|
How We Die: Reflections on Life's Final Chapter
|
|---|
Sherwin B. Nuland. 278 pages. New York: Alfred A. Knopf; 1994. $24.00.
Graphic description, hyperbole, and poetic nuance are combined in this book to rub the reader's nose in the gore, smell, wet-stickiness, and mess of the final moments of life. I remember Jim Vetter, pediatrician at the Marshfield Clinic early in the 1960s, smashing a doll to bits in a frenzy at the appropriate moment in his pioneering lectures on child abuse: head, arms and legs, and stuffing flying all over! No one forgot that, and you won't forget this book.
The long, slow slide of aging and its inevitability are beautifully presented in the author's description of his "Bubbeh" (grandmother). I suspect her nocturia, however, was caused by mobilization of her peripheral edema, not just by decreasing bladder volume.
Nuland describes the roller coaster, bobsled, car-off-a-cliff course of heart disease, the acquired immunodeficiency syndrome, Alzheimer disease, and cancer graphically and in loving detail.
The point of this book, and the reason it is required reading for all physicians, is the chapter "Hope and the Cancer Patient." Dr. Nuland clearly shows that hope (what was left in the bottom of Pandora's box) may be a blessing for ill patients or a curse used to justify useless treatment.
Medical oncology is all about helping and comfort and failure and death. It is said that many of us go into medicine and nursing to deny death, so is it any wonder we go on denying it?
Dr. Nuland separates patients with cancer from all the rest, but his words are lightning-bolt true for all patients with terminal illness. Why should the hypoxemic, hypercarbic "chronic lunger" be put on the "vent" once more? Why should the patient with end-stage, hyperammonemic cirrhosis and recurrent bleeding varices be "Sengstakened," "lactulosed," and pumped full of blood one more time, each intensive care unit visit another tryst with Torquemada?
A great man once said that the job of a physician is to cure rarely, help often, and comfort always. Have we all forgotten how to be helpful and comforting? And are we all about to be punished for our omissions?
If you take care of human beings, read this book.
Article
