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2fbccf0
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Dying begins with the first act of life.
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Sherwin B. Nuland |
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b869d19
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The lesson is never learned--there will always be those who persist in seeking the Fountain of Youth, or at least delaying what is irrevocably ordained.
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Sherwin B. Nuland |
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abf1fad
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Human beings are capable of the kind of love and loyalty that transcends not only the physical debasement but even the spiritual weariness of the years of sorrow.
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Sherwin B. Nuland |
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40352bb
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Share your optimisms and keep your pessimisms to yourself.
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Sherwin B. Nuland |
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ef15c90
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The more knowledge we have about the realities of lethal illness, the more sensible we can be about choosing the time to stop or the time to fight on, and the less we expect the kind of death most of us will not have. For those who die and those who love them, a realistic expectation is the surest path to tranquillity.
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Sherwin B. Nuland |
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8e89ac6
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When we mourn, it should be the loss of love that makes us grieve, not the guilt that we did something wrong.
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Sherwin B. Nuland |
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b1fdc51
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knowledge without wisdom is a clear and present danger
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Sherwin B. Nuland |
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0829205
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The kind of child our society resembles just now is one whose intelligence far exceeds his maturity. Every teacher and every parent knows what a formula for disaster that can be.
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Sherwin B. Nuland |
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e4554cd
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Though their doctors dutifully record such distinct entities as stroke, or cardiac failure, or pneumonia, these aged folk have in fact died because something in them has worn out. Long before the days of scientific medicine, everyone understood this. On July 5, 1814, when he was seventy-one years old, Thomas Jefferson wrote to the seventy-eight-year-old John Adams, "But our machines have now been running seventy or eighty years, and we must..
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Sherwin B. Nuland |
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a7a9fc7
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When my time comes, I will seek hope in the knowledge that insofar as possible I will not be allowed to suffer or be subjected to needless attempts to maintain life; I will seek it in the certainty that I will not be abandoned to die alone; I am seeking it now, in the way I try to live my life, so that those who value what I am will have profited by my time on earth and be left with comforting recollections of what we have meant to one anot..
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Sherwin B. Nuland |
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30f3358
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Mine is not the first voice to suggest that as patients, as families, and even as doctors, we need to find hope in other ways, more realistic ways, than in the pursuit of elusive and danger-filled cures. In the care of advanced disease, whether cancer or some other determined killer, hope should be redefined. Some of my sickest patients have taught me of the varieties of hope that can come when death is certain. I wish I could report that t..
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Sherwin B. Nuland |
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e6c63aa
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Every triumph over some major pathology, no matter how ringing the victory, is only a reprieve from the inevitable end.
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Sherwin B. Nuland |
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00dbd6b
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Before you conclude that your options are limited, you need evidence that you cannot do something, rather than just deciding that you cannot do it.
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Sherwin B. Nuland |
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a68d85c
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The only certainty, whether spoken or not, is that the doctors, nurses, and technicians are fighting not only death but their own uncertainties as well. In most resuscitations, those can be narrowed down to two main questions: Are we doing the right things? and, Should we be doing anything at all?
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Sherwin B. Nuland |
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2b7cafd
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There is no way to deter old age from its grim duty, but a life of accomplishment makes up in quality for what it cannot add in quantity.
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Sherwin B. Nuland |
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50f5e1b
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We are not well served by being lulled into unjustified expectations.
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Sherwin B. Nuland |
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4b5ef16
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Nature is being kind without knowing it, as nature can be cruel without knowing it.
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Sherwin B. Nuland |
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7fef3c8
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Though their doctors dutifully record such distinct entities as stroke, or cardiac failure, or pneumonia, these aged folk have in fact died because something in them has worn out. Long before the days of scientific medicine, everyone understood this. On July 5, 1814, when he was seventy-one years old, Thomas Jefferson wrote to the seventy-eight-year-old John Adams, "But our machines have now been running seventy or eighty years, and we must..
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Sherwin B. Nuland |
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73419dd
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Shakespeare has Julius Caesar reflect that: Of all the wonders that I yet have heard, It seems to me most strange that men should fear; Seeing that death, a necessary end, Will come when it will come.
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Sherwin B. Nuland |
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23139f6
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We live today in the era not of the art of dying, but of the art of saving life,
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Sherwin B. Nuland |
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6f06841
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This is the period when hard decisions are faced by families, having to do with the insertion of feeding tubes and the vigor with which medical measures should be taken to fend off those natural processes that descend like jackals--or perhaps like friends--on debilitated people.
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Sherwin B. Nuland |
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5b323d2
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Though everyone may yearn for a tranquil death, the basic instinct to stay alive is a far more powerful force
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medicine
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Sherwin B. Nuland |
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819ad02
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Whatever mystery attaches to such a death is imposed on it by those who live. It is a tribute to the human spirit that the life preceding triumphs over the ugly events that most of us will experience as we die, or as we move toward our last moments.
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Sherwin B. Nuland |
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7b7244a
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Today the law defines death, with appropriate blurriness, as the cessation of brain function. Though the heart may still throb and the unknowing bone marrow create new cells, no man's history can outlive his brain.
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Sherwin B. Nuland |
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b00c526
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Whether the result of wear, tear, and exhaustion of resources or whether genetically programmed, all life has a finite span and each species has its own particular longevity. For human beings, this would appear to be approximately 100 to 110 years. This means that even were it possible to prevent or cure every disease that carries people off before the ravages of senescence do, virtually no one would live beyond a century or a bit more.
