Word: nuland
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...Hamlet put it. It may be life's last mystery, the only truly private realm, since sex today is practically a spectator sport. What are the contours of this frightening place? What does it look like, feel like? How does it sound? These are questions that Dr. Sherwin B. Nuland seeks to answer in How We Die (Knopf; 278 pages; $24), a series of eloquent and uncommonly moving reflections on what his subtitle calls "life's final chapter...
Thousands of tomes have been composed about death, but few of them, the author notes, are by those who see the experience most often and up close: physicians and nurses. Nuland is a surgeon who also teaches the history of medicine at Yale. He has the rare ability -- like John McPhee exploring a geological fault -- to explain the abstruse in language that can be both meticulously exact and wondrously evocative. In a chapter on cancer, for instance, his description of how the cells operate contains this startling analogy: "In the community of living tissues, the uncontrolled mob of misfits that...
...Nuland writes about death with unsentimental passion. In an opening episode -- which squeamish readers may find hard to get through without wincing -- he describes his first professional encounter with the phenomenon. As a third- year medical student, he was checking on a 52-year-old male who had entered the hospital with chest pains when the patient suddenly had a massive, life- ending heart attack. In a state of preternatural calm, Nuland responded as his training had taught him: he grabbed a scalpel and scissors, cut open the man's chest and began massaging the still twitching heart. The organ...
...death rattle, the patient "threw back his head once more and, staring upward at the ceiling with the glassy, unseeing gaze of open dead eyes, roared out to the distant heavens a dreadful rasping whoop that sounded like the hounds of hell were barking." The intern on duty assured Nuland he had done all that could be done. Conscious only of his failure, the doctor-to-be wept uncontrollably...
...contains vivid accounts, based on individual case histories, of death's major causes, from accidents to Alzheimer's to AIDS. One of Nuland's case histories involves a drug addict and AIDS victim he calls Ishmael Garcia. With chilling clarity, the author describes Garcia's gradual and painful "descent into the valley of fever and incoherence" via pneumonia, meningitis and lymphoma of the brain. As he lay dying, Garcia was taking 14 experimental medications, none of which slowed what Nuland calls "a jet- propelled pestilence." Death certificates require that attending doctors state a cause; Nuland points out that for most...