Dr. Sherwin B. Nuland was a respected surgeon and bioethicist at Yale University and author of two modestly successful books when he was approached in the early 1990s by a young literary editor. The agent was looking for someone to write a book about what happens to the body and mind during the process of dying, and Nuland had been recommended to him.
"I thought surely there were hundreds of books already" on the topic, Nuland later said, but the agent said there were not and encouraged him to check his libraries. Indeed, Nuland found there were no such books, either for the general public or for physicians.
Already in his 60s, Nuland had been thinking about retiring. An older surgeon doesn't lose his skills or his judgment, he noted later, but he does get slower. An operation that might have previously taken one and a half hours now took two.
After consulting his wife, Sarah, he decided to take a year off and write a book about dying. He collected every detail he could find about what happened to the body before a person passes. The result was the 1994 masterpiece, "How We Die: Reflections on Life's Final Chapter."
Nuland, 83, died Monday at his home in Hamden, Conn. He had prostate cancer, according to his family.
His book portrayed in unflinching detail how the lungs fill with fluid, how the heart weakens and stops providing adequate blood to the body, how the kidneys wither and allow the body to fill with toxins. Nuland concluded that the idea of death with dignity was largely a fiction, unobtainable by most people. Instead, most patients suffer interminably, often having the process prolonged through aggressive treatment by physicians and hospitals. Humiliation and lack of control, he said, are the fates of most.
"I have not seen much dignity in the process by which we die," he wrote. "The quest to achieve true dignity fails when our bodies fail."
Despite its gloomy subject matter, the book was hugely successful, selling more than 500,000 copies and winning Nuland a National Book Award for Nonfiction and a Pulitzer nomination. It also propelled him to a full-time writing career.
Nuland was born in the East Bronx, N.Y., as Shepsel Ber Nudelman on Dec. 8, 1930, the child of Russian Jewish immigrants. He adopted the Americanized first and middle names Sherwin Bernard when he entered kindergarten, and later legally changed his surname to Nuland to increase his chances of getting into medical school at a time when few Jews were accepted.
His father, Meyer, was a Yiddish-speaking garment worker who refused to assimilate, never learning English. Meyer Nudelman had an explosive temper and often erupted in rage, terrifying his family. He later suffered physical disabilities that forced young Sherwin to help him up and down the stairs to their apartment. After he became a doctor, Sherwin realized that his father suffered the debilities as a result of chronic syphilis.
Nuland's life was filled with pain and suffering. His grandmother, who lived with them in their small four-room apartment, lost three sons to tuberculosis. His mother had one child stillborn and lost another son at age 3. When he was 3, Sherwin was hospitalized for diphtheria. His mother died when he was 11.
"Death was part of the legacy and lore of our family," he said in an oral history.
He received his bachelor's degree from New York University in 1951, then enrolled at Yale to study medicine — in part to get away from New York City and his father. After he received his medical degree in 1955, he joined the Yale-New Haven Hospital to specialize in surgery. By 1958, he was the chief surgical resident, an honor that had only rarely been accorded Jewish physicians.
He spent his entire medical career at the hospital and at Yale, where he was a professor of surgery and also taught bioethics and the history of medicine.
Influenced in part by these many tragic events, Nuland developed severe depression and at 42 was hospitalized for a year. Because his illness proved exceptionally resistant to treatment, doctors planned to perform a lobotomy. But a young psychiatric resident, Dr. Vittorio Ferrero, persuaded them to hold off on the surgery and instead try electro-convulsive therapy, in which mild electric shocks are applied to the brain to, in effect, "reboot" it.
The therapy was successful, although Nuland later suffered from mild bouts of the disease. The institutionalization was largely responsible for his divorce from his first wife. In 1977, he married his second wife, actress and director Sarah Peterson.
Nuland's views on dying were also influenced by the 1990 death of his brother Harvey from colon cancer. Nuland had urged him to fight the disease and encouraged him to undergo a painful experimental course of treatment that had little prospect for success. Only later did he realize that he had simply exacerbated his brother's suffering.
Before "How We Die," Nuland wrote "Doctors: The Biography of Medicine" (1988) and "Medicine: The Art of Healing" (1992), both of which illuminate the history of medicine by focusing on the biographies of famous physicians. The success of "How We Die" and the freedom it offered him led him to formalize his retirement and devote the rest of his life to writing.
Among his other books were "The Wisdom of the Body" (1997), later relabeled "How We Live," and a 2008 memoir, "The Uncertain Art: Thoughts on a Life in Medicine." He also wrote non-academic articles for magazines and newspapers.
In addition to his wife, Nuland is survived by two daughters, two sons and four grandchildren.
Maugh is a former Times staff writer.Copyright © 2014, Los Angeles Times