Sherwin Nuland is dead. The sage of the Yale Medical School and author of 1994’s bestselling study of modern mortality, How We Die, has succumbed to prostate cancer in his Connecticut home. I read his seminal book when I was twenty-two, during a season in which I was particularly vexed and spurred by mortal questions. Some nights, even after I had put it down on the bedside table, the book kept me up later than I’d perhaps have wanted. But what could I have expected from a hardcover titled How We Die? And anyway that’s how you know the text is doing it’s job; when it comes to our debitum naturae, we should be dogged enough to eschew smiles and happy-talk. Jules Renard observed that, “it is when facing the subject of death that we become most bookish.”  My experience reading How We Die expressly corroborated that claim.

But backtrack to the end of that second sentence. Nuland died in his Connecticut home. Readers of his will know why this is important: How We Die is an analysis of the way contemporary physicians administer (and tend to over-medicalize) the process of dying. Of the many anxieties it may alternately allay and unleash, perhaps the most startling conclusion one may draw from Nuland’s book is that in approaching death as our ultimate failure – rather than as our manifest fate – modern medicine is making us stoics, but not philosophers — men and women who, in forgoing daily dread of a painful death, do very little brooding on the ultimate significance of our mortality.

Studies consistently show that as a professional class, doctors have the highest levels of personal angst about dying (novelists must be a close second). On the surface, this may seem like a good thing: the medical profession does not like casualties, and surgeons, like sergeants, don’t want to see anyone in their units K.I.A. But there is a downside, given that doctors are likely to involuntarily transmit their own thanatophobia on to their patients, over-emphasizing curability while spurning death as defeat. In findings conspicuously absent from our ongoing national healthcare debate, studies show that the majority of a person’s medical expenditure will occur during the final 6 months of his or her life. This is partly a function of doctors’ (and patients’) desires to throw anything at the reaper, if only to stall his encroachment by days if not hours. But what is the ultimate financial cost? What is the emotive one?

In her superb biography How to Live: Or a Life of Montaigne, Sarah Bakewell pays careful attention to the role of death in Montaigne’s life and philosophy. One conclusion drawn in stark relief is that Montaigne – like Michelangelo – was galvanized from childhood by the animalistic process of dying, the fact that our exits often come after higher cognitive faculties have evaporated, leaving our bodies to pump and heave through the auto-processes of our endocrine and limbic systems.

When we face the prospect of our own deaths – that is, if we can overcome the Freudian paradox and actually picture it – we typically imagine a worst- or best-case scenario. Drowning, claustrophobia, extreme isolation and physical pain accompany the former category. In the latter scenario, we conjure the reconciliation and serenity of a Socratic, Jeffersonian, or Abrahamic terminus, wherein we, surrounded by loved ones, are lucidly doling out individual blessings to familiar faces. But what is most likely to happen? In How We Die Nuland observes that, “No matter the degree to which a man thinks he has convinced himself that the process of dying is not to be dreaded, he will yet approach his final illness with dread.” That trepidation is hard enough to get over, but what if you mix it with a potent cocktail of opiates served in an atmosphere of marked industrial sterility? How dignified, how lucid and decorous could one be in such a state, bloated with pain-reducing chemicals and confined to a frenetic hospital? This is why “home” is the key word in the first line of Nuland’s obituary. It tells you what kind of departure he chose to have.

Rest in peace, Dr. Nuland. Thank you for teaching me some of the lessons of mortality, and not a minute too soon.

__________

Sherwin Nuland, born Shepsel Ber Nudelman in The Bronx, New York, passed away on Monday in his home in Hamden, Connecticut. He had been a professor of surgery at Yale and surgeon at Yale-New Haven Hospital for over three decades.

Read his obituary or pick up a copy of his National Book Award-winner How We Die.

Explore on about matters moriendi:

• Neurologist David Eagleman explains how consciousness may outlast the brain
• Professor Stephen Cave summarizes the Freudian paradox, which holds that we cannot picture our own demise
• Jefferson consoles his old political rival John Adams upon the death of Adams’s wife