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

Sherwin B. Nuland

 

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 an insignificant natural event. Perhaps this fantasy of a courageous end, even among non-combatants, is meant to take the edge off what Thomas Hobbes pointed out, “... that continual fear and danger of violent death; and the life of man solitary, poor, nasty, brutish, and short.” 

Nuland wants to deflate the myth of death as a confrontation that should be engaged in with courage, fortitude, and spiritual energy. For him, “Death is the surcease that comes when the exhausting battle has been lost.” One might even say that death is a kind of victory over the attempts of medical science, pharmaceutical companies, and self-concerned families to avoid it. The release from pain, distress, and worry is in this light our ultimate blessing.

The core of Nuland’s book is the detailed description of the mechanisms by which most of us will die - heart disease, cancer, and infections of infinite variety. In addition to preparing the reader for more productive conversations with his or her end-of-life consultant physician, the text is mesmerising in its upbeat account of lethal bodily processes. I find his casual insistence about the inevitability of such processes to be oddly comforting. In dying, the abnormal is normal. Knowing that one is more likely to be better off cooperating with nature sounds to me like pretty good advice.