(Excerpts From a lecture delivered by the author at the NYU School of Medicine, January, 1995)
"These days we don't learn about death firsthand as we did when I was a small boy, when most people died at home. Death is no longer a part of life, that old cliche, but that true cliche. Most people learn about death by reading about it in novels, going to the movies, where the patriarch lies in bed surrounded by those who love him and he gives his final blessing and says his last words, closes his eyes. . ."
"I realized early in my career that for both me and my colleagues what fueled the engines of our excitement about medicine was no longer the patient in the bed but the thrill of solving the riddle; the riddle of diagnosis, the riddle of therapy; it became an enormous intellectual exercise."
"We can only give people the hope they will not die alone if we are totally honest with them about what is happening to their bodies. If a physician from the very beginning of a patient's downhill course allows that patient to become a partner in the knowledge of what is going on, there is no sudden moment when he has to say, 'well, there is nothing more we can do"; there is no sudden moment when she has to turn to a family and say, 'shall I tell this patient?'"
"We live today in the era not of the art of dying, but of the art of saving life and the dilemmas in that art are multitudinous. As recently as half a century ago, that other great art, the art of medicine, still prided itself on its ability to manage the process of death, making it as tranquil as professional kindness could. Except in the too few programs such as hospices, that part of the art is now mostly lost, replaced by the brilliance of rescue and, unfortunately, the all too common abandonment when rescue proves impossible.
"Death belongs to the dying and to those who love them. Though it may be sullied by the incursive havoc of disease, it must not be permitted to be further disrupted by well-meant exercises in futility."
Audio and text of commentary reproduced with the permission of Sherwin B. Nuland, M.D., 1995.
Text of reading reproduced with the permission of Sherwin B. Nuland and Alfred A. Knopf, Inc. Excerpt from How We Die: Reflections on Life's Final Chapter, p. 265. Copyright (c) 1994 by Sherwin B. Nuland, M.D.