8 Lessons on Aging and Death From the Man Who Explained ‘How We Die’

Sherwin Nuland, surgeon and acclaimed author of “How We Die: Reflection’s on Life’s Final Chapter,” recently passed away from prostate cancer.

“How We Die,” which sold more than 500,000 copies and won a National Book Award, has been credited with igniting the ongoing societal discussions on assisted suicide, when to stop aggressive medical intervention and other important end-of-life-issues.

In the book, Nuland writes of that often desired (yet frequently elusive) concept of a dignified death: “The belief in the probability of death with dignity is our, and society’s, attempts to deal with the reality of what is all too frequently a series of destructive events that involve, by their very nature, the disintegration of the dying person’s humanity. I have not seen much dignity in the process by which we die.”

He describes the revelation that eventually convinced him to write the book during an interview on webofstories.com. As recently as the early 1990s, for doctors and patients alike, “There was no place where everything [about the actual physical and mental processes of dying] was put together. So I thought, ‘That is a book worth writing,'” he says.

Nuland’s daughter, Amelia, told the Associated Press that her father’s final days were marked by alternating periods of peace and fear. “He wasn’t scared of death itself, but he loved everything about his world and the people in his world.”

In addition to “How We Die,” Nuland penned countless essays and a dozen additional books, tackling topics that ranged from the art of healing, to how to age well.

Here are a few of his more poignant proclamations on life and death:

  1. On the sneaky side of aging: “So gradually a progression is the onset of our aging that we one day find it to be fully upon us. In its own unhurried way, age soundlessly and with persistence treads ever closer behind us on slippered feet, catches up, and finally blends itself into us—all while we are still denying its nearness.” (From “The Art of Aging: A Doctor’s Prescription for Well-Being,” by Sherwin Nuland)
  2. What to do the day we finally realize we’re old: “Finally, we try to reconcile ourselves to the inescapable certainty that we are now included among the elderly. Realizing how much of our dreams we must concede to that unalterable truth, we should not only watch out horizons come closer, but allow them to do precisely that.” (From “The Art of Aging: A Doctor’s Prescription for Well-Being,” by Sherwin Nuland)
  3. The hidden gifts of getting old: “For aging can be the gift that establishes the boundaries of our lives, which previously knew far fewer confines and brooked far fewer restrictions. Everything within those boundaries becomes thus more precious than it was before: love, learning, family, work, health and even the lessened time itself. We cherish them more, as the urgency increases to use them well.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)
  4. Why we fear death: “None of us seems psychologically able to cope with the thought of our own state of death, with the idea of a permanent unconsciousness in which there is neither void nor vacuum—in which there is simply nothing. It seems so different from the nothing that preceded life.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)
  5. The identity of life’s true enemy: “Not death but disease is the real enemy. Disease, the malign force that requires confrontation. Death is the surcease that comes when the exhausting battle has been lost.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)
  6. Medical miracles are just stopgaps: “Every triumph over some major pathology, no matter how ringing the victory, is only a reprieve from the inevitable end.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)
  7. How not to set oneself up for disappointment in death: “There is a nice Victorian reticence in denying the probability of a miserable prelude to mortality, and it is what everyone wants to hear. But if peace and dignity are what we delude ourselves to expect, most of us will die wondering what our doctors have done wrong.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)
  8. Death doesn’t equal an ultimate end: “When the human spirit departs, it takes with it the vital suffering of life. Then, only the inanimate corpus remains, which is the least of all the things that make us human.” (From “How We Die: Reflection’s on Life’s Final Chapter,” by Sherwin Nuland)

Dealing with the impending death of a loved one is a scenario that caregivers of elderly family members will all eventually face, and even the experts can’t provide one clear path to prepare for the inevitable.

However, there are resources that can help provide guidance for those dreading an end-of-life journey with a loved one:

  • Death Cafés, which began in Europe and are currently gaining traction in the U.S., are gatherings of people interested in discussing a range of issues relating to death and dying. Different from a bereavement group, a Death Café meeting focuses more on discussing the idea of death, and is thus more suitable for caregivers whose loved one’s are not terminally ill or recently deceased.
  • Hospice care providers offer spiritual and psychological services to assist patients and their families in coming to terms with death.
  • Close friends and family members are vital sources of support when trying to come to terms with an impending loss. Knowing what to say to someone who is dying can be difficult for some, but even just the physical presence of a friend can have a much-needed comforting effect on caregivers and their elderly loved ones.

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