How We Die: Reflections on Life's Final Chapter

"One thing about this book is that, although it’s not a literary perspective, it’s one of the best-written doctor’s books I’ve come across. It’s also interesting on faith because he comes from a faith background, although he himself is agnostic. It’s a description of what people actually die of and the mechanisms by which life is extinguished. He’s very blunt about it. He has a striking opening chapter where he’s a young rookie doctor, confidently looking after his first case, and a man expires in front of him with a heart attack in the most horrendous and spectacular fashion. That really knocked him for six. That’s the beginning of it. Again, it taps into what I was saying earlier about the idea of the good way of ageing and the wrong way of ageing. What Nuland says is that, basically, at the end of life there’s this myth that we’re all going to expire peacefully surrounded by our loved ones. And it mostly doesn’t happen like that. It’s mostly ugly and mucky and brutal and rather disgusting. We just need to face up to that. So that’s an interesting counterargument to all the sentimentality that surrounds death and also the tidiness that we have these days. We push it away into hospitals and clinics and hospices. He says that you have to face this. You are a mortal, animal creature and, when you go, it’s not nice. Yes, and he draws out the common features. He answers the question ‘How does cancer or a heart attack actually kill you? What does it do in the body?’ This book was written quite a long time ago and it’s interesting to see, for me having just written my book, where it’s at and how the thinking has changed since his day. And, in fact, a lot of things he talks about have been developed further. It gives people a warning of what to expect. There may be certain symptoms, there may be nastiness, there may be ugliness to deal with, and you have to get through that. Otherwise, I suspect it would be a most horrendous shock for somebody who went in thinking that the patient just kind of lies there quietly and then breathes their last. It is not always like that. People should be better forewarned and I think that’s one of the reasons why he wrote the book."