Nuland gives what I take to be a clinically realistic, but nonetheless sensitive, account of dying. He makes it clear that, "We rarely go gentle into that good night." The practical value of reading his book, for me, is to have a better idea of what one might expect when dying and perhaps somewhat ease the process thereby. As Nuland points out, "In his essay 'Use Makes Perfect,' Michael de Montaigne suggests that a lifelong acquaintance with the ways of death will soften one's final hours." In the epilogue to How We Die, Nuland writes about his personal expectations for dying:
The only certainty I have about my own death is another of those wishes we all have in common: I want it to be without suffering. There are those who wish to die quickly, perhaps with instantaneous suddenness; there are those who wish to die at the end of a brief, anguish-free illness, surrounded by the people and the things they love. I am one of the latter, and I suspect I am in the majority.What I hope, unfortunately, is not what I expect. I have seen too much of death to ignore the overwhelming odds that it will not occur as I wish it. Like most people, I will probably suffer with the physical and emotional distress that accompany many mortal illnesses, and like most people I will probably compound the pained uncertainty of my last months by the further agony of indecision-- to continue or to give in, to be treated aggressively or to be comforted, to struggle for the possibility of more time or to call it a day and a life-- these are the two sides of the mirror into which we look when afflicted by those illnesses that have the power to kill. The side in which we choose to see ourselves reflected during the last days should reveal an image that is tranquil in its decision, but even that is not to be counted on.
