When I heard the news that Sherwin Nuland, author of "How We Die: Reflections on Life's Final Chapter," had died, I immediately thought of a song. It's by Iris DeMent and it begins:
(begin ital)"Go on ahead and go home,
Go on ahead and go home
Boy, you've done your best
Time you took your rest
In the sheltering loam" (end ital)
I realize that "loam" isn't a tip-of-the-tongue word for most of us, but you get the point. The song is about giving someone you love permission to die, and yourself the courage to accept it, despite your desire to shriek, "Don't go. Never go."
In "How We Die," Nuland addresses a version of the same idea, though less sweetly, and he's addressing doctors along with the rest of us.
A surgeon and medical ethicist, Nuland was renowned for "demythologizing" death. He argued that dying is not only inevitable, it's often inevitably messy and undignified, a fact we should get used to.
"The necessity of nature's final victory was accepted in generations before our own," he wrote. "Doctors were far more willing to recognize the signs of defeat and far less arrogant about denying them."
I read "How We Die" shortly after it came out in 1994, attracted by the title even though at the time I'd had very few encounters with death.
My grandparents and my father were gone, but otherwise I'd been lucky. Dying's least romantic realities -- how it can punish a body, strip away everything we associate with physical beauty -- were still largely in my educational future.
Even without intimate knowledge of death, though, I read the book avidly. Many people did. It became a best-seller, evidence of the collective hunger to penetrate our shared ultimate mystery.
One reason Nuland's death on March 3 drew so much attention is that we want a reason and a way to talk about these things. Just as his book opened a discussion 20 years ago, his passing renewed it.
So how do we die? How should we?
A lot of people have no choice. They're taken in a flicker, by an accident, a murder. Most of us, on the other hand, are destined go more slowly, with time to ponder the medical options. Since we live in a society that equates medical intervention with fighting and fighting with courage, we can be tempted to extremes.
I've seen a lot of death up close since I read "How We Die." In the past four years, I've witnessed the dying days of my mother, my closest aunt, one of my brothers.
I'm far clearer on how we die by now, and one of the things I've discerned is that no matter how much we talk about death beforehand, we die baffled.
"Am I dying?" my mother said to me a few days before she did.
"I don't know," I said. I was pretty sure she was. I thought she knew. I didn't want to be the one to say it.
"People seem to think I'm dying," my brother said a couple of months before he did. "I don't feel like I'm dying."
His statement seemed like an implicit question: Did I think he was? I did. I stayed silent. Who was I to take away his hope, a hope that had flourished on more and more chemo, even as the chemo ravaged his body?
Nuland argued that the "hope" of extreme medical intervention often did little more than to multiply suffering.
"Too often," he wrote, "physicians misunderstand the ingredients of hope, thinking it refers only to cure or remission."
I think Nuland overly exalts earlier generations that more readily accepted, in his phrase, "nature's final victory." They didn't have our medical resources. Acceptance was their primary option.
But having witnessed death by disease up close now, I feel the truth of Nuland's basic argument. To use DeMent's words, sometimes we should just allow ourselves, or the people we love, the permission to go on ahead and go home.
At the same time, I've seen that you can't be sure how you'll view the end of life until you get there.
"He wasn't scared of death itself," Sherwin Nuland's daughter was quoted as saying, "but he loved everything about his world and the people in his world and life. And he didn't want to leave."
It's not just fear of death but love of life that guides how we die.
By MARY SCHMICH