A certainty of life...

... is death. But it is a subject that people don't like to talk of, not even to think about. Yet this is what the book How We Die - Reflections on Life's Final Chapter by Dr Sherwin B Nuland touches upon. Unlike in earlier times when people usually die at home, Nuland says that today "we have created a method of modern dying. Modern dying takes place in the modern hospital, where it can be hidden, cleansed of its organic blight, and finally packaged for modern burial. We can now deny the power not only of death but of nature itself."

He writes in his introduction, "I have written this book to demythologize the process of dying. My intention is not to depict it as a horror-filled sequence of painful and disgusting degradations, but to present it in its biological and clinical reality, as seen by those who are witness to it and felt by those who experience it. Only by a frank discussion of the very details of dying can we best deal with those aspects that frighten us the most."

In this book, Dr Nuland has chosen six of the most common diseases, which have "characteristics that are representative of certain universal processes that we will all experience as we are dying. The stoppage of circulation, the inadequate transport of oxygen to tissues, the flickering out of brain function, the failure of organs, the destruction of vital centres." These diseases are heart attack, old age, stroke, Alzheimer's Disease, AIDS and cancer. 

The book draws you into the experiences undergone by patients with serious illnesses, by doctors treating them, and by families and friends dealing with emotionally draining situations. Along the way, Dr Nuland describes what happens to the patients' bodies as life slips away. He is very matter-of-fact about this. At the end of the book, he tells us, "Nature has a job to do. It does its job by the method that seems most suited to each individual whom its powers have created... It is incumbent on us to remember that (death) is not only the way of all flesh but the way of all life, and it has its own plans for us. Though we find clever ways to delay, there is no way to undo those plans." 

And he slips in a quote by Shakespeare in Julius Caesar:

"Of all the wonders that I yet have heard,

It seems to me most strange that men should fear;

Seeing that death, a necessary end,

Will come when it will come."

Dr Nuland concludes, "The dignity that we seek in dying must be found in the dignity with which we have lived our lives... 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."