Eight Lessons on Aging and Death from the Doctor Who Explained ‘How We Die’

(Anne-Marie Botek is a passionate storyteller committed to helping others find their voice through writing. Her journey began as an NCAA Division I athlete and honor roll scholar, continuing in middle-school teaching and as editor-in-chief of AgingCare.com.)

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Dr. Sherwin B. Nuland, surgeon, bioethicist, speaker and award-winning author of How We Die: Reflections on Life’s Final Chapter, has been credited with igniting widespread interest in and discussion on controversial topics like physician-assisted death, when to stop aggressive medical interventions, and other important end-of-life care decisions.

A New York Times bestseller, How We Die has sold more than 500,000 copies worldwide and won the National Book Award for Nonfiction in 1994. In this book, Nuland confronts the illusion of a peaceful and dignified death – a final wish of the masses that is seldom granted.

“The belief in the probability of death with dignity is our, and society’s, attempt 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,” he writes. “I have not seen much dignity in the process by which we die.”

In an interview, Nuland described the revelation that eventually convinced him to pen How We Die. For doctors and patients alike, “There was no place where everything [about the actual physical and mental processes of dying] was sort of put together,” he recalls. “So I thought, ‘That is a book worth writing.’”

In addition to How We Die, Nuland authored countless essays and several other books, drawing on his own personal experiences and his decades-long career in medicine to address subjects like the art of healing and how to age well.

The following insights are direct quotes from How We Die and another of Nuland’s acclaimed books, The Art of Aging: A Doctor’s Prescription for Well-Being.

Aging and the End of Life

1. How aging catches us by surprise. “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.”
2. What to do the day we 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 our horizons come closer, but also allow them to do precisely that.”
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.”
4. Why we are afraid of 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.”
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.”
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.”
7. Setting realistic expectations for the end of life: “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.”
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.”

Dr. Sherwin Nuland died at his home in Hamden, Connecticut, of prostate cancer in 2014. He was 83. His 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,” she explained. “He didn’t want to leave.”

Additional Resources for Seniors and Family Caregivers

Death is something that all family caregivers will experience and someday face themselves. Through his work, Nuland has made it clear that even medical experts cannot postpone the inevitable or provide one definite path for ensuring a comfortable and dignified passing.

However, there are resources available on the merits of palliative care options, tips for talking about death, and ways to engage in end-of-life planning to ensure one’s preferences are respected.

Educating ourselves and our loved ones, striving to take good care of our bodies and minds, setting realistic expectations for the end of life, making legal and medical plans that reflect our wishes, and communicating these goals to care team members will help to increase our chances of dying with dignity.

For more information on helping a loved one navigate a serious illness, visit Making Care Decisions for Aging Loved Ones, the Caregiver’s Guide to End of Life Care, or browse other caregiving topics.

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.

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