‘How We Die’ Becomes Surprise Hit

When Sherwin B. Nuland set aside his surgical practice and teaching chores to write a book, friends asked what exactly was keeping him from the fray.

“I would tell them what my book was about--and that would end the conversation,” Nuland recalls.

Many others have been far less squeamish. Nuland’s “How We Die” (Knopf), a graphic but sage reflection on the ways people die from heart attacks, cancer and other killers, has become what would seem to be the unlikeliest bestseller of 1994.

Compelling text, fine reviews and abundant broadcast interest have stirred sales so that the initial print run of 50,000 copies last month has since grown to 307,000. After a recent TV hour with Oprah Winfrey, who interviewed Nuland along with several terminally ill patients, the Waldenbooks chain reported selling nearly 2,900 copies last week.

“I don’t say anything that people don’t know,” Nuland says. Or that people don’t want to know. “We have been fed a diet of pap about death--that thinking good thoughts can cure cancer, for example--while people crave the truth and reality about death.”

Nuland, 63, draws truth and reality from his four decades as a doctor, beginning with the ‘50s before cardiopulmonary resuscitation, when he once cut open a man’s chest in a futile bid to jump-start his stricken heart by hand. Eyes bulging, fists balled up against his chest, the man soon “roared out to the distant heavens a dreadful rasping whoop that sounded like the hounds of heaven were barking,” Nuland writes. “Only later did I realize that what I had heard was the man’s version of the death rattle, a sound made by spasm in the muscles of the voice box.”

Nuland began to write “How We Die” two years ago. This was before Betty J. Eadie’s “Embraced by the Light” (Gold Leaf Press), a Christian account of her near-death experience, began its appearances atop bestseller lists and spawned other death-minded titles. The latest, Dannion Brinkley’s “Saved by the Light” (Villard), which tells of the author’s two near-death encounters, recently went back to press for an additional 5,000 copies that raise its in-print total to 40,000 after two weeks on sale.

Nuland, whose effort breaks down one of publishing’s last taboos with its candor, does not claim credit for the idea.

Literary agent Glen Hartley, of Writers’ Representatives in New York, envisioned the market for such a book and conceived of the attention-grabbing title, despite the assurance of several physicians that people would not want to know the nitty-gritty of how we die. Hartley eventually phoned Nuland in hopes of enlisting him to write “How We Die,” but the surgeon had other representation at the time and was working on another book.

“But that night I found myself thinking about my adolescence,” Nuland recalled. “My mother died when I was 11, which was a central event of my life, and in years of practice I had treated numerous patients who died from terminal illnesses. I thought, ‘Why am I saying no to this idea?’ ”

Nuland called Hartley back and became a client. Nuland’s proposal earned him a six-figure advance from Knopf and enabled the publisher to sell publication rights in 14 other countries. Knopf last year sent the first chapter to booksellers--a tease usually reserved for upcoming novels--to help generate the orders that now far exceed Nuland’s expectations.

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