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How We Die: Reflections on Life's Final Chapter | [Sherwin B. Nuland]

How We Die: Reflections on Life's Final Chapter

There is a vast literature on death and dying, but there are few reliable accounts of the ways in which we die. The intimate account of how various diseases take away life, offered in How We Die, is not meant to prompt horror or terror but to demythologize the process of dying, to help us rid ourselves of that fear of the terra incognita.
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Publisher's Summary

There is a vast literature on death and dying, but there are few reliable accounts of the ways in which we die. The intimate account of how various diseases take away life, offered in How We Die, is not meant to prompt horror or terror but to demythologize the process of dying, to help us rid ourselves of that fear of the terra incognita.

Though the avenues of death, AIDS, cancer, heart attack, Alzheimer's, accident, and stroke, are common, each of us will die in a way different from any that has gone before. Each one of death's diverse appearances is as distinctive as that singular face we each show during our lives. Behind each death is a story.

In How We Die, Sherwin B. Nuland, a surgeon and teacher of medicine, tells some stories of dying that reveal not only why someone dies but how. He offers a portrait of the experience of dying that makes clear the choices that can be made to allow each of us his or her own death.

©1994 Sherwin B. Nuland; (P)1994 Random House Inc. Random House Audio, a division of Random House Inc.

What the Critics Say

  • National Book Award, 1994

"Drawing upon his own broad experience and the characteristics of the six most common death-causing diseases, Nuland examines what death means to the doctor, patient, nurse, administrator, and family. Thought provoking and humane, his is not the usual syrup-and-generality approach." (Booklist)

What Members Say

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  •  
    Ruth Upper Kingsclear, NB, Canada 07-16-08
    Ruth Upper Kingsclear, NB, Canada 07-16-08 Member Since 2004
    HELPFUL VOTES
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    "Required reading for those still breathing"

    This book places the responsibility for living and dying where it should be placed, firmly with the individual in process.The suggestion that modern western medicine can and has made life easier is countered with the fact that sometimes, it can prolong life too far, and then allows more suffering than was necessary. It is up to each person to decide whats enough. Thats a hard choice, when you begin to balance what others want, who you will dissapoint,and so on.A very thought provoking look at death in its visceral form, sometimes messy, emotionally charged, very human.

    12 of 12 people found this review helpful
  •  
    Amazon Customer Portland, OR 01-05-08
    Amazon Customer Portland, OR 01-05-08 Member Since 2007

    amazon fan in portland

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    "Good Account of the Facts"

    The author tells the story of death through case studies. The first two case studies deal with sudden death by myocardial infarction (heart attack) - one resulting in death, the other saved by CPR. There is a no sugar coating of the facts, just a very careful and illustrative accounting. My first two takeaways were improve my eating habits and to teach my kids CPR so that I may survive my "golden hour" if I have a heart attack. The author then dispels the "died of old age" myth and describes the the telltale, small signs of decline in aging. I think the factual approach is refreshing. I was unprepared for death of my father that died similar to his grandmother. I was unprepared for the death of my father-in-law that died like his very first patient. This book not only prepares you for these realities but also offers a cautionary signs to help you avoid an early end. This book is not the subject of the teen set perhaps. But anyone with parents over 50 would do well to read it or just be surprised by inevitable events later.

    16 of 17 people found this review helpful
  •  
    Tim McGrath Chicago 03-07-14
    Tim McGrath Chicago 03-07-14 Member Since 2004
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    "Rip-off"

    I didn't notice until I downloaded it that it's an abridged version. This is not the type of book, in either length or content, that can benefit from being abridged.

    7 of 7 people found this review helpful
  •  
    Beth Overland Park, KS, United States 10-22-09
    Beth Overland Park, KS, United States 10-22-09 Member Since 2007
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    "A very special read"

    I have a difficult time dealing with loss and didn't expect to like this book because I thought it would just be too sad; but I did enjoy it. Very different than what I was expecting. Helpful to anyone. A must-read for health care professionals.

    6 of 6 people found this review helpful
  •  
    Caryl SPRING VALLEY, MN, United States 05-07-10
    Caryl SPRING VALLEY, MN, United States 05-07-10 Member Since 2009
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    "The doctors viewpoint"

    Finely written and a good read.

    2 of 2 people found this review helpful
  •  
    Ron Green Valley, AZ USA 05-14-14
    Ron Green Valley, AZ USA 05-14-14 Member Since 2014
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    "Very Abridged"
    Would you recommend How We Die to your friends? Why or why not?


    I would definitely not recommend the audiobook, buy the hardcopy instead.

    Similar to reviewer Wisefool, I didn't notice that this is a very abridged version until it ended after the 3rd chapter. The original book is 12 chapters + epilogue, so what your getting here is 1/4 of the book which isn't that long (270 pgs) to begin with. Widefool calls it a ripoff, and I agree.


    1 of 1 people found this review helpful
  •  
    Constance NEW YORK, NY, United States 11-05-12
    Constance NEW YORK, NY, United States 11-05-12 Member Since 2008

    Mom in Movement

    HELPFUL VOTES
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    "Nuland's vision: a new approach to dying"
    Would you say that listening to this book was time well-spent? Why or why not?

