Scan barcode
r0b3rta's review against another edition
4.0
Each chapter details a different death - Alzheimer's, AIDS, Cancer, Suicide, etc. The author is a doctor so he really gets into the medical terminology and makes it accessible to the layperson.
"It is also the recognition that the real event taking place at the end of our life is our death, not the attempts to prevent it. We have somehow been so taken up with the wonders of modern science that our society puts the emphasis in the wrong place."
Well written and intense.
"It is also the recognition that the real event taking place at the end of our life is our death, not the attempts to prevent it. We have somehow been so taken up with the wonders of modern science that our society puts the emphasis in the wrong place."
Well written and intense.
jessicawoodxo's review against another edition
dark
emotional
inspiring
reflective
sad
fast-paced
4.0
tonioberto's review against another edition
4.0
Coming off some fresh losses, this was a tough read. Important and timely, especially given the shift and popularity of hospice care, and my personal experiences. Highly recommended but be guarded if you are new to loss.
llhensel's review against another edition
5.0
Sherwin Nuland's purpose in writing this book (in 1994) was to "demythologize the process of dying." He wrote that he wanted to present the biology and clinical realities of death as witnessed by both himself as a physician and through family members, patients he encountered in his life. He organized his telling on chapters focused on the heart, Alzheimers, cancer, AIDS, accidents/suicide and murder - all as avenues to death. Though there is a lot of science in his writing that was tricky for me at times because I have a limited background in the scientific words and concepts, he also explains the impact of so much of what the body experiences as we age using words that helped me to learn a lot about physical and emotional health. After reading this book, I feel more accepting that whatever process I experience when I die, I can't do anything to make it smooth or clean or not disruptive for my family. He challenges the idea of a dignified death - that dignity comes from how we live our life, how we are living - not dying. I learned so much about the human body and the positive impact of our facing the reality of death - I know more what my wishes will be for end of life care if that opportunity comes to me. I am ready now to write them down so my family has them! And thanks to this book, I am waking up grateful that for today I have good health and opportunities to experience what it means to be living - no matter what the day brings. I am really glad I read this book.
lweihl's review against another edition
5.0
I don't give out 5 stars easily. To me this book deserves it simply for how it demystifies death. My mother recently passed. age 93 and lived at home until an ER visit for low heart rate. Long story short she passed away 60 days later in a nursing home. She went through many of the things Dr. Nuland described. This book is definitely thought provoking.
sarahbreeze's review against another edition
5.0
Beautiful writing on life's most scary subject. This book should be required reading for anyone who has a pulse.
panicorpotato's review against another edition
4.0
I found this book morbidly fascinating, but then again I probably have more interest in death and dying than most. This book lays out, quite literally, how we die. It breaks down several leading causes of death (stroke, heart attack, cancer) and lays out what each systematically does to the body. It's essentially a biology book, but one with a very narrow theme and little textbook jargon. Highly recommended for the curious.
erika_is_reading's review against another edition
1.0
As Ned Stark says, "Nothing someone says before the word 'but' really counts." In this case, nothing in the book's title, before the colon, counts. Reviews on Goodreads, and blurbs about the book, led me to expect a neutral, unvarnished, and perhaps even helpful account of what to expect during the dying process. This is not that book.
These are Dr. Nuland's reflections. And he has a philosophical point he wants to make, which is unrelated to explaining the mechanics of the death process and might not even be a scientific or medical point.
The book is strongest in its detailed descriptions of how the body works and how it stops working. For instance, his explanation of the cardiovascular system, and the heart in particular, and what exactly happens in congestive heart failure, etc., will be super accessible to people complete outside the medical space. Some of the science (e.g., on Alzheimer's Disease) has advanced since he wrote this book more than 30 years ago. But those details are probably of less importance to the lay reader, anyway. From time to time he uses vernacular that undermines the book's ... well, I can't say credibility ... but it undermines the book's authoritativeness, in order to increase its accessibility, I suppose. Perhaps an acceptable tradeoff given the intended audience.
The book is most compelling and engaging in its autobiographical moments. Not so much the gruesome details of particular deaths he witnessed, but rather the stories from his childhood, within a poor Orthodox Jewish family that had immigrated from the Ukraine, and his grandmother's elderly years and eventual death. That was riveting.
