Sherwin B. Nuland (1930–2014)

I'm not saying that only formally-trained historians can write history books, but I am saying that this book is a solid example of the kind of bad history that a non-historian can produce when writing about a topic that they're in many ways quite knowledgeable about.

Sherwin Nuland was a physician, and so knows what he's talking about when it comes to puerperal fever—a possibly fatal form of infection or sepsis that can be contracted by post-partum people—and the technical processes by show more which the Hungarian-born Ignać Semmelweis discovered the disease's causation in the mid-nineteenth century.

He's on much shakier ground, however, when it comes to understanding the history of medicine, claiming that physicians didn't really understand that their ideas needed to be based on evidence until the nineteenth century and demonstrating little familiarity with the scholarship on pregnancy and childbirth during the Middle Ages and in early modern Europe.

And then there's the weird, fictional intro where Nuland imagines a virginal upper-class Viennese teenager who gets pregnant and is kicked out of the house by her "Papa", so is taken in by her former maidservant and ultimately dies shortly after giving birth from puerperal feveral. It's weird and creepy, and also unnecessary given how many real life women actually died an agonizing death from it—but then again, throughout Nuland seems not particularly interested in writing a history which centres women overly much. show less

I was accused of being morbid for enjoying this book so much. It's a surprisingly well written treatise on the various biological processes that occur when we die, for various causes of death. It's the kind of book that makes you want to talk about it, but I caution you -- almost any time you bring it up in conversation, you will be accused of making "the worst segue *ever*". Be warned, this book will prove difficult to put down, and it's really difficult to explain on your bedside.

A few years back I read with great interest and enjoyment Sherwin Nuland's memoir about his immigrant father, LOST IN AMERICA. It explained a lot about the author's ambition and success as a physician and scholar. Then I began reading his best known book, HOW WE DIE, but still have not finished it. But now I have done a quick read of his THE ART OF AGING and quite enjoyed it. My own aging process hasn't been very artful, but is anyone's?

In his clinical descriptions of the process, you're show more bound to learn something. For instance -

"... testicles hang lower than they did years ago, because of loss of turgor in the skin muscle of the scrotum, a muscle called the dartos."

Turgor? Dartos? Your scrotum has muscles? See what I mean? Who knew?

But seriously - for this is a serious book - Nuland looks far beyond the physiological aspects of aging here, with a chapter about choices, in which he gives us three case studies of people who suffered strokes and how they coped and came back from them. One of these was actress Patricia Neal, who credits her then-husband Roald Dahl with forcing her recovery and return to acting.. Another chapter, "A Friendship in Letters" gives us Nuland's years-long correspondence with an aged Indian widow and her struggles with and recovery from suicidal depression.

"Drinking from the Fountain of Youth" was an especially entertaining chapter, as Nuland related his friendship with a med school classmate, Frank Scott, inventor of an inflatable penile implant playfully labeled "the hydraulic hard-on."

Later he tells us that wisdom - so often equated with age - is not just knowledge, but the proper management of knowledge. And that "caring" is vital to a happy old age. And lots more. So much more. And yes, there is wisdom here. Nuland knew how to manage his accumulated years of study and the knowledge he had gleaned. A wise man. Dr Nuland died in 2013.

This is a good book, filled with useful information - and yes, wisdom. Very highly recommended.

- Tim Bazzett, author of the memoir, BOOKLOVER show less

In this well-written book, Nuland, a practicing surgeon and faculty member of Yale Medical School, describes six of the most common illnesses that kill us, from heart disease to cancer. By educating us non-physicians, he aims to enable us to make more informed choices when faced with terminal disease.

Nothing can change the fact that we will die. Without minimizing the sobering impact of this, Nuland stresses that our death is necessary for the future vitality of life on earth— just as with show more each plant or animal.

Further, he stresses from the outset to the conclusion that our hopes for death with dignity are illusory for most of us. The transition from life to death is not pretty. He urges his readers to focus on a life with dignity instead.

To help us make choices, Nuland stresses the recognition that specialists see pathology as a puzzle and tend to forget the aspect of the reasonable limits of treatment (reminds one of Dr. House, doesn’t it?). Nuland writes: “The Riddle is the doctor’s lodestone as an applied scientist; it is his albatross as a humane caregiver.” Thus, the need for family physicians. Their long-term acquaintance with the afflicted person makes them valuable in helping weigh the benefits and risks of any proposed treatment.

Medical science has made breathtaking advances (and has continued to in the thirty years since this book was published). Survival rates have extended life for many (of course, our mortality rate remains at 100%). This progress must be measured against the suffering an ultimately futile battle brings. Thus, the need for informed patients and loved ones. Another need that Nuland advocates is more availability of hospice care.

Despite the sometimes gruesome details, I found this book engaging and readable. Since it was a library book, I copied many passages. I hope to remember the lessons this book imparts when my life draws to its close. show less