Sherwin B. Nuland Quotes

Life is dappled with periods of pain, and for some of us is suffused with it. Inthe course of ordinary living, the pain is mitigated by periods of peace and times of joy. In dying, however, there is only the affliction. Its brief respite and ebbs are known always to be fleeting and soon succeeded by a recurrence of the travail. The peace, and sometimes the joy, that may come occurs with the release. In this sense, there is often a serenity - sometimes even a dignity - in the act of death, but rarely in the process of dying.

Dying begins with the first act of life.

Only the emerging specialty of psychoanalysis seemed to understand that mental maladies are not fully analogous to physical disease. They resist classification, and might better be known by their symptoms and the individualized sufferings of patients than by assigned names.

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.

I think when you think of death as being part of the life cycle and recognize that death is an inevitability for our species because the world has to be renewed with each death, then the hope becomes when it is renewed it will be renewed by people on whom I have had some influence for good.

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.

Whether wisely or not, one of the first priorities of the incoming Obama administration was to present a package of healthcare benefits, which, to no one's surprise, produced an uproar in Congress and an assortment of polls declaring that the majority of Americans were opposed to it.

Those who would live beyond their nature-given span lose their framework, and with it lose a proper sense of relationship to those who are younger, gaining only the resentment of youth for encroaching on its careers and resources. The fact that there is a limited right time to do the rewarding things in our lives is what creates the urgency to do them. Otherwise, we might stagnate in procrastination. The very fact that at our backs, as the poet cautions his coy mistress, we "always hear / Time's winged chariot hurrying near" enhances the world and makes the time priceless.

We die so that the world may continue to live. We have been given the miracle of life because trillions upon trillions of living things have prepared the way for us and then have died - in a sense, for us. We die, in turn, so that others may live. The tragedy of a single individual becomes, in the balance of natural things, the triumph of ongoing life.

'Death with dignity' is our society's expression of the universal yearning to achieve a graceful triumph over the stark and often repugnant finality of life's last sputterings. But the fact is, death is not a confrontation. It is simply an event in the sequence of nature's ongoing rhythms.

The very old do not succomb to disease-they implode their way into eternity. (How We Die)

We bear more than pain and sorrow when we depart life. Among the heaviest burdens is apt to be regret, which deserves a word at this point.

Could there, I wanted to know, be any dignity in such a death? Can anything be salvaged of what once was, to bring a sense of himself to aman near his final hour, when he has been through so much?

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.

Death belongs to the dying and those who love them.

Only by a frank discussion of the very details of dying can we best deal with those aspects that frighten us the most. It is by knowing the truth ... that we rid ourselves of that fear of the terra incognita of death.

For aging is an art. The years between its first intimations and the time of the ultimate letting go of all earthly things can-if the readiness and resolve are there-be the real harvest of our lives.

For many of the dying, intensive care, with its isolation among strangers, extinguishes their hope of not being abandoned in the last hours. If fact, they are abandoned, to the good intentions of highly skilled professional personnel who barely know them.

Though moral axioms to guide the conduct of the practitioner have existed since the beginnings of the profession of healing, Western doctors are most likely to view the Hippocratic Oath of approximately two-and-a-half millennia ago as the first codified set of statements to which they can look for guidance.

The greatest dignity to be found in death is the dignity of the life that preceded it. This is a form of hope we call all achieve, and it is the most abiding of all. Hope resides in the meaning of what our lives have been.

Nature is being kind without knowing it, as nature can be cruel without knowing it.

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.

All through your life you are building an intellectual and emotional framework and it gets bigger and bigger and the more there are places where books and experiences can latch.

knowledge without wisdom is a clear and present danger

Where the despair of loneliness and poverty haunts every hour, the optimism to embark on new projects cannot find a place to alight on the brain's cortex. Poverty itself is an enormous obstacle to an enlightened and enlightening - not to say healthy - old age.

I've seen so many patients, particularly elderly patients, over the years who become debilitated and changed by the process by which I cure them or another doctor cures them. And has it really been worth it?

The art of dying is the art of living. The honesty and grace of the years of life that are ending is the real measure of how we die. It is not in the last weeks or days that we compose the message that will be remembered, but in all the decades that proceeded them. Who has lived in dignity, dies in dignity.

... death hath ten thousand several doors For men to take their exits.

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 expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way; and however we may tinker them up for awhile, all will at length surcease motion.

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.

I never had a conscious fear of death, but I did have a conscious fear of sickness. By the time I completed medical school, that fear was gone.

Do you know what the world will be saved by? I'll tell you. It'll be saved by the human spirit. And by the human spirit, I don't mean anything divine, I don't mean anything supernatural - certainly not coming from this skeptic.

Both individual fulfillment and the ecological balance of life on this planet are best served by dying when our inherent biology decrees that we do.

The dignity we seek in dying is not to be found in our final weeks, days or moments but in the way we live and how we are seen by those people whose lives we affect.

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.

The heart is far more than just another stolidly stupid pump - it is a responsive, dynamic participant in the enterprise of life, capable of adaptation, accommodation, and, to some extent, repair.

That enormously complex biological interactions are so flawlessly coordinated as to result in such obvious manifestations as human thought or the electrical activity that dries the heartbeat is as exciting to me
actually more exciting
than such phenomena were when I was a small boy and thought them divinely (in the supernatural sense) driven.

How much of the "good death" is for the person dying and how much for the person helping him?

The life sciences contain spiritual values which can never be explained by the materialistic attitude of present day science

Where nothing in a person's earlier years lends itself to an old age devoted to continuing intellectual and physical pursuits, a late-life interest in Tolstoy or even crossword puzzles is unlikely to appear, no matter the urging by well-intentioned social workers or people like me who write books about it.

