Today, a doctor reflects on death and the machinery of
sustaining life. The University of Houston's College of
Engineering presents this series about the machines that
make our civilization run, and the people whose ingenuity
Sherwin Nuland's book, How
We Die, sat on my desk for a year. Now I've
finally read it and it was a jolt. Nuland takes on the
most forbidden topic of all. Society lets us talk about
politics and sex as long as we're careful. But talk of
death remains taboo.
Nuland is a surgeon and medical historian. His book deals
with a primary dilemma. To be a doctor is to fight death.
Yet death always wins in the end. Doctors, armed with
spectacular new technologies, engage in a combat they
cannot ultimately win. It is a situation that becomes
more paradoxical all the time.
Nuland begins by explaining death itself. And it isn't
pretty. Death is invariably caused by a lack of oxygen
brought on by a hundred different scenarios of system
failure. It is seldom a matter of passing gently over the
Great Divide. In a harrowing sequence of chapters he
explains how our bodies fail in heart disease, cancer,
AIDS, Alzheimer's disease, and more.
For those of us old enough to know our time's limited,
Nuland's book is frightening at first. But it grows
reassuring as he demystifies death. He takes it out of
that place where things go bump in the night. He puts it
where it can be seen and understood.
He also deals with another seldom-discussed aspect of
death. It is that the old usually reach a point where
they accept it. Nuland quotes Jefferson who, at 71, wrote
to John Adams, then 78.
Our machines have been running seventy or eighty
years and we must expect ... here a pivot, there a wheel,
now a pinion, next a spring will be giving way; ... There
is a ripeness of time for death ... when it is reasonable
we should drop off and make room for another growth.
But Nuland's main concern is with doctors and their
machines, their compulsion to win the unwinable fight
with death, their frequent inability to talk candidly
with patients. He tells of the reflex need to fight for a
patient's life long after there's any profit in it for
the patient. He tells how he cheated his own brother of
the chance to deal with his death by cancer. He offered
empty hope instead of joining him in grieving the
In the poignant apogee of this remarkable book, Nuland
quotes the hopeless words doctors tell each other when
they fail to level with a patient: "I could not take away his hope."
Then he adds,
Unless [we're] aware [we're] dying and ... know the
conditions of our death, we [can't] share any sort of
final consummation with those who love us. Without this
consummation, no matter their presence at the hour of
passing, we will remain unattended and isolated.
Others have certainly raised questions about the
technologies of preserving life. But Nuland, coming from
the very center of those technologies, tells us what
every technologist in every field should understand. It
is that we cannot let the objective purpose of our
machines become ends in themselves. The true purpose of
any machine can only be shaped by the people it is meant
I'm John Lienhard, at the University of Houston, where
we're interested in the way inventive minds work.