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  • Writer's pictureCindy Davis

Understanding Death: How We Die by Dr. Nuland

Updated: Jun 4


Woman looking at an Illustration of the heart and the brain as cogs working together to operate the body because the book How We Die builds that understanding.

How We Die, Reflections on Life’s Final Chapter, a National Book Award nonfiction winner by Yale physician Sherwin B. Nuland, is a profound exploration into the clinical, biological, and emotional details of dying. At GeriScope, we understand the importance of comprehending the intricacies of aging and end-of-life care, and Dr. Nuland's work provides enlightening insights into these critical issues.


Unveiling the Truths of Dying: A Deep Dive into How We Die

How We Die is not just a book; it’s a journey through the realities of death. Nuland, with his extensive medical background and compassionate approach, addresses the natural course of various chronic conditions and terminal illnesses and how they lead to one’s ultimate death. This is done with a combination of technical descriptions and real-world stories of his patients and family members. It’s a valuable guide for anyone grappling with the complexities of aging, chronic conditions, or end-of-life care.


Essential Guide for Aging: Why How We Die Matters to You

For those in our GeriScope community, dealing with serious illness like heart disease, stroke, Alzheimer’s, and others, How We Die offers a clear, humane, and scientifically accurate understanding of these diseases.


For example, Dr. Sherwin B. Nuland provides invaluable clarity on conditions like Alzheimer’s Disease, often mentioned in terms of its symptoms like forgetfulness and the poignant 'long goodbye.' He goes beyond these surface descriptors to explain the profound medical implications of such conditions. For those in our GeriScope community, particularly those dealing with Alzheimer’s, this book offers a clear, humane, and scientifically accurate understanding of the disease's progression and its ultimate impact on the body for those without medical training trying to help themselves and their loved ones.


Dr. Nuland describes Alzheimer’s as a condition marked by the progressive degeneration and loss of nerve cells in the brain's cortex, affecting memory, learning, and judgment. As the disease progresses to its later stages, patients often become uncommunicative and immobile, posing overwhelming challenges for family caregivers. The gradual slide toward complete dependency is heartbreaking, with some patients losing the ability to chew, walk, or swallow.


This detailed exposition sheds light on the realities faced by families during the late stages of Alzheimer's. The hard decisions about care, supervision, and the eventual transition to dependency are discussed with compassion and realism. Dr. Nuland's insights help demystify the dying process associated with Alzheimer’s, empowering readers with knowledge to make informed decisions about care. Understanding these harsh realities enables families and caregivers to have more meaningful and prepared conversations with medical professionals regarding the care of their loved ones.


How We Die serves as a crucial resource for anyone seeking to comprehend the full scope of Alzheimer’s impact on the human body and mind. Dr. Nuland’s descriptions provide a basis for understanding and anticipating the challenges and decisions that lie ahead for those affected by this condition, reinforcing the importance of comprehensive care planning and empathetic support.


Throughout the book, Dr. Nuland’s insights help demystify the dying process, empowering readers with knowledge to make informed decisions about their care and to have more meaningful conversations with medical professionals. This ties into the importance of having “The Talk” about quality-of-life decisions long before one loses the capacity to make those choices.


Oxygen: The Universal Factor in Life and Death

In another set of informative chapters, Dr. Sherwin B. Nuland’s How We Die illuminates the crucial role of blood flow and oxygen in the body, especially concerning heart disease and stroke. His insights are particularly poignant for our GeriScope community, as many face the realities of these conditions.


Heart Disease: The Compounding Effects of Diminished Blood Flow

In the context of heart disease, Dr. Nuland explains how the aftermath of a heart attack involves the loss of muscle tissue in the heart. Each attack weakens the heart's ventricles, diminishing their power. This weakened state affects the entire circulatory system, leading to a general slowdown of blood flow. As a result, oxygen-rich blood struggles to reach the tissues efficiently, and waste removal becomes sluggish.

Patients with heart disease increasingly experience shortness of breath, even with minimal exertion. The heart and lungs, already strained, cannot cope with additional demands. This inefficiency can lead to the accumulation of fluid in the lungs, creating an environment ripe for bacterial growth and inflammation. Pneumonia, often a consequence of this condition, becomes a leading cause of death in cardiac patients. Dr. Nuland's explanation underscores the importance of maintaining heart health to ensure efficient oxygen distribution throughout the body.


Stroke: The Impact of Interrupted Blood Supply to the Brain

Turning to strokes, Dr. Nuland describes them as neurological deficits resulting from decreased blood flow through arteries that supply the brain. Strokes demonstrate the immediate and often catastrophic effects of interrupted oxygen supply to brain tissues. Depending on the area of the brain affected, strokes can lead to various impairments, highlighting the brain’s dependency on a constant supply of oxygenated blood.


Dr. Nuland summarizes the essence of his findings by stating, "If one were to name the universal factor in all death, whether cellular or planetary, it would certainly be the loss of oxygen." This profound statement encapsulates the importance of oxygen in sustaining life. Chronic conditions like heart disease and stroke disrupt the body's ability to deliver oxygen effectively, leading to a cascade of adverse effects and, ultimately, death.


In How We Die, the connection between chronic conditions and oxygen flow is clearly delineated, offering the GeriScope community an invaluable perspective. Understanding these processes empowers individuals to make informed decisions about their health, anticipate potential complications, and discuss care options more effectively with their medical teams. This knowledge also emphasizes the importance of proactive healthcare and lifestyle choices to maintain optimal oxygen flow and minimize the risk of severe conditions like heart disease and stroke.


In addition to these topics, the book also discusses:

  • Role of Geriatricians: Nuland highlights the unique perspective geriatricians provide in how to care for those over 80 years of age given h ow their bodies process medications and handle various treatments and procedures.

  • Advocating for Hospice and Palliative Care: The book encourages earlier consideration of hospice and palliative care given the probable trajectory of their illnesses to help everyone achieve their desired end of life.

  • Advance Care Planning: It underscores the importance of advance care planning in aligning medical interventions with one’s quality-of-life goals.


Personal Insights: My Reflections on How We Die

After reading How We Die, I gained a deeper understanding of the medical rationale behind certain tests and lifestyle recommendations from my own doctors. This book is not just a read; it's an eye-opener that guides you through understanding your health conditions and re-evaluating your advance care plans.  What I really like is that each chapter covers a different chronic condition or terminal illness.  So, if you have an interest in a particular one you can read only the chapters that apply to your situation.  But by reading the whole book your knowledge deepens helping you make key connections.


Dr. Nuland’s work aligns perfectly with GeriScope’s themes, especially in “The Talk,” “The Crisis,” and “The End” phases. It equips readers with the necessary understanding to navigate these stages with informed confidence.


Join the Conversation: Your Experience with How We Die

I highly encourage our readers to delve into How We Die. Pay special attention to the final chapters where Nuland summarizes the lessons learned. This book is available at local libraries and online bookstores.

Once you’ve read the book, please share your insights and how it helped shape your understanding of end-of-life decisions. Let’s discuss how this book has impacted your perspective on aging and dying.

How We Die by Sherwin B. Nuland is an essential read for anyone in the GeriScope community. It’s a resource that offers not just medical insights but also emotional support, helping readers, caregivers, and families navigate the complexities of end-of-life with empathy and understanding.

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