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How We Die: Reflections of Life's Final Chapter

4.06  ·  Rating details ·  7,582 ratings  ·  615 reviews
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 ...more
Paperback, 320 pages
Published January 15th 1995 by Vintage (first published January 25th 1994)
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Nov 01, 2020 rated it it was amazing
Shelves: american, culture, science
The Ultimate Indignity

Either our end will be painful but mercifully quick; or it will be gradual and exceptionally uncomfortable. Medical science makes the latter increasingly likely. Quite apart from the pain involved, the process of dying is always acutely humiliating. I trust Nuland when he says,“I have not often seen much dignity in the process by which we die.”

Perhaps this is why warrior cultures promote the idea of courageous violent death. Such an idea fetishises death which is otherwise
Paul Bryant
Jan 02, 2008 rated it liked it
Shelves: science
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
Abeer Hoque
Sep 24, 2010 rated it really liked it
Shelves: i-recommend
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
Jamie Collins
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,
Paul Corrigan
Dec 23, 2012 rated it really liked it
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
Sep 15, 2019 rated it really liked it

“Malignant cells concentrate their energies on reproduction rather than in partaking in the missions a tissue must carry out in order for the life of the organism to go on. The bastard offspring of their hyperactive (albeit asexual) “fornicating” are without the resources to do anything but cause trouble and burden the hardworking community around them. Like their progenitors, they are reproductive but not productive. As individuals, they victimize a sedate, conforming society.
Cancer cells do no
Richard Kramer
Oct 12, 2013 rated it it was amazing
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
Jun 25, 2017 rated it really liked it
Shelves: memoir, nonfiction
It's hard not to compare this to Kalanithi's When Breath Becomes Air. Like Kalanithi, Nuland is a surgeon who has written a book exploring themes/ideas surrounding death. Nuland's account is a lot less personal; for one, he didn't experience dying as he wrote the text. His inspiration for writing was not his own mortality but rather the result of decades upon decades of watching his own patients suffer through the so-called "hidden" process of dying. Nuland explores the more common ways that mos ...more
Larry Bassett
Dec 25, 2012 rated it it was ok  ·  review of another edition
Shelves: nonfiction
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.

May 15, 2017 rated it it was amazing
A beautifully written account by one who has witnessed many deaths, as a retired surgeon, in a hospital setting.

A scholarly and reflective depiction on the process of quietus.

Great insight for anyone who is concerned that one day they might die.
Jef Sneider
Apr 27, 2014 rated it really liked it
Shelves: medical-social
Sherwin Nuland, MD, was a well known and successful surgeon at Yale Medical Center for many years. In this book he begins to describe, literally, the way we die. In detail, he explains how infection and cancer and heart disease ravage the body and cause essential systems to fail. As a physician, I found it interesting, but I did not think I would finish the book if that was all there was to it.

Then the book began to hold my attention as it developed into an exploration of how people deal with dy
Manuel Antão
Jun 05, 2021 rated it really liked it
Shelves: 2021
If you're into stuff like this, you can read the full review.

The Handsome Hand: "How We Die - Reflections of Life's Final Chapter" by Sherwin B. Nuland

"Stand by me, Death, lest these dark days

Should hurt me more than I may know;

I beg that if the wound grows sharp

You take me when I ask to go.

Step closer, Love, and dry your eyes,

What's marred you'll never mend by tears;

Let's finish where the tale began

And kiss away the ruined years.

A moment, Faith, before you leave,

There's one last favour I would
India M. Clamp
Oct 25, 2013 rated it really liked it
Tenacity cannot be taught! It is a skill indicative of what a physician must be (having ability to impart life/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 instructs us in "How We Die."

Just engaging. Dr. Sherwin Nuland's description of Heart attack as "failure of a Valentine" was literary martini with olive on toothpick. In this book journey he dictates process of observing a f
Michael Perkins
Lest there be any doubt, it was doctors who created the opioid epidemic. Big Pharma was there, ready to pounce, but it was foolish, god-like thinking that set it up....


My father practiced medicine for 40 years, retiring at the end of 1982. Subsequent generations of doctors now consider my dad's time the golden era of primary care. He was a master diagnostician (he loved to say that it was no accident that the author of the Sherlock Holmes stories an
Lyn Elliott
Jan 03, 2013 rated it it was amazing
A remarkable book which my mother, my husband and I all read when my mother developed the heart condition from which she eventually died about 8 years later. Sherland combines scientific knowledge, medical experience, ethical concern and emotional sensitivity as he describes the stages people go through when they are dying of the most common conditions that kill us. It helped us all live with Mum's condition, has since helped through the passing of other close people and I hope will help us in t ...more
Dec 31, 2011 rated it really liked it
Shelves: medical
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
Jose Moa
Oct 22, 2016 rated it it was amazing
Shelves: meicine, favorites
As Adan was expeled from paradise for chosing freedom and knowledge ,paid a high price and was punished by his election so we being inteligent beings also have to pay a high price for our inteligence and be punished,our punishment is that we are aware of our inexorable future death and destruction as individuals that we will be departed of our loved ones and we will dont enjoy terrenal future life nor will know future world.
It is a cruelty of the evolutive path that create us inteligent and mort
Lệ Lin
Feb 23, 2019 rated it it was amazing  ·  review of another edition
[updated 2020 /english review]

I just realised I didn’t write an English review for this book after reading it almost two years ago but believe me, if I can recommend you only one book, this is the one.