But that's the surface. The agenda is deeper. He is trying to convince the reader of more fundamental points: (1) that the dying process -- not death, but dying, hence "how" we die -- is usually painful, humiliating, and terrifying [take a shot every time he describes a person's dying expression as "panicked" or wildly "desperate," and see if you make it through the first quarter without expiring of alcohol poisoning, go ahead, I dare you]; (2) that the body begins to decay, indeed begins to die, much earlier than the lay person realizes and that much has already happened even when all external appearances are to the contrary; and (3) that efforts to extend the human lifespan will be utterly futile, i.e., all of this is inevitable, including the timing. I believe this final point is actually his most important point, meaning the point most important to him. [Who wins, in a cage fight between Nuland and Aubrey de Grey? Google is your friend.]
He returns, over and over, to a more philosophical point -- that death is natural, because the old must make way for the new, because this is how trees work, and how the earth works, there must be turnover. Ecclesiastes 3:1-8 (for everthing there is a season...), and so forth. My gut tells me that this philosophical point was a foundation for him; it was the source spring from which the book, and perhaps much more, sprang. And it seemed more of a quasi-spiritual point than a scientific point. Much of the book's positive reception probably stems from people who find that message reassuring. For me, this message -- even if reassuring -- was utterly overwhelmed by the jackhammer of HUMILITATING DESPERATE PAINFUL PANICKY SUFFERING and the fact that the more descriptive portions (e.g., what is involved when the body is decaying and dying) are mind-numbingly repetitive. (He needs to flog the dead horse a few thousand times.)
It is easy to see why the book won a National Book Award and why it was a finalist for the Pulitzer. But I think he did the then-emerging field of anti-aging research a disservice, and I think the discoveries and developments of the last 30 years put the lie to some of what he insisted. Finally, many people who read this book will probably conclude that all is lost, and that there's nothing they can do to age more comfortably. And that is simply wrong.
These are Dr. Nuland's reflections. And he has a philosophical point he wants to make, which is unrelated to explaining the mechanics of the death process and might not even be a scientific or medical point.
The book is strongest in its detailed descriptions of how the body works and how it stops working. For instance, his explanation of the cardiovascular system, and the heart in particular, and what exactly happens in congestive heart failure, etc., will be super accessible to people complete outside the medical space. Some of the science (e.g., on Alzheimer's Disease) has advanced since he wrote this book more than 30 years ago. But those details are probably of less importance to the lay reader, anyway. From time to time he uses vernacular that undermines the book's ... well, I can't say credibility ... but it undermines the book's authoritativeness, in order to increase its accessibility, I suppose. Perhaps an acceptable tradeoff given the intended audience.
The book is most compelling and engaging in its autobiographical moments. Not so much the gruesome details of particular deaths he witnessed, but rather the stories from his childhood, within a poor Orthodox Jewish family that had immigrated from the Ukraine, and his grandmother's elderly years and eventual death. That was riveting.
But that's the surface. The agenda is deeper. He is trying to convince the reader of more fundamental points: (1) that the dying process -- not death, but dying, hence "how" we die -- is usually painful, humiliating, and terrifying [take a shot every time he describes a person's dying expression as "panicked" or wildly "desperate," and see if you make it through the first quarter without expiring of alcohol poisoning, go ahead, I dare you]; (2) that the body begins to decay, indeed begins to die, much earlier than the lay person realizes and that much has already happened even when all external appearances are to the contrary; and (3) that efforts to extend the human lifespan will be utterly futile, i.e., all of this is inevitable, including the timing. I believe this final point is actually his most important point, meaning the point most important to him. [Who wins, in a cage fight between Nuland and Aubrey de Grey? Google is your friend.]
He returns, over and over, to a more philosophical point -- that death is natural, because the old must make way for the new, because this is how trees work, and how the earth works, there must be turnover. Ecclesiastes 3:1-8 (for everthing there is a season...), and so forth. My gut tells me that this philosophical point was a foundation for him; it was the source spring from which the book, and perhaps much more, sprang. And it seemed more of a quasi-spiritual point than a scientific point. Much of the book's positive reception probably stems from people who find that message reassuring. For me, this message -- even if reassuring -- was utterly overwhelmed by the jackhammer of HUMILITATING DESPERATE PAINFUL PANICKY SUFFERING and the fact that the more descriptive portions (e.g., what is involved when the body is decaying and dying) are mind-numbingly repetitive. (He needs to flog the dead horse a few thousand times.)
