How We Die: Reflections of Life's Final Chapter

4.01 of 5 stars 4.01  ·  rating details  ·  2,947 ratings  ·  270 reviews
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 r...more
Paperback, 320 pages
Published January 15th 1995 by Vintage (first published January 1st 1993)
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Paul
When I log on to my Goodreads home page I always see many notices saying things like

Brainiac the Magnificent is now friends with Death By Radiation

Is This Catching? is now friends with My Mother Has Turned Blue

Tiny Little Aardvark is now friends with The Biker who Eats Babies

The Seventeenth Beatle is now friends with Barkybarkywoofwoof

But really, that's got nothing whatsover to do with how we die. At least, I don't think so. Unless these are all the names of angels.

As regards the book itself, s...more
Jamie
This book is an attempt by the author, a surgeon, to de-mystify the process of death. He feels that our modern expectation of a "death with dignity" leads to increased suffering when we confront the ugly reality: most people don't experience a peaceful, pain-free death; they don't die at home surrounded by their loved ones; they don't utter profound last words of comfort to those they leave behind.

He offers detailed, technical descriptions of the most common mechanisms of death, including vivid,...more
Abeer Hoque
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...more
Larry Bassett
My Dad is ninety-three. I bought this book to share with him some time ago as we have been grappling with the Inevitably of Death for some time now. He is relatively healthy and he has always counted on living at least until ninety-six, the age his father died. But this past year his sharp mind has begun to notice his body lagging somewhat. He likes to have his “four wheeler” to help him get around and dozes more frequently sitting in his chair. “Maybe I won’t make it to ninety-six,” he says.

I t...more
Richard Kramer
If you are alive, and might someday die, or know anyone who is alive and might someday
die, this might be one of those books you have to read. It takes the piss out of heroics,
and science, and the Dignified Death; it harshly regards the coldness of medical personnel dedicated to solving what
the author calls the Riddle and ignoring the needs of the person that provides it. He is hard on doctors, and hard on himself. Some books please, some entertain, some disappoint. Few,though, change you, and t...more
Paul Corrigan
I felt compelled to reread HOW WE DIE, starting with the chapters on Cancer, after my wife passed away from an aggressive form of breast cancer. Doctor Nuland is right on when he talks about how the specialists, for whom a disease such as cancer becomes a great riddle to solve, somehow withdraw from the patient's presence when the disease they are trying to interdict cannot be stopped with the assortment of chemo drugs and radiation therapy they have in their tool box. Yes, tool box seems like a...more
Rebecca Lech
A truly enlightening read for those who want to either know more about the physiological processes of terminal diseases, those with a family member or loved one suffering from one of the six common pathways to death Nuland outlines, or even those who simply wish to expose themselves in a relatively removed environment to the mysterious process of their ultimate fate, How We Die explores just that- the physical, mental, and emotional processes one goes through on the journey to the other side. Nu...more
Alexis
a well-written book. Dr. Nuland writes from years of experience on the topic of death, and how really there is no dignity to it. he explores this myth of 'ars moriendi' (the art of dying) and both the pathophysiology and mental/emotional states that accompany it. he argues against the modern 'hospital' death devoid of feeling, he reproaches biomedicine for it's mistakes in prolonging the lives of their patients for their benefit in solving the Riddle, and not for the patient's best interest... "...more
Bob Hoffman
It’s not new (1993), but Sherwin Nuland’s How We Die is a timely treatise on what’s going on under the hood when humans die. We all have to leave this world sooner or later, whether by heart attack, stroke, cancer, or accident, but in our culture, it’s not that common to think about or speak of our own demises. Most of us act, instead, as if we will live forever.

In these days there is also a tendency to hide death from view, particularly in nursing homes and hospitals. (As of 1993, 80% of Americ...more
Charity
The purpose of this book is to help people have reasonable expectations about death and is a plea for more empathetic doctoring; namely more family practitioners and hospice workers.

