REVIEW THE BOOK "UNDERSTANDING DEATH"

Author Sherwin B. Nuland wrote "Understanding Death" to lift the veil of mystery surrounding the dying process, but the purpose was not to depict the horrific scenes of painful and gruesome decline in health, but rather to present it from a realistic biological and clinical perspective, exactly as those who have witnessed and experienced it see and feel.

Human nature is curious. Curious about death, yet afraid of dying. It is understandable that poets and writers often write about death but rarely witness it, while doctors and nurses who see it frequently rarely write about it.

The book "Understanding Death" is therefore a rare find. This is because it was written by a clinical professor of surgery, someone who, while not a frequent witness, has certainly seen more people die than we do. He wrote this book to unveil the mystery of the dying process, helping us – those who are always curious about death – to understand the characteristics of the process that we will all eventually go through as we gradually die. Death means the cessation of the circulatory system, the lack of oxygen transport to cells, the gradual decline of brain function, the weakening of body parts, and the destruction of living cells. A stark truth, a purely scientific topic, yet presented in a way that is far from dry; on the contrary, it is profound and touches the reader's heart.

The deaths described in the book, whether from old age, cancer, AIDS, accidents, Alzheimer's disease, heart disease, or stroke, are no longer as frightening as we imagine through the author's understanding and empathy. After reading the book, we might exclaim, "Ah, so that's it. So that's what death is like!" Because we've had a frank and detailed discussion about death, our curiosity about it has been partially satisfied, and we've been mentally prepared to deal with the issue we fear most.

It can be said that the lingering impression after reading "Understanding Death" is haunting. Haunting, yet satisfying.

The following quotes from "Understanding Death" will help you grasp the spirit of this book.

1. Every life is different from the lives that came before it, and so is every death. The uniqueness of each of us extends even to the way we die. While most people know that various illnesses lead us to our final moments through different paths, few fully understand the richness of the myriad ways in which the ultimate power of the human soul can break free from the body. Death appears before each person in a different form, just as each of us has a unique appearance when we appear before others. Every man goes to heaven in a way even heaven doesn't know, every woman reaches her final journey in her own way.

2. Poets, writers, historians, witty people, and intelligent people often write about death but rarely witness it. Doctors and nurses see it frequently but rarely write about it. Most people witness it once or twice in their lives, in circumstances where they are too overwhelmed by intense emotions to retain reliable memories.

3/ But in reality, death is not a confrontation. It is merely an event in a rhythmic sequence of natural events. It is not death but disease that is the real enemy, the insidious force demanding confrontation. Death is the cessation of appearance when the exhausting battle is over. Even the confrontation with disease should be approached with the understanding that many of our human illnesses are merely a means in the inevitable journey by which each of us returns to a state of non-existence, both physically and perhaps spiritually, like the state from which we emerge at conception. Every victory over some serious illness, however glorious it may seem, is only a delay before the inevitable death.

4. Your death is part of the order of things, it is part of the life of the world… it is the condition for your creation.”… “Make room for the guests, as others have made room for you.”

Montaigne believed that, in this age of violence and instability, death was easiest for those who, throughout their lives, had given it the most thought, as if always ready for its inevitable arrival. He wrote that only in this way could one die “patiently and peacefully,” after having experienced life more fully through the constant awareness that the end might come soon. From this philosophy, he formulated his advice: “The usefulness of life does not depend on the length of the days, but on the use of time; one may have a very long lifespan but live very little.”

5. Dignity is something, John says, that survivors cling to—it exists only in their minds, if it exists at all:

We who are left behind seek dignity so as not to think negatively of ourselves. We try to redeem our dying friend's inability to attain a certain degree of dignity, perhaps by imposing it on him. That is our only possible victory against the horrific process of this kind of death. With a disease like AIDS, we need to cope with the agonizing grief of witnessing a beloved friend lose his individuality, his uniqueness. In the end, he is no different from the most recent person he has witnessed. He feels sad at having to watch someone lose their individuality and become a clinical specimen.

How much of this “good death” is for the dying person and how much is for the person helping him? These things are obviously related, but the question is how much. In my opinion, the concept of a good death in general is not something easily controlled by a dying person. A “good death” is only relative, and its true meaning is merely to reduce the mess and disarray. There isn’t much you can do besides trying to keep things orderly and painless – to keep someone from being alone.

But as we approach these final moments, I think, even the importance of not leaving someone alone is something we deduce.

Looking back, and in a way this sounds brutal, my own experience is that the only way we know if we’ve just helped someone have a better death is whether we feel regret, or whether there’s anything we regret or haven’t done. If we can honestly say that we didn't miss the opportunity to do what we could, we did the best we could. But even that, as an absolute achievement, is only of absolute value to that person alone. What remains for him in the end is a situation that can't make anyone happy. The fact is, he's lost someone. There's no way to feel good about that.

One bond that we truly need to believe is completely unbreakable in death is love. If, in these mysterious moments leading up to death, you feel you are giving love, then I suppose this is what makes death “good,” if anything can actually do that. But it is a very subjective quality.