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.

The growing professional disciplines of medical ethics and bioethics have had a profound impact on researchers, bedside doctors, associations of physicians, and government.

We are not well served by being lulled into unjustified expectations.

The dignity to be sought in death is the appreciation by others of what one has been in life, ... that proceeds from a life well lived and from the acceptance of one's own death as a necessary process of nature ... It is also the recognition that the real event taking place at the end of our life is our death, not the attempts to prevent it.

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 after Phil died, they asked me if I wanted to see his body. I said no. My friend, who is a devout Catholic, had gone with me, and she couldn't understand my refusal. But I didn't want to remember that face dead. You have to understand - it wasn't for me that I felt that way. It was for him.

Moths and flames, mankind and death
there is little difference.

Not death but disease is the real enemy; disease, the malign force that requires confrontation. Death is the surcease that comes when the exhausting battle has been lost.

The good thing that may yet happen during dying is not the possibility of survival when we're beyond that point. The good thing that may yet happen is that our lives will have great meaning for those we leave behind.

The dignity we create in the time allotted to us becomes a continuum with the dignity we achieve by the altruism of accepting the necessity of death.

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.

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.

There is, to be sure, sometimes only a small difference between being alert to possible danger and allowing oneself to become terrified to the point of paralysis by seeming or imagined portents.

It's unnatural to believe death usually has a beauty and a concordance and is usually a coming together of your life's work. It leads to frustration for the patient. And it leaves grieving families convinced they did something wrong.

Medical judgment can be taught - laboriously, in long periods of training - but it cannot be neatly handed over as the occasion demands it. It is the irreplaceable and untransferable contribution that the healer makes to the suffering individual who would be healed.

My mother died of colon cancer one week after my eleventh birthday, and that fact has shaped my life. All that I have become and much that I have not become, I trace directly or indirectly to her death ... In my professional and personal life, I have lived with the awareness of death's imminence for more than half a century, and labored in its constant presence for all but the first decade of that time.

Nosology (from the Greek 'nosos,' meaning 'disease,' and 'logos,' referring to 'study') is not a sport for the timid, and certainly not for those so scrupulous about rules and order that they demand consistency in all things.

There is a nice Victorian reticence in denying the probability of a miserable prelude to mortality, and it is what everyone wants to hear. But if peace and dignity are what we delude ourselves to expect, most of us will die wondering what we, our our doctos, have done wrong.

Long regarded as central to the contemporary understanding of medical ethics are four principles that must be satisfied in order to fulfill the requirements of moral decision-making. These principles are autonomy, justice, beneficence, and non-maleficence.

These are two different belief systems. There is no reason in the world that the religious have to explain their faith on a scientific basis. It makes no sense. What is needed between science and religion is not a debate but a conversation, each one saying: you're here to stay, and I'm here to stay, so let's find out how our relationship can be of greatest benefit to this world.

The force of life fills out our tissues with its pulsing vibrancy and puffs them up with the pride of being alive. Whether it departs with a bang, or a prolonged whimper, it often leaves behind an object of shrunken unrealness.

Every life is different from any that has gone before it, and so is every death.

Though President George W. Bush made some small noises about his intention to present some form of improved health coverage, nothing grew out of them.

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 though we will be on this earth forever.

The dignity we seek in dying must be found in the dignity with which we have lived our lives.

Hope is an abstract word. In fact, it is more than just a word; hope is an abstruse concept, meaning different things to each of us during different times and circumstances of our lives. Even politicians know its hold on the human mind, and the mind of the electorate.

Of all the named structures within the abdomen and the chest, those associated with reproduction retained the mysteries of their willful behavior long after others had been solved to the satisfaction of physicians and philosophers.

Once the notion of depression had begun to dominate the diagnostic armamentarium, it became but a matter of time before patients with relatively mild disorders of mood or anxiety would be entered into it.

In the community of living tissues, the uncontrolled mob of misfits that is cancer behaves like a gang of perpetually wilding adolescents. They are the juvenile delinquents of cellular society.

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?

Our deaths become a part of our lives in the sense that with our deaths we give something to those who are left behind, as we have given our lives to them.

But the fact is, death is not a confrontation. It is simply an event in the sequence of nature's ongoing rhythms. Not death but disease is the real enemy, disease the malign force that requires confrontation. Death is the surcease that comes when the exhausting battle has been lost. Even the confrontation with disease should be approached with the realization that many of the sicknesses of our species are simply conveyances for the inexorable journey by which each of us is returned to the same state of physical, and perhaps spiritual, nonexistence from which we emerged at conception. Every triumph over some major pathology, no matter how ringing the victory, is only a reprieve from the inevitable end.

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.

We have had a rewarding relationship, the belly and I.

Being someone who had had a very difficult childhood, a very difficult adolescence - it had to do with not quite poverty, but close. It had to do with being brought up in a family where no one spoke English, no one could read or write English. It had to do with death and disease and lots of other things. I was a little prone to depression.

Too many of the elderly do not have the family or the communal attachments necessary to feel valued; too many are widowed or otherwise alone; too many live in surroundings where they are essentially without the companionship necessary to stimulate a mind in danger of deteriorating.

At times, morality can be dismissed as a matter of personal conscience, no matter how widespread its acceptance. Ethics, on the other hand, arises from societal or group commitments to principia of behavior.

To become comfortable with uncertainty is one of the primary goals in the training of a physician.

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.

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 preparation for departure, the gradual easing out of life that makes its ending more palatable not only for the elderly but for those also to whom they leave the world in trust.

When we mourn, it should be the loss of love that makes us grieve, not the guilt that we did something wrong.