The author explains the physical processes that occur during death, starting with the process of aging. He then goes into detail about the ways the body can shut down and why. This may be too much information for some and although a little morbid, I found it well worth understanding. He also covers some of the most...more
Holly
Since we all share this experience, this is a must read. Honest and realistic yet still very tender in its approach. I read pertinent chapters to my Mom while she was dying of liver cancer. We both appreciated the insights. It empowered her to maintain a voice and make choice in a situation where she could easily have just gotten swept along by the current. Our lovely Hospice Nurse recommended it and it was a gift. Now that she has died, I can look back and say "We did right by our Mom".
Abby
A very well-written, unsentimental account of how it is that we actually die, what happens in our bodies, and which ailments are most likely to kill us. As Dr. Nuland points out, waxing eloquent about death is a very common theme among artists, but it is rare that we get to hear about death from someone whose actual business is living and dying. A thoughtful and important perspective. Recommended.
Lalena
I do want to actually finish it sometime. I think it's important to have accurate information about the process of dying instead of holding on to myths about what it's like to end this life. Dying is indeed messy, painful and undignified business. I'm grateful that this detailed account of how different diseases kill us is out there. Just wasn't ready to read it all right now.
Pamela Ward
I am in my second year of graduate school in the field of mental health counseling and I had the opportunity to meet a truly remarkable woman who works in the field of hospice care and grief/bereavement counseling. She made me look at grief and bereavement in a totally different way. So anyway, now that I'm considering this option, I found this book and was hoping it would teach me something. Dr. Nuland presents the facts about how we die in a straightforward manner and I believe his message is,...more
Wendy
Mar 10, 2009 Wendy rated it 4 of 5 stars
Recommends it for: people who are curious about death
I am only giving this book 4 stars because I am not the most medically/scientifically minded, so sometimes it made me say "huh?" and I had to go back and reread certain things to really get a grasp. Lots of big words and new ideas here for me.

That being said, since having a life now touched by death, I have looked to solace in the biological (as opposed to the spiritual) aspect of what it means to die and be dead, so this book was pretty good for explaining how death happens physically (if you...more
Tracy
Oct 13, 2009 Tracy marked it as to-read
I have been reading this off and on, skipping around and reading different chapters. It is so relevant to the work I do. The author draws upon his experience as a physician as well as the losses experienced in his own family. (One very touching account of his grandmother "Bubbeh" and her last months following a stroke, and how the family cared for her.) It spares the reader none of the explicit detail of what is occurring in the body during a particular illness or injury, but he weaves in the em...more
Nathan
For some parts of this book its helpful to have an anatomy/physiology background of any sort, but even if you don't Nuland explains really well. His detail is great, he says he has a photographic memory, and I believe it. I was astounded at the details of his memories as a child, jealous really, since my memory is crap. I like his theories even if unproven or unscientific (in the sense that they have not been proven, but there is evidence of its distinct possibility). Nuland basically takes the...more
Eva
Super interesting in the beginning, but then petered out. Some quotes:

The chief ingredient of the [“good death”] myth is the longed-for ideal of “death with dignity.”

I had read that the sensation imparted by a fibrillating heart is like holding is one’s palm a wet, jellylike bagful of hyperactive worms, and that is exactly the way it was. – p7

Nowadays, very few of use actually witness the deaths of those we love. Not many people die at home anymore….approximately 80 percent of Americans who die...more
Debbi
How We Die is a sometimes raw look at the different ways we will all face death and End of Life issues. The author, a surgeon, doesn't hold back, even when it means facing his own failings as a doctor and brother (his brother died of colon cancer a few years before the book was written).

The Dr. Nuland's discomfort with the vast amount of intervention at the end of life often mirrored my own thoughts and concerns as my convictions on childbirth have migrated to End of Life decisions.

“Beyond the...more
Bobby
Though not quite as accessible as other medical writers like Atul Gawande or Abraham Verghese, Sherwin Nuland's book is definitely very thought provoking, even if a bit depressing at times. The description above does a pretty good job of explaining what the book is about. There are some rather dry parts here; for instance, when he explains how the heart/blood circulation works. On the other hand, it's one of the best BRIEF descriptions of the working of the heart written for a lay audience (albe...more
Lynn

I found it fASCINATING!
When I was working at Columbia Med Cntr (Columbia Presbyterian to long-time New Yorkers. I went to a lecture he gave. Very clear, but compassionate.

If you like MD lit, I would recommend Healing from the Heart by Mehmet Oz. I bought in the med school bookstore when he was a heart surgeon and co-founder of the Complementary Care Center Center, and before
Oprah made him a celebrity.

