MELISSA BLOCK, HOST:
Twenty years after Sherwin Nuland changed the way we talk about dying, the surgeon and best-selling author of the book "How We Die" has died himself. Dr. Nuland died on Monday at the age of 83. The cause was prostate cancer. In "How We Die," Nuland sought to demythologize the process of dying by offering up a frank discussion of the details of physical deterioration. Here he is, speaking on ALL THINGS CONSIDERED in early 1994.
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DR. SHERWIN NULAND: Every clinical physician can tell you of how many, many, many experiences he or she has had in which a patient goes through the terrible misery of pain and nausea and vomiting, and all that messy stuff that happens so often toward the end of life. And in the last day or days, or sometimes in the last hours, something changes; and there is a peace.
BLOCK: To talk about the life and career of Sherwin Nuland, I'm joined now by Atul Gawande, himself a surgeon, and a writer and a friend of Dr. Nuland. Dr. Gawande, welcome to the program.
DR. ATUL GAWANDE: Thank you.
BLOCK: Sherwin Nuland was known for acknowledging some pretty hard truths. And in his book, he wrote this: I have not often seen much dignity in the process by which we die. Did that frankness catch people by surprise when his book came out?
GAWANDE: I think it did. And it certainly caught me. I was a medical student at the time. And in medical schools, you didn't learn about dying. It was not considered part of the job. It's all about making people well. And here he was saying, no, the doctor has a special vantage point and witness to offer around this process, and people need to know about what happens.
BLOCK: Sherwin Nuland talked about challenging the notion of a good death. He wrote: We rarely go gentle into that good night. Was he criticizing the medical community? And was there a backlash from the medical community when he said things like that?
GAWANDE: You know, he was criticizing the medical community, but he wasn't getting a tremendous backlash. People felt the truth of it. On the whole, it was at a time when we were starting to wake up to the hospice movement. He made it mainstream to recognize that there might be different ways of serving people's needs, at the end. He was also trying to say to people that death with dignity was not always achievable. There were things that happen at the end that were going to be about what you make of your life. Dignity was, to him, about what you make of your life all the way to the end. Death itself is not entirely controllable.
BLOCK: When you think about the effect that Sherwin Nuland had on you as a doctor, what comes to mind? What's the longest lasting impact, do you think, of your connection with him?
GAWANDE: I think it was a fundamental humanity that could be expressed in two ways. One was just in writing. And his writing itself was just beautiful. It's evocative. It was concise. He told stories that you just don't hear elsewhere. And then the second part was in saying that you could be direct with people. You could tell them the truth about what happens while being humane.
You know, it was a revelation, even to us as doctors, to read and think about, what is the experience of going through a heart attack. What is that like? What is the experience of dying of a pneumonia? What is the experience of dying from a stab wound? You know, he depicts a child stabbed on the street, and what happens to that child. And it's fascinating and eerie. And the way he does it also helps you understand, this is a life we're talking about. And that, I think, captures what it means to be a good doctor.
BLOCK: Well, Dr. Gawande, thank you so much for talking with us today.
GAWANDE: And thank you. I'm just sorry it's on this occasion.
BLOCK: Atul Gawande is a surgeon at Brigham and Women's Hospital in Boston, and a professor at the Harvard School of Public Health. We're remembering Dr. Sherwin Nuland, who died Monday at age 83. As Dr. Nuland's daughter Amelia told the Associated Press, her father said: I'm not scared of dying but I've built such a beautiful life, and I'm not ready to leave it.
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