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Book: How We Die: Reflections of Life's Final Chapter
Quotes of Book: How We Die: Reflections of
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  1. Sherwin B. Nuland _ How We Die: Reflections of

    All along the way, family members have been experiencing feelings of ambivalence, helplessness, and crisis. They fear what they are seeing, as well as what they have yet to see. No matter how often they are reminded, many people persist in believing they are permitting conscious suffering. And yet, it is always so hard to let go. Such legal instruments as living wills and durable power of attorney may function as so-called advance directives, but all too often they do not exist; a grieving wife or husband, or children already struggling with family problems of their own, are adrift in a sea of conflicting emotions. The difficulty of deciding is compounded by the difficulty of living with what has been decided.
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  2. Sherwin B. Nuland _ How We Die: Reflections of

    This is the period when hard decisions are faced by families, having to do with the insertion of feeding tubes and the vigor with which medical measures should be taken to fend off those natural processes that descend like jackals-or perhaps like friends-on debilitated people.
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  3. Sherwin B. Nuland _ How We Die: Reflections of

    The originator of the literary form we call the essay, the sixteenth-century Frenchman Michel de Montaigne, was a social philosopher who viewed mankind through the scrutinizing lens of unadorned and unforgiving reality and heard its self-deceits with the ear of the skeptic. In his fifty-nine years, he gave much thought to death, and wrote of the necessity to accept each of its various forms as being equally natural: "Your death is a part of the order of the universe, 'tis a part of the life of the world...'tis the condition of your creation." And in the same essay, entitled "To Study Philosophy Is to Learn to Die," he wrote, "Give place to others, as others have given place to you.
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  4. Sherwin B. Nuland _ How We Die: Reflections of

    Far from being irreplaceable, we should be replaced. Fantasies of staying the hand of mortality are incompatible with the best interests of our species and the continuity of humankind's progress. More directly, they are incompatible with the best interests of our very own children. Tennyson says it clearly: "Old men must die; or the world would grow moldy, would only breed the past again.
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  5. Sherwin B. Nuland _ How We Die: Reflections of

    I recently discussed this with my school's professor of geriatric medicine, Dr. Leo Cooney, who later summarized his viewpoint in two pithy paragraphs of a letter: "Most geriatricians are at the forefront of those who believe in withholding vigorous interventions designed simply to prolong life. It is geriatricians who are constantly challenging nephrologists {kidney specialists} who dialyze very old people, pulmonologists {lung specialists} who intubate people with no quality of life, and even surgeons who seem unable to withhold their scalpels from patients for whom peritonitis would be a merciful mode of death. We wish to improve the quality of life for older individuals, not to prolong its duration. Thus, we would like to see that older people are independent and lead a dignified life for as long as possible.
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  6. Sherwin B. Nuland _ How We Die: Reflections of

    The patient dies alone among strangers: well-meaning, empathetic, determinedly committed to sustaining his life - but strangers nonetheless.
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  7. Sherwin B. Nuland _ How We Die: Reflections of

    Nowadays, very few of us actually witness the deaths of those we love. Not many people die at home anymore, and those who do are usually the victims of drawn-out diseases or chronic degenerative conditions in which drugging and narcosis effectively hide the biological events that are occurring. Of the approximately 80 percent of Americans who die in a hospital, almost all are in large part concealed, or at least the details of the final approach to mortality are concealed, from those who have been closest to them in life.
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  8. Sherwin B. Nuland _ How We Die: Reflections of

    Carolyn had told me that while he was still able, Bob had arranged to have his favorite words from his favorite work of Dickens inscribed on his grave marker, but still I was unprepared for their effect when actually seen. Engraved across the granite face of the footstone was the epitaph by which Bob DeMatteis had chosen to be remembered: "And it was always said of him that he knew how to keep Christmas well.
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  9. Sherwin B. Nuland _ How We Die: Reflections of

    Endorphin elevation appears to be an innate physiological mechanism to protect mammals and perhaps other animals against the emotional and physical dangers or terror and pain. It is a survival device, and because it has evolutionary value it probably appeared during the savage period of our prehistory when sudden life-threatening events occurred with frequency. Many a life has no doubt been saved by the absence of panicky response to sudden danger.
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  10. Sherwin B. Nuland _ How We Die: Reflections of

    It is probably a universal teaching of all cultures that putting a name to a demon helps to decrease its fearsomeness. I sometimes wonder whether the real, perhaps culturally subconscious, reason that medical pioneers have always sought to identify and classify specific diseases is less to understand than to beard them. Confrontation, somehow, is safer once we have set a label on a thing, as if the very process makes the beast sit still for a while and appear susceptible to taming; it puts under some element of control what has previously been a wilderness of unrestrained terror. When we give sickness a name, we civilize it-we make it play the game by our own rules. Naming a disease is the first step in organizing against it."
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  11. Sherwin B. Nuland _ How We Die: Reflections of

    Since human beings first began to write, they have recorded their wish for an idealized ending some call the "good death," as if any of us can ever be sure of it or have any reason to expect it. There are pitfalls of decision-making to be sidestepped and varieties of hope to seek, but beyond that we must forgive ourselves when we cannot achieve some preconceived image of dying right.
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  12. Sherwin B. Nuland _ How We Die: Reflections of

    Perhaps the mere existence of things undone should be a sort of satisfaction in itself, though the idea would appear to be paradoxical. Only one who is long since dead while still seemingly alive does not have many "promises to keep, and miles to go before I sleep," and that state of inertness is not to be desired. To the wise advice that we live every day as though it will be our last, we do well to add the admonition to live every day as though we will be on this earth forever.
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