Sunday, August 8, 2010

By Reviewed by Snow Philip

"How We Die: Reflections on Life's Final Chapter"

By Sherwin B. Nuland

Vintage, $16

Roberta Lowe, one of the eight gracious ladies in my reading group, Books on Wine, suggested that we read "How We Die: Reflections on Life's Final Chapter." Otherwise I'd probably not have read this book, preferring instead something to do with how we live.

But from the first page of Dr. Sherwin Nuland's book to its own final chapter, I was enthralled.

Nuland doesn't exactly take us on a romp through the various ways in which we die. But he does make it easy to read our way through the gamut and gauntlet of aging, disease, accident, homicide, suicide and/or euthanasia that will eventually see each of us out.

He conceived this book "with no other purpose in mind than that of conversing with people who want to know what it is like to die," he says. And to demythologize the process.

He writes in the best tradition of other physician-authors such as Atul Gawande and Oliver Sacks, and he refers to writers like Tacitus and Tolstoy. His book is a literary experience as well as a scientific and medical one.

By recognizing our universal curiosity about the details of dying coupled with the equally universal reluctance to admit to that curiosity, Nuland succeeds in lifting the veil that obscures those details. He does it by personalizing the accounts of deaths that he has witnessed: his first horrific experience attending a dying patient when he was still a medical student; the decline of his own grandmother; the murder of a friend's child; the peaceful leave-taking of a colleague.

By turns clinical and philosophical, Nuland warns that few of us will go gentle into that good night. Karen Frusher, one of our reading group's gracious ladies, says this book taught her that we need to rethink how we expect to die. We don't just smile and fade away.

We live in a time of cynicism regarding our medical system. When I finished reading Randy Shilts' "And the Band Played On," I was left with the impression that AIDS had for years been ignored by the American medical community. Nuland presents a different picture in his book, describing America's intense efforts from the earliest 1980s to discover the genesis of the disease. Nuland's book, in addition to enlightening me about how we die, restored a measure of confidence in medical research and care in the United States.

William Saroyan wanted to believe that, when it came to dying, an exception would be made in his case. I'd like to think that, too, but I now face the fact that all the research and care in the world will not alter the closing chapter of our lives.

Our big task in life is coming to grips with dying. When you've read this book and absorbed the clinical data, read Joseph Epstein's collection of graceful essays, "Narcissus Leaves the Pool," for another angle on a journey that is common to all of us. Then give some time to Julian Barnes' lovely book, "Nothing to Be Frightened Of."