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Review: "How We Die," by Sherwin Nuland

Sherwin Nuland is the acid to Ray Kurzweil's base. In The Singularity is Near Kurzweil offers hope of immortality achieved through technology. Can we Live Long Enough to Live Forever as Kurzweil suggests?

No, Nuland says, offering his experience as a physician, "Nature will always win in the end, as it must if our species is to survive...Against the relentless forces and cycles of nature there can be no lasting victory." In How We Die, Nuland depicts our likelihood of death from heart disease ("...each cigarette, each pat of butter, each slice of meat, and each increment of hypertension make the coronary arteries stiffen their resistance to the flow of blood."), stroke, cancer, AIDS, and Alzheimer's disease and gives detailed, clinical accounts of our miserable departures.

It's a morbid book, unsurprisingly, but it's also gruesome. There's a disturbing account of a young girl's random murder by a lunatic and blow-by-blow descriptions of the physical effects of suicide by barbiturates, hanging, and asphyxiation.

Chapter after suffering chapter, there's little talk of the humanity, hopefulness, and spirituality of the dying. How We Die eschews the peaceful death.

However, it is not without feeling. On the contrary, How We Die becomes a passionate non-fiction/memoir hybrid as Nuland shares his personal experiences of the deaths of his mother, grandmother and brother as well as of patients who touched him. He richly expresses his experiences and explores his ethical thinking and relationship to death as a medical healer and a human being.

Finally, in the last chapter "The Lessons Learned," and in the epilogue, Nuland offers a glimpse of hope — that we accept the process of death as a natural part of life ("We die so that others may live.") and thereby reduce our suffering (avoid prolonging our lives and suffering at the very end out of fear or fervor for high-tech medical salvation) — and that we use the knowledge of our likely ends to live the possible best lives.

Considering death becomes a celebration of life. It provokes gratitude. "All of this makes more precious each hour we have been given; it demands that life must be useful and rewarding."

This is an excellent, informative, and beautifully written book, its five-star worthy, but not for the faint-hearted.

Pairs well with: Rebecca Brown's The Gifts of the Body and Beyond Forgetting: Poetry and Prose About Alzheimer's Disease other personal accounts of how we die; Michel de Montaigne's essays and Leo Tolstoy's The Death of Ivan Ilyitch both mentioned in the book; and for gentler approaches to the topic Using the Power of Hope to Cope with Dying: The Four Stages of Hope and Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying.

Quotes:
"Every life is different from any that has gone before it, and so is every death...Every man will yield up the ghost in a manner that the heavens have never known before: every woman will go her final way in her own way."

"Death belongs to the dying and those who love them."

"The dignity that we seek in dying must be found in the dignity with which we have lived our lives. Ars moriendi is ars vivendi: The art of dying is the art of living. The honesty and grace of the years of life that are ending is the real measure of how we die. It is not in the last weeks or days that we compose the message that will be remembered, but in all the decades that preceded them. Who has lived in dignity, dies in dignity."

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