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Sherwin B. Nuland |
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1b1be59
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It is through the eyes of youth that everything is constantly being seen anew and rediscovered with the advantage of knowing what has gone before; it is youth that is not mired in the old ways of approaching the challenges of this imperfect world. Each new generation yearns to prove itself--and, in proving itself, to accomplish great things for humanity. Among living creatures, to die and leave the stage is the way of nature--old age is the..
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Sherwin B. Nuland |
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5dca592
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Persistence can only break the hearts of those we love and of ourselves as well, not to mention the purse of society that should be spent for the care of others who have not yet lived their allotted time.
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Sherwin B. Nuland |
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27fa8bc
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And when he died, I was glad. I know it sounds terrible to say that, but I was happy he was relieved of that degrading sickness. I knew he never suffered, and I knew he had no idea what was happening to him, and I was grateful for that. It was a blessing--it was the only thing that kept me going, all of those months and years. But it was a horrible thing to watch happening to someone I loved so much. You know, when I went to the hospital af..
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Sherwin B. Nuland |
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dbca2ce
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No matter the technological sophistication of ultramodern molecular research, and no matter the increasingly abstruse terminology of its current literature, the circle of knowledge always returns to its starting point: In order to live, man must have air.
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Sherwin B. Nuland |
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c4c80bd
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Beyond the curiosity and the problem-solving challenge fundamental to good research, I believe that the fantasy of controlling nature lies at the very basis of modern science.
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Sherwin B. Nuland |
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17b6ef7
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The ultimate aim of the scientist is not only knowledge for the sake of knowledge, but knowledge with the aim of overcoming that in our environment which he views as hostile. None of the acts of nature (or Nature) is more hostile than death.
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Sherwin B. Nuland |
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6a7f186
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Nature will always win in the end, as it must if our species is to survive.
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Sherwin B. Nuland |
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0c7be56
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Perhaps the mere existence of things undone should be a sort of satisfaction in itself, though the idea would appear to be paradoxical. Only one who is long since dead while still seemingly alive does not have many "promises to keep, and miles to go before I sleep," and that state of inertness is not to be desired. To the wise advice that we live every day as though it will be our last, we do well to add the admonition to live every day as ..
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Sherwin B. Nuland |
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2cf0b23
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Since human beings first began to write, they have recorded their wish for an idealized ending some call the "good death," as if any of us can ever be sure of it or have any reason to expect it. There are pitfalls of decision-making to be sidestepped and varieties of hope to seek, but beyond that we must forgive ourselves when we cannot achieve some preconceived image of dying right."
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Sherwin B. Nuland |
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388aa42
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It is probably a universal teaching of all cultures that putting a name to a demon helps to decrease its fearsomeness. I sometimes wonder whether the real, perhaps culturally subconscious, reason that medical pioneers have always sought to identify and classify specific diseases is less to understand than to beard them. Confrontation, somehow, is safer once we have set a label on a thing, as if the very process makes the beast sit still for..
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Sherwin B. Nuland |
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0888664
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Endorphin elevation appears to be an innate physiological mechanism to protect mammals and perhaps other animals against the emotional and physical dangers or terror and pain. It is a survival device, and because it has evolutionary value it probably appeared during the savage period of our prehistory when sudden life-threatening events occurred with frequency. Many a life has no doubt been saved by the absence of panicky response to sudden..
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Sherwin B. Nuland |
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81b19ee
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These days (if I may steal a term from the jargon of the contemporary rialto), it is not politically correct to admit that some people die of old age.
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Sherwin B. Nuland |
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8c0a108
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So it was like the old scenario that so often throws a shadow over the last days of people with cancer: we knew--she knew--we knew she knew--she knew we knew--and none of us would talk about it when we were all together.
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Sherwin B. Nuland |
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a5896d6
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Carolyn had told me that while he was still able, Bob had arranged to have his favorite words from his favorite work of Dickens inscribed on his grave marker, but still I was unprepared for their effect when actually seen. Engraved across the granite face of the footstone was the epitaph by which Bob DeMatteis had chosen to be remembered: "And it was always said of him that he knew how to keep Christmas well."
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Sherwin B. Nuland |
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9b5b214
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Nowadays, very few of us actually witness the deaths of those we love. Not many people die at home anymore, and those who do are usually the victims of drawn-out diseases or chronic degenerative conditions in which drugging and narcosis effectively hide the biological events that are occurring. Of the approximately 80 percent of Americans who die in a hospital, almost all are in large part concealed, or at least the details of the final app..
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Sherwin B. Nuland |
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6bba49b
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The patient dies alone among strangers: well-meaning, empathetic, determinedly committed to sustaining his life - but strangers nonetheless.
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Sherwin B. Nuland |
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a319f3b
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Unless we are aware that we are dying and so far as possible know the conditions of our death, we cannot 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
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Sherwin B. Nuland |
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3b95717
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unattended and isolated. For it is the promise of spiritual companionship near the end that gives us hope, much more than does the mere offsetting of the fear of being physically without anyone.
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Sherwin B. Nuland |
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7215111
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I recently discussed this with my school's professor of geriatric medicine, Dr. Leo Cooney, who later summarized his viewpoint in two pithy paragraphs of a letter: "Most geriatricians are at the forefront of those who believe in withholding vigorous interventions designed simply to prolong life. It is geriatricians who are constantly challenging nephrologists [kidney specialists] who dialyze very old people, pulmonologists [lung specialists..
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Sherwin B. Nuland |