Sherwin B. Nuland, Author of ‘How We Die,’ Is Dead at 83
Dr. Sherwin B. Nuland, a surgeon and author who drew on more than 35 years in medicine and a childhood buffeted by illness in writing “How We Die,” an award-winning book that sought to dispel the notion of death with dignity and fueled a national conversation about end-of-life decisions, died on Monday at his home in Hamden, Conn. He was 83.
The cause was prostate cancer, his daughter Amelia Nuland said.
To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.
“I have not seen much dignity in the process by which we die,” he wrote. “The quest to achieve true dignity fails when our bodies fail.”
In “How We Die, ” published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital. It won a National Book Award.
“The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” Dr. Nuland wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.”
Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, “How We Die” was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.
In chiding physicians, Dr. Nuland, a surgeon at Yale-New Haven Hospital for three decades, pointed the finger at himself, confessing that on more than one occasion he had persuaded dying patients to accept aggressive treatments that intensified their suffering and robbed them of an easier death. One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.
Dr. Nuland’s adolescent years were dominated by his father, Meyer Nudelman, a garment worker who was incapacitated by chronic illness and physical infirmities; he could not walk more than a short distance without his son’s help. Resisting a new way of life, the father never learned to read or write English — Yiddish was the predominant language at home — and he terrified his family with explosive rages.
Dr. Nuland regarded him with fear and shame, emotions that would take a deep psychological
While still in high school, Dr. Nuland and his older brother changed their names from Nudelman, separating themselves from a weak, angry man who, Dr. Nuland wrote, represented “everything I so desperately wanted to be rid of.” They chose a name first adopted by a cousin, Willie Nuland, a physician who looked after the boys’ parents when they were ill, and whose compassion and competence pointed Dr. Nuland toward his career.
Dr. Nuland received his medical degree from Yale in 1955. Electing to specialize in surgery, he set his sights on becoming chief surgical resident at Yale-New Haven Hospital, entering a Darwinian competition for a position seldom occupied by Jews. In 1958, Dr. Nuland won the coveted appointment. Four days later, his father died of complications of syphilis, a condition Mr. Nudelman did not know he had.
Mr. Nudelman’s death fulfilled Dr. Nuland’s wish to escape his father, but instead of liberation, he felt intense guilt and shame. Plagued by feelings of unworthiness, he felt himself becoming his father, assuming Mr. Nudelman’s hunched shoulders and shuffling gait.
From 1962 until 1991, he was a clinical professor of surgery at Yale, where he also taught bioethics and medical history. He was a surgeon at Yale-New Haven from 1962 to 1992, when he retired to write full time.
Dr. Nuland’s books include “Doctors: The Biography of Medicine” (1988), “The Wisdom of the Body” (1997), “The Doctors’ Plague” (2003) and “The Uncertain Art” (2008). He was a contributing editor to The American Scholar and The New Republic.
“How We Die,” which won the National Book Award for nonfiction in 1994 and was a finalist for the Pulitzer Prize in nonfiction in 1995, has sold more than 500,000 copies worldwide. In its concluding chapter, Dr. Nuland confessed that he, like many of his readers, desired a death without suffering “surrounded by the people and the things I love,” though he hastened to add that his odds were slim. This brought him to a final question.
Because of an editing error, an obituary on Wednesday about Sherwin B. Nuland, the author of “How We Die,” in referring to his father, Meyer Nudelman, misidentified the person whose death occurred without Mr. Nudelman’s knowing the cause. It was his own death, not that of his father.