In this well-written book, Nuland, a practicing surgeon and faculty member of Yale Medical School, describes six of the most common illnesses that kill us, from heart disease to cancer. By educating us non-physicians, he aims to enable us to make more informed choices when faced with terminal disease.

Nothing can change the fact that we will die. Without minimizing the sobering impact of this, Nuland stresses that our death is necessary for the future vitality of life on earth— just as with each plant or animal.

Further, he stresses from the outset to the conclusion that our hopes for death with dignity are illusory for most of us. The transition from life to death is not pretty. He urges his readers to focus on a life with dignity instead.

To help us make choices, Nuland stresses the recognition that specialists see pathology as a puzzle and tend to forget the aspect of the reasonable limits of treatment (reminds one of Dr. House, doesn’t it?). Nuland writes: “The Riddle is the doctor’s lodestone as an applied scientist; it is his albatross as a humane caregiver.” Thus, the need for family physicians. Their long-term acquaintance with the afflicted person makes them valuable in helping weigh the benefits and risks of any proposed treatment.

Medical science has made breathtaking advances (and has continued to in the thirty years since this book was published). Survival rates have extended life for many (of course, our mortality rate remains at 100%). This progress must be measured against the suffering an ultimately futile battle brings. Thus, the need for informed patients and loved ones. Another need that Nuland advocates is more availability of hospice care.

Despite the sometimes gruesome details, I found this book engaging and readable. Since it was a library book, I copied many passages. I hope to remember the lessons this book imparts when my life draws to its close. ( )

A myth-busting book that addresses the many ways our bodies fail us in the end. Not particularly uplifting.
( )

Very helpful in understanding that last phase of life, and keeping it all in perspective when dealing with a family member's imminent demise. And of course, one's own ultimate journey, as no one gets out of here alive. ( )

This is a great book if you would like to know about the physical responses that the body goes through while dying and after death. Each chapter is framed with, i believe, a factual story about someone who suffered with the condition that the chapter is about. Sad and fascinating. ( )

"Stand by me, Death, lest these dark days

Should hurt me more than I may know;

I beg that if the wound grows sharp

You take me when I ask to go.

Step closer, Love, and dry your eyes,

What's marred you'll never mend by tears;

Let's finish where the tale began

And kiss away the ruined years.

A moment, Faith, before you leave,

There's one last favour I would ask:

Put to use your handsome hand

And show me the face behind your mask."



"Three Pleas" by Henry Treece



I understand that imagining my personal death, for instance, is truly horrendous, and I guess that what makes me worried is indeed the very thought of that last process of existence, particularly whether it would be with great physical and mental suffering while I am being aware of it. I would rather dream of having a quick, sudden and peaceful end. Although I have to admit that the process of planning it that how it ought to happen would be desirable, but absurd. Of course, in an ideal situation, I guess, I should rather be thinking about the moments that I am still around (alive), not thinking all the time when its time comes or how I would prefer “to plan” it to proceed. Moreover, there is a sort of irony in this way of defining life, waiting to end that is, and I blame it to a metaphorical conceptualisation of sort of banal existence that derives us unwillingly and irrationally to self termination. Isn’t it prioritising life for ding rather than living? The irony is that life, in general, might have already become something of illusionistic, artificial and self oriented materialistic values. Say for example, I am recording and televising my death. What am I trying to say by that? Self-pity?

After having finished Nuland’s book, I have allocated some minutes to wondering about death and have emerged hoping that I will be struck by lightening or hit by a coconut. And then people would say, "He was sooo random until the end." I think we have a whole industry devoted to making us smile in the face of fear, not least the execrable breast cancer pink posse making it sound like it's as easy as getting over being fired.

The great thing about living to the threshold of old age is that it gives you a chance to adjust to the idea of dying. When I was young, the idea of dying appalled me, but as I died to my youth, the prospect of dying to my life didn't seem anywhere near as appalling as it did when I still possessed youth - or the illusion thereof. As you get older, you die bit by bit, so the final heave into death doesn't seem as great as it once did. Of course, the prospect of suffering pain while dying, is not alluring, but, as for death itself, I think in the end you realise that it just goes with the territory and accept it.

I used to live each day as if it were my last. Now I live each block of hours and it's fun. I'm not thinking about death but rather about enjoying life and not wasting time.

Who has any idea how they will react when it happens. And what is right or noble? ( )