HOW WE DIE

A sobering look at the clinical reality of death by a physician who wants it known that ``we rarely go gentle into that good night.'' Nuland (Yale Medical School; Doctors, 1988) takes the position that if we know the truth about the physical process of dying, we can rid ourselves of both our fears and our false expectations. By becoming familiar with the common patterns of illness, he says, we'll be better prepared to make appropriate decisions about continuing treatment or calling it quits. Nuland selects several common causes of death—heart attack, old age, Alzheimer's, violence, AIDS, and cancer—and, with unrelenting honesty and unsettling detail, shows precisely what happens to the body involved. His account of the decline and death of his grandmother—with whom he shared a bedroom until he was in his late teens and she in her late 90s—is unforgettable, as is his story of his well-intentioned mismanagement of the care of his older brother when he was dying of cancer. The emotional impact of these stories is quite different from that produced by the author's coldly clinical accounts (``a specific sequence of events takes place in people who bleed to death. At first, they will usually hyperventilate...''); but by demonstrating that dying is usually a messy business, Nuland succeeds in demythologizing death. His message is that the dignity we seek in dying must be found not in our final weeks, days, or moments—but in how we've lived our lives. Strong stuff: not for those who prefer to cling to comforting illusions about life's end.