    This is a modest book, but one in which Dr. Nuland, reading his own work, expresses a clear viewpoint as a physician familiar with every aspect of How We Die. Using various professional anecdotes and personal stories to illustrate the need for change in our approach to dying, Nuland posits that doctors and families need to be honest with their patients and loved ones about the approach of death. Only by offering the dying patient honesty, rather than false hope, Nuland believes, can we spare them unnecessary and ultimately futile treatments, and allow them to prepare themselves properly for death, surrounded by their loved ones, "so that our last moments will be guided not by the bioengineers, but by those who know WHO WE ARE (emphasis Nuland) ."

    Nuland repositions death as more than just the final moment marking the demise of a particular individual; he urges acceptance of death as a natural and ever-repeated stage in the eternal cycle of life, as a gift the dying person can give to the new generation, without which new life cannot thrive. He sends out an urgent call for revision of our attitudes towards death, for funding for new facilities and education for professionals who thus will have better expertise in this area, and for what we might now call hospice care, so that, rather than "sequestering the dying", "no man will be left to die alone." How We Die is compelling, timely, and, in spite of its daunting title, uplifting. It's worth a listen.




    What three words best describe Sherwin B. Nuland’s voice?

    Familiar, kind, emphatic


    Did How We Die inspire you to do anything?

    Rethink my own attitudes towards death and dying.


    Any additional comments?

    At first, I found Dr. Nuland's reading style a little over the top. His writing at times is a little fulsome (for e.g. I found it a little fussy to refer to a dying person as a "groundling" at the metaphoric 'performance' of his own death, in which he ought to be the 'principal player.'), but overall Nuland seems very sincere and I grew to like him more and more as he went on. In the end he won me over with his thoughtfulness and sincerity.

    1 of 1 people found this review helpful
  •  
    Elaine Wiseman INDEPENDENCE, KY, US 09-13-13
    Elaine Wiseman INDEPENDENCE, KY, US 09-13-13 Member Since 2012
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    "Let's face it, we are all curious."
    What did you love best about How We Die?

    I appreciated Nuland's gentle yet frank description of the way in which our bodies enter into and complete their life cycles. He offers a simple, clinical explanation about a topic I want to be prepared for when my time comes as well as if I should I be present for the death of another.


    What does Sherwin B. Nuland bring to the story that you wouldn’t experience if you just read the book?

    The fact that he is a medical doctor and has experienced death in many presentations qualifies him to speak on this matter.


    Any additional comments?

    Our culture so fears death that we don't prepare for it. We come to our own deaths and to those of our loved ones with such denial that we run the risk of increasing suffering rather than mediating it. I've read that American Indians greeted their deaths with a particular song. I've read that some in Africa bury the mothers of children beneath the floors of the rooms in which their children sleep in order to comfort the children. I don't know if the reports of these traditions are accurate but I believe accepting death is a healthy thing. Nuland demystifies the dying process in a way that helps take away some of my fear of it.

    0 of 0 people found this review helpful
  •  
    PLCC 08-29-13
    PLCC 08-29-13
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    "Medically Acurate and Realistically presented"
    What did you love best about How We Die?

    This book has terrific practical medical perspective as well as presents the reality of what often happens when death reaches into the personal life of a medical professional. There is no immunity to the reality and need for allowing a place of denial. Even doctors and nurses become as one of those who have no practical knowledge of the death process. They take on the role of protector rather than informant. The author steps away from the absolute reality of medical knowledge and becomes any one of those family members who sit at the bedside waiting for death to come and take our loved on away. The information concerning how the dying process is determined by the diagnosis is excellent! The process of dying with AIDS is shared quite frankly.Having spent many years at the bedside of the terminally ill, I found this book interesting, educational and insightful. I will use the information gained for patient teaching along the journey.


    What was one of the most memorable moments of How We Die?

    The Author was ever changed by his own experience with a dying brother.


    What does Sherwin B. Nuland bring to the story that you wouldn’t experience if you just read the book?

    The narrator does an excellent job with the authors profound descriptions.


    Was this a book you wanted to listen to all in one sitting?

    YES!


    Any additional comments?

    A must read for anyone who cares for the dying.

    0 of 0 people found this review helpful
  •  
    D. S. Brandt Bellevue, WA USA 05-30-13
    D. S. Brandt Bellevue, WA USA 05-30-13 Member Since 2012
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    "LOved it!"
    Where does How We Die rank among all the audiobooks you’ve listened to so far?

    This book leaves me feeling good about my own mortality....Like all things in nature, we are part of the cycle of life.


    What did you like best about this story?

    The author's authenticity


    Which scene was your favorite?

    When his brother was diagnosed with cancer


    Was this a book you wanted to listen to all in one sitting?

    Yes!


    Any additional comments?

    I wish this wasn't abridged...would love to hear the entire book

    0 of 0 people found this review helpful
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