It is easy to see why the book won a National Book Award and why it was a finalist for the Pulitzer. But I think he did the then-emerging field of anti-aging research a disservice, and I think the discoveries and developments of the last 30 years put the lie to some of what he insisted. Finally, many people who read this book will probably conclude that all is lost, and that there's nothing they can do to age more comfortably. And that is simply wrong.
al13ex's review against another edition
5.0
The book was written by a surgeon in 1995, when he was in his seventies. He provides down to earth descriptions of diseases and the processes that take place when people die. I am tempted to say that it can be very brutal to think and read about this, but I suppose it just takes a bit of time to get comfortable with such thoughts. There is also a lot of raw medical information that might require a little bit of background in order to follow it (or at least some years of watching medical dramas on TV). I wanted to know how we die and I have a better view on this aspect of life, the ending, after reading this book. I wanted to face man’s mortality and to understand it.
We live in a world where we deny death. We keep it behind closed doors and as far away from us as possible. Yet, it’s the most natural process one can imagine. “Dying begins with the first act of life”, says the author. Death is a process, rather than a moment. We refuse to think about it and we refuse to die when the time comes. Our survival instinct takes over and there are few people who accept it. I want to be one of those people.
”Though everyone may yearn for a tranquil death, the basic instinct to stay alive is a far more powerful force.”
There are facts, study cases, philosophical questions and even emotions rising throughout the pages. I was deeply impressed at times by accounts of dying and by the thoughts that invaded my mind in response. I have learnt that there’s no such thing as dying of old age, because everyone has a very specific thing that kills them. And today, people no longer die when their hearts stop, but when their brain dies. Our civilization has advanced up to a point where it changes everything we knew about life. We keep learning and developing, but we can’t stop death.
The human organism is frail and it has an expiration date. The best we can hope for as humans is to meet the life expectancy and not die before that. Without doubt, our genes and lifestyle combined will influence the illnesses and the time of death for all of us.
The author made efforts in explaining and persuading the readers that they should accept death. I saved some quotes from the book, because they present things very clearly.
“There is a vanity in all of this, and it demeans us. At the very least, it brings us no honor. Far from being irreplaceable, we should be replaced. Fantasies of staying the hand of mortality are incompatible with the best interests of our species and the continuity of humankind’s progress. More directly, they are incompatible with the best interests of our very own children. Tennyson says it clearly: Old men must die; or the world would grow moldy, would only breed the past again.”
“It is through the eyes of youth that everything is constantly being seen anew and rediscovered with the advantage of knowing what has gone before.”
“Persistence can only break the hearts of those we love and of ourselves as well, not to mention the purse of society that should be spent for the care of others who have not yet lived their allotted time.”
He also discussed old age and the health issues that appear from the wear of our bodies.
“Among living creatures, to die and leave the stage is the way of nature—old age is the preparation for departure, the gradual easing out of life that makes its ending more palatable not only for the elderly but for those also to whom they leave the world in trust.”
Despite this being a book about death, there are valuable lessons about life. Again, quotes from the book will express these ideas much better than I ever could.
“The fact that there is a limited right time to do the rewarding things in our lives is what creates the urgency to do them.”
“The utility of living consists not in the length of days, but in the use of time; a man may have lived long, and yet lived but a little.”
“The greatest dignity to be found in death is the dignity of the life that preceded it.”
“There isn’t much you can manage beyond trying to keep things neat and keep things painless—keeping someone from being alone.”
“To the wise advice that we live every day as though it will be our last, we do well to add the admonition to live every day as though we will be on this earth forever.”
“Malignant cells concentrate their energies on reproduction rather than in partaking in the missions a tissue must carry out in order for the life of the organism to go on. The bastard offspring of their hyperactive (albeit asexual) ‘fornicating’ are without the resources to do anything but cause trouble and burden the hardworking community around them. Like their progenitors, they are reproductive but not productive. As individuals, they victimize a sedate, conforming society.“
This paragraph was actually about cancerous cells, but unfortunately it made me think about the humans as a species. Basic human behavior, as history teaches us, hurts the environment and disturbs the balance of life and death.
The main lesson I got from reading the book is that “you have to live before you die.”
Ars moriendi is ars vivendi: The art of dying is the art of living.
