Demystifying Death


By Sherwin B. Nuland

Knopf x 278pp x $24

The subject of Dr. Sherwin B. Nuland's How We Die: Reflections on Life's Final Chapter is of inevitable interest to us all. This is no poetic treatment; the book describes exactly what the human body does as it prepares to give up the ghost. Connecticut surgeon Nuland provides a scalpel's-eye view of the erosion of cells, tissues, organs, and life that occurs when we succumb to six major killers--heart failure; lung disease; Alzheimer's; murder, suicide, and accidents; AIDS; and cancer. He spares few gruesome details. "We rarely go gentle into that good night," he writes. Still, he hopes accurate information can at least "free us from unnecessary terrors" about how we'll go.

Nuland writes with real emotion, and in sharing his feelings about the deaths of people close to him, he becomes a compassionate guide rather than detached lecturer. His philosophical explorations of how far medicine should go to fight death are a bit disorganized, but he excels at conjuring metaphors for the enemy's strategies: A cascade of systems gone awry accompanies the "failing Valentine" of heart disease. Malignant, endlessly reproducing cancer cells are "a gang of perpetually wilding adolescents." Such images put dying in a context of biological logic and complexity, and thus dignity, even amid sadness.

Unfortunately, if you're squeamish, How We Die may remind you of that personable doctor you met at a cocktail party. He was interesting, but you feigned thirst when he began droning on about matters you'd prefer not to think about before dinner. You did make a mental note to call him should you or a loved one develop one of those nasties. Write down the name of this book, too, for a time when you may feel the need to separate real from imagined terrors.