Through the eyes of American surgeon Sherwin B. Nuland, the book examines the current state of healthcare (first published in 1994 but most of what he mentioned in the book is still applicable), analyses the moments when his patients walk on the thin string between life and death scientifically (
Sep 05, 2007 rated it really liked it
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
Patrick Peterson
6 Jan. 2019 - Wow - what a book.
I read this book because my folks are 89 and having difficulties, plus many aunts, uncles and pretty close friends died this last year and another friend wrote a very short, but very compelling review here on Goodreads (Reena Kapoor - Thanks Reena). This book was DEFINITELY worth reading for the reasons I mentioned above. But reading it, I found many more reasons why it was worth spending the time to savor it. Here are just some of the reasons, even though I know
Bob Hoffman
Jun 30, 2011 rated it really liked it
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
Jan 15, 2015 rated it it was amazing
Nuland died last year at 94 years of age. He wrote “How We Die” as a surgeon in New Haven Connecticut in his 70s looking back on his career and his life. What makes this book stand above most others, is Nuland’s wisdom and wonderful ability to write about how death has affected him both personally when dealing with family members’ deaths, but also outlining how his patients have died from different types of diseases, giving us a full, frank picture of the details and ways we could die personally ...more
Jan 20, 2019 rated it liked it
Interesting book, not what I thought it was going to be. A lot of technical information about death and the human body.
Feb 04, 2018 rated it liked it
Shelves: human-body
It’s no secret or surprise that much of my processing and understanding of life happens through reading. I’ve been a bibliophile since birth (literally– one of my dad’s proudest moments as a father was reading to me on the day that I was born); books are the primary way in which I explore the world, grapple with emotion, and make sense of the human condition. So, naturally, after the death of my grandfather on January 26th, one of my first instincts was to find the right story for this time in m ...more
Aug 29, 2020 rated it it was amazing  ·  review of another edition
The writing and story-telling captivated me from the first to the last sentence of this book, including the epilogue. I haven’t been up-to-date on the medical sciences since this book was written in 1994, so I can’t speak to the accuracy of the sciences and techniques, although I think the basics are still valid. I cried at the heartfelt stories because they conveyed successfully the author’s point of view as a medical doctor and as a writer. But there were parts of the book where the technical ...more
Pooja Goyal
May 04, 2018 rated it it was amazing
If I could give 'How we Die' more than 5 stars, I would. Having seen the deaths of some loved ones from close quarters, which gave rise to many difficult questions about the nature of death, the kind of death I want and more importantly why do doctors overreach their responsibilities ( is the reason only commercial or something deeper), this book helped answer many questions while explaining the logic and science behind them. Not only is Nuland's description of biology readable, he has the gift ...more
Jun 06, 2009 rated it really liked it
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
Apr 09, 2018 rated it it was amazing
I'm currently reading Being Mortal, and I thought back to How We Die and how profoundly it affected me. From the first page to the last, it had me in its grip.

And here's the thing. I read a review when the book was first published and rushed out to buy it. I was about 30. So the stories and vignettes highlighted in the book held a medical fascination for me. When I re-read the book 20 years later, wow. The perspective that the years bring really changed my experience. I had that "it tolls for t
Ardon Pillay
Feb 26, 2020 rated it it was amazing
Shelves: medicine
Death has and will likely always be a difficult subject to write about. However, Nuland has taken this challenge head on, analysing the physiology of death. No stone is left unturned as he explores how each key system in the body fails, considering each point of failure using first principles and clearly explaining how the end result comes about.

There is a fascinating blend of philosophy together with science in this book, particularly when Nuland considers what people mean when they say that t
Peter Welch
Apr 06, 2018 rated it it was amazing  ·  review of another edition
Important book

I read this as my 80 year old mom was rapidly dying from brain cancer. Some of the technical descriptions of major bodily functions are gripping, especially from the underlying perspective of their eventual failure towards death. Reading this as we sat for many days in vigil as my mom went through the dying process gave me a unique comfort that I’m deeply grateful for. It was comfort in the brutal transparency and absolute universal reality of death as someone I loved so deeply was
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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:

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Oh hey, we're nearly halfway through 2021! We can't really believe it either... Traditionally, this is the time when the Goodreads editorial...
56 likes · 9 comments
“The greatest dignity to be found in death is the dignity of the life that preceded it. This is a form of hope we call all achieve, and it is the most abiding of all. Hope resides in the meaning of what our lives have been.” 19 likes
“The art of dying is the art of living. The honesty and grace of the years of life that are ending is the real measure of how we die. It is not in the last weeks or days that we compose the message that will be remembered, but in all the decades that proceeded them. Who has lived in dignity, dies in dignity.” 18 likes
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