In spite of everything, “as inevitable as death is and as likely to be preceded by a difficult period, especially for people with cancer, there are additional pieces of baggage we shall all take to the grave, but from which we may somewhat disencumber ourselves if we anticipate them. By these, I mean conflicts unresolved, breached relationships not healed, potential unfulfilled, promises not kept, and years that will never be lived. For virtually every one of us, there will be unfinished business. Only the very old escape it, and even then not always.”
Acceptance of death could ease the mental process and the agony caused by the instinct of survival; and we might have the chance to live better if we keep the ending in mind.
We live in a world where we deny death. We keep it behind closed doors and as far away from us as possible. Yet, it’s the most natural process one can imagine. “Dying begins with the first act of life”, says the author. Death is a process, rather than a moment. We refuse to think about it and we refuse to die when the time comes. Our survival instinct takes over and there are few people who accept it. I want to be one of those people.
”Though everyone may yearn for a tranquil death, the basic instinct to stay alive is a far more powerful force.”
There are facts, study cases, philosophical questions and even emotions rising throughout the pages. I was deeply impressed at times by accounts of dying and by the thoughts that invaded my mind in response. I have learnt that there’s no such thing as dying of old age, because everyone has a very specific thing that kills them. And today, people no longer die when their hearts stop, but when their brain dies. Our civilization has advanced up to a point where it changes everything we knew about life. We keep learning and developing, but we can’t stop death.
The human organism is frail and it has an expiration date. The best we can hope for as humans is to meet the life expectancy and not die before that. Without doubt, our genes and lifestyle combined will influence the illnesses and the time of death for all of us.
The author made efforts in explaining and persuading the readers that they should accept death. I saved some quotes from the book, because they present things very clearly.
“There is a vanity in all of this, and it demeans us. At the very least, it brings us no honor. Far from being irreplaceable, we should be replaced. Fantasies of staying the hand of mortality are incompatible with the best interests of our species and the continuity of humankind’s progress. More directly, they are incompatible with the best interests of our very own children. Tennyson says it clearly: Old men must die; or the world would grow moldy, would only breed the past again.”
“It is through the eyes of youth that everything is constantly being seen anew and rediscovered with the advantage of knowing what has gone before.”
“Persistence can only break the hearts of those we love and of ourselves as well, not to mention the purse of society that should be spent for the care of others who have not yet lived their allotted time.”
He also discussed old age and the health issues that appear from the wear of our bodies.
“Among living creatures, to die and leave the stage is the way of nature—old age is the preparation for departure, the gradual easing out of life that makes its ending more palatable not only for the elderly but for those also to whom they leave the world in trust.”
Despite this being a book about death, there are valuable lessons about life. Again, quotes from the book will express these ideas much better than I ever could.
“The fact that there is a limited right time to do the rewarding things in our lives is what creates the urgency to do them.”
“The utility of living consists not in the length of days, but in the use of time; a man may have lived long, and yet lived but a little.”
“The greatest dignity to be found in death is the dignity of the life that preceded it.”
“There isn’t much you can manage beyond trying to keep things neat and keep things painless—keeping someone from being alone.”
“To the wise advice that we live every day as though it will be our last, we do well to add the admonition to live every day as though we will be on this earth forever.”
“Malignant cells concentrate their energies on reproduction rather than in partaking in the missions a tissue must carry out in order for the life of the organism to go on. The bastard offspring of their hyperactive (albeit asexual) ‘fornicating’ are without the resources to do anything but cause trouble and burden the hardworking community around them. Like their progenitors, they are reproductive but not productive. As individuals, they victimize a sedate, conforming society.“
This paragraph was actually about cancerous cells, but unfortunately it made me think about the humans as a species. Basic human behavior, as history teaches us, hurts the environment and disturbs the balance of life and death.
The main lesson I got from reading the book is that “you have to live before you die.”
Ars moriendi is ars vivendi: The art of dying is the art of living.
In spite of everything, “as inevitable as death is and as likely to be preceded by a difficult period, especially for people with cancer, there are additional pieces of baggage we shall all take to the grave, but from which we may somewhat disencumber ourselves if we anticipate them. By these, I mean conflicts unresolved, breached relationships not healed, potential unfulfilled, promises not kept, and years that will never be lived. For virtually every one of us, there will be unfinished business. Only the very old escape it, and even then not always.”
Acceptance of death could ease the mental process and the agony caused by the instinct of survival; and we might have the chance to live better if we keep the ending in mind.