6/ Kent died among friends who helped keep him alive for the last two years of his life. He wasn’t among the many gay and drug addicts ostracized by their families – he was the only child of an elderly couple who had passed away years earlier. Without the devotion of his friends, his death, and his life as well, would quickly be forgotten.

This should not be interpreted as implying that traditional families rarely care about the care of children (or spouses) who die of AIDS. The opposite is true. Gerald Friedland depicts the return, the reunion, of parents, specifically mothers, with children they had rejected years earlier. This is true not only for the families of gay men but also for the families of addicts. Of course, not all gay men and not all addicts are separated from their roots, so it is not uncommon for a young person with AIDS to spend their final months in the supportive care of siblings or parents, sometimes with a small group of their children's friends or a loved one. Typically, a middle-class parent is more likely to give up a job or a distant home than a family from a slum, where even a single day off work means losing not only their income but possibly their low-paying job itself. I have spoken with mothers whose four children all died from AIDS – the brutality of this virus has reached levels beyond any imaginable reality.

At the bedside of these dying young people, mothers, wives, husbands, and loved ones – sisters, brothers, and friends – are present, doing everything they can to alleviate the violent onslaught of this chaotic death. Months pass, as the child is critically ill, the whispers of the parents are heard. These are gentle words of encouragement and prayers.

Gerald Friedland speaks of “the reversal of the expected cycle of life” – parents burying their children. A fallacy repeated centuries ago, just as we complacently concluded that our science had triumphed over it. Not only has the virus reversed its course, but so has the pattern of natural logic, according to which youth should bury old age. There is ultimately a metaphorical lesson here – in the therapy that is currently our best way to suppress the spread of HIV: With AZT and other drugs, we try to stop the reverse replication, thus also stopping the reversal that has turned the life cycle upside down. Our plan works, but not as well as we would like, and death continues to pursue young and even very young people, while older people can only stand there and mourn.

No one knows what dignity or meaning can be drawn from such a death, except for those who have spent their lives clinging to the life they have just lost. Young people caring for young people who are dying – and here I'm not just talking about doctors and nurses, but about all dedicated healthcare workers – look on and wonder if such selflessness exists in the world they were taught. Their daily actions dispel that doubt – they too are heroes in a sense. Their heroism is timely and unique to the path they have chosen – to be healthcare workers who have overcome their own fears, their own vulnerability, for the benefit of those afflicted with AIDS. They make no moral judgments – they don't discriminate based on social class, how they contracted the disease, or membership in high-risk groups. Camus aptly described it: “What is true about all the crimes in the world is also true about plague. It helps people to rise above themselves.”

7. We endure not only the pain and sorrow of bidding farewell to life. Among the heaviest burdens is the tendency toward regret – a matter worth mentioning here. While death is inevitable, and the period before it is certainly difficult, especially for those with cancer, there are added items to the baggage we all take to the grave, but it is from this that we can remove some of the obstacles if we anticipate them. Here, I am referring to unresolved conflicts, unhealed strained relationships, unfulfilled tasks, unfulfilled promises, and years that will never be lived. For most of us, there will always be unfinished business. Only the very old escape it, and even that is not always true.

Perhaps the very existence of unfinished business should be a kind of contentment, though the idea seems counterintuitive. Only a person long dead yet seemingly alive has not many “promises to fulfill, and many paths to traverse before falling asleep,” and such stagnation is undesirable. With the wise counsel to live each day as if it were our last, it would be helpful to add the admonition to live each day as if we were to be on this earth forever.

It would also be good to avoid another unnecessary burden by remembering the warning of Robert Burns (who contributed greatly to traditional English poetry and music) about the best-laid plans. Death rarely, if ever, unfolds according to our plans or even our expectations. Everyone desires to die in a fitting way, a modern version of ars moriendi (the art of death) and the beauty of the final moments. Since humankind began to write, they have recorded their wishes for an ideal end, what some call a "beautiful death," as if any of us could be certain of it or have any reason to look forward to it. There are pitfalls in making the decision to avoid it and countless different hopes to seek, but above all, we must forgive ourselves for not being able to achieve a predetermined image of a proper death.

Nature has its work to do. It does its work in a manner that seems perfectly suited to each individual whose power it has created. It has made some people susceptible to heart disease, others to stroke, and still others to cancer; some live long lives on this earth, and others live very short ones, at least according to our own measure. The harmony of the biological world has created the conditions under which one generation follows the next. Resisting the power and ceaseless cycle of nature will not bring lasting victory.

When the final moment arrives and we cannot escape the realization that we have reached the point that, as Jochanan Hakkadosh of Browning (English poet and playwright (1812-1889)) described: “set foot on the path made entirely of flesh,” our duty is to remember that it is not only the path of flesh but also the path of all life, and it has its own plan for us. Although we find clever ways to delay, there is no way to eliminate these plans. Even suicidal acts are subject to the cycle, and as far as we know, the triggers for such actions are pre-designed within some grand scheme, another example of the unchangeable laws of nature and the harmony within its biological world. Shakespeare's Julius Caesar reflected:

Of all the wonders I have heard,

It seems to me that the strangest thing is that man fears

When he witnesses death, an inevitable end,

When it comes.