A serious subject but very well presented from both a clinical and emotional standpoint. "How We Die" by Sherwin B. Nuland.
A review written shortly after his death...an extraordinary man indeed.
I attended the Yale School of Medicine when Shep Nuland taught there, and despite our both being surgeons, I know him best in my capacity as a reader. I don’t recall when I first read How We Die—I was just finishing high school when it came out—but I do know that few books I had read so directly and wholly addressed that fundamental fact of existence: all organisms, whether goldfish or grandchild, die. His description of his grandmother’s illness showed me how the personal, medical, and spiritual all intermingled. As a child, Nuland would play a game in which he indented her skin to see how long it took to resume its shape—a part of the aging process that, along with her newfound shortness of breath, showed her “gradual slide into congestive heart failure … the significant decline in the amount of oxygen that aged blood is capable of taking up from the aged tissues of the aged lung.”
But “what was most evident,” he continued, “was the slow drawing away from life… By the time Bubbeh stopped praying, she had stopped virtually everything else as well.” With her fatal stroke, Shep Nuland remembers Browne’s Religio Medici: “With what strife and pains we come into the world we know not, but ’tis commonly no easy matter to get out of it.”
I studied literature at Stanford, and later history of medicine at Cambridge, to better understand the particularities of death, which still seemed unknowable to me—and yet vivid descriptions like Nuland’s convinced me that such things can only be known face to face. How We Die brought me into medicine to bear witness, as Shep Nuland had done, to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal.
I like to think of Nuland, in the opening chapters of How We Die, as a young medical student, alone with a patient whose heart had stopped. In an act of desperation, he cut open the patient’s chest and tried to pump the patient’s heart manually, to literally squeeze the life back into him. The patient died, and Shep was found by the intern, his supervisor, covered in blood and failure.Medical school has changed since Shep’s time, and such a scene is unthinkable now: medical students are barely allowed to touch patients. What has not changed, though, I hope, is the heroic spirit of responsibility amid blood and failure. This is the true image of a doctor. It is not the idealized happy profession in which we always cure diseases and ease suffering, our patients invariably leaving us better than we found them. It is also doctors facing the enormity of patient problems, seeing the crudeness of our tools, and, inevitably, watching our patients die, usually either in agony or under sedation.