One more, My Own Country by Abraham Verghese. He wrote it when he was a young Indian doc in th...more
Jill Sansone


Nuland's book was a way for me to develop a new (better?) perspective on the recent death of my father. Nuland's knowledge, wisdom, humanity, and, well -- balance-- provided everything I would have hoped for.

None of us wants to contemplate the end of life--either our own or that of loved ones-- but HOW WE DIE is like a lamp casting a little bit of light down a dark alley that I have never wanted to acknowledge. What's more, the book was a comfort, and in its exploration of illness and death, som...more
Justcasper
I have just finished reading a few chapters in Nuland's book How We Die, it describes how our physical body deserts its owner in different situations of death. I myself felt a sense of chill when I read the naked literal words and it makes me feel so powerless in the face of even a natural heart failure. As a student in psychotherapy I feel like a child fighting death with a wooden stick, suddenly all my knowledge abandons me and is replaced by mocks of competing with the finest nature design. U...more
Jeff
Aug 01, 2014 Jeff rated it 4 of 5 stars  ·  review of another edition
Recommends it for: Cristian (you know you were thinkin of readin it so do it already!)
Recommended to Jeff by: Cristian's bookshelf
I learned quite a bit about disease, anatomy, medicine, science et al from this otherwise philosophical (and only occasionally moral) book. I recommend it for anybody in the mood for hard truths about the brutal facts of life.

Some Goodreads reviewers criticized the AIDS chapters' currency so i had to look up the numbers. HAART therapy became the standard of care 3 years after this book was published and mortality rates improved drastically. (See Figure 24). The sad racial/ethnic disparities in c...more
Sondra Wolferman
The author does a very good job of describing in layman's terms the physiological changes that take place within the human body as it ages, losing its ability to ward off the diseases that will inevitably lead to its demise. However, with such an intriguing title, I expected more from this book. The focus is almost exclusively on the physical realm and there is little information here that cannot be found in any reputable medical textbook, journal, or even popular literature dealing with the var...more
David
While on a trip abroad to Trinidad and Tobago, a conversation with two women (nurses from San Francisco, if memory serves)brought to my attention this book by a Yale professor. It came highly recommended to any person thinking of the physical and mental failings of old age as well as particular organ and neurological deterioration which bring consequences on the functioning of the human body during its last effective time.
This remains in memory as a superb expression placed on the record by a ve...more
Peggy
This book is a must read for anyone over 60 and perhaps many under as well. Dr. Nuland states in his intro: "I have not often seen much dignity in the process by which we die" - this after 30+ years as a surgeon. His book describes the inevitable aging of the body. Even when we think we are doing just fine, irreversible internal changes are taking place in the body year after year. The good doctor also hopes to prepare patients and their families for the messy exit that dying often is and he cov...more
Andrew Updegrove
Nuland is a fluid and readable author with quite a few valuable insights to share. The book is loosely organized around the major disease conditions that result in 85% of all fatalities in the US. Some chapters work much better than others, however. The chapter on cardiac failure is detailed and interesting, while the chapter on Altzheimer's is mostly just a description of one person's decent into ultimate death, with little additional text of interest or value.

The other technical element I'd fa...more
Dina
I read this book several years ago and used to assign certain chapters as mandatory reading to my nursing students.
The chapter on the cardiac diseases was especially compelling as this was my area of expertise. I used many of his literary examples of how the heart a vascular system functions.
Excellent book.
Greg
Emotionally difficult to get through, but worth it. It will change your views of death for better AND worse. The author is a genius... your vocabulary will improve... and you will be in greater control when you and those you love reach life's final chapter.
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Sherwin Nuland was an American surgeon and author who taught bioethics and medicine at the Yale University School of Medicine. He was the author of The New York Times bestseller and National Book Award winning How We Die, and has also written for The New Yorker, The New York Times, The New Republic, Time, and the New York Review of Books.

His NYTimes obit: http://nyti.ms/1kxNtQC
More about Sherwin B. Nuland...
The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis Leonardo da Vinci: A Life Doctors: The Biography of Medicine The Soul of Medicine: Tales from the Bedside How We Live

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“The belief in the probability of death with dignity is our, and society’s, attempt to deal with the reality of what is all too frequently a series of destructive events that involve by their very nature the disintegration of the dying person’s humanity. I have not often seen much dignity in the process by which we die.” 5 likes
“Though biomedical science has vastly increased mankind’s average life expectancy, the maximum has not changed in verifiable recorded history.” 3 likes
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