Sherwin B. Nuland, the surgeon and man of letters who unshrouded death in “How We Die,” a best-selling volume that received the National Book Award and became a classic of medical literature, died March 3 at his home in Hamden, Conn. He was 83.
The cause was prostate cancer, said his son Drew Nuland.
Dr. Nuland was known to fellow doctors, writers and thousands of readers as a sort of modern-day Maimonides — part physician, part philosopher and the repository for the wisdom in medicine as he saw it practiced.
He spent years as a surgeon at Yale-New Haven Hospital, then turned to writing and produced a series of books that illuminated how human life evolves, and ultimately ends.
“How We Die: Reflections on Life’s Final Chapter” received the 1994 National Book Award for nonfiction and was translated into numerous languages. The book presents accounts of death by various causes — heart attack, cancer, Alzheimer’s disease, even homicide — in such raw detail that some readers said they were unable to finish it.
The publication of the book coincided with an intensifying societal debate about death with dignity, as it was called — an outcome, in Dr. Nuland’s view, that was exceedingly difficult to achieve.
“It’s unnatural to believe death usually has a beauty and a concordance and is usually a coming together of your life’s work,” he once told Newsweek magazine. “It leads to frustration for the patient. And it leaves grieving families convinced they did something wrong.”
Dr. Nuland opened the book by describing the first death he witnessed as a doctor. It happened to be the death of his first patient, a 52-year-old man who seemed stable upon arrival at the hospital but was suddenly gripped by a massive heart attack.
Dr. Nuland opened the patient’s chest in a futile effort to save him and held in his hand the man’s fibrillating heart. It felt, Dr. Nuland wrote, like a “bagful of hyperactive worms.” Then, Dr. Nuland watched “something stupefying in its horror.”
The patient, he wrote, “whose soul was by that time totally departed, threw back his head once more and, staring upward at the ceiling with the glassy, unseeing gaze of open dead eyes, roared out to the distant heavens a dreadful rasping whoop that sounded like the hounds of hell were barking.”
The sound, Dr. Nuland later realized, was the so-called death rattle frequently emitted from the voice box of the newly dead.
“Now you know,” a more seasoned colleague told him, “what it’s like to be a doctor.”
The National Book Award citation honored him for a style of writing that was “vivid, straightforward, at times almost painful to read” and that “strips the act of dying of all its romantic aspects.”
Dr. Nuland’s work transcended death to encompass the marvels of a healthy human organism, a topic that he addressed in “The Wisdom of the Body” (1997), later republished as “How We Live.”
His books also included: “Doctors: The Biography of Medicine” (1988); “The Mysteries Within” (2000);“The Art of Aging” (2007); “The Uncertain Art: Thoughts on a Life in Medicine” (2008); and “The Soul of Medicine” (2009). He wrote biographies of Leonardo da Vinci and Maimonides, as well.
But Dr. Nuland was best known for his insights into death, a topic with which he said he had a “unique relationship.”
Dr. Nuland was born Dec. 8, 1930, to a Yiddish-speaking family of immigrants in the Bronx. He was called Shepsel Ber Nudelman and later took the name Sherwin Bernard.
His grandfather and two uncles made their way from Russia to America, only to succumb here to tuberculosis. A brother died of an infectious disease before Dr. Nuland was born. His mother died of cancer when he was 11.
“The whole atmosphere was one of looming tragedy,” Dr. Nuland told the New York Times. “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.”
His father, Meyer Nudelman, was a garment-district sweatshop worker and struggled to walk. Dr. Nuland recalled fearing that his father would drop him when the older man carried him home from the hospital, where as a boy Dr. Nuland was treated for diphtheria. Years later, Dr. Nuland realized that his father had been suffering from the consequences of syphilis.
In addition to his medical books, Dr. Nuland wrote “Lost in America” (2003), which the Times described as an “agonizing memoir” about his father and the difficulty of reckoning with his legacy.
Meyer Nudelman was described as being deeply proud of his son’s accomplishments, which included a bachelor’s degree from New York University in 1951, a medical degree from Yale in 1955 and appointment as chief surgical resident.
In the early years of his career, Dr. Nuland descended into a depression so severe that a lobotomy was considered. The idea was ultimately rejected, and Dr. Nuland underwent a course of electroshock therapy. He emerged from the depression and continued his work at Yale, where he taught and practiced for years.
Despite the candor with which he discussed the limitations of medicine, he also maintained his belief in its possibilities.
“We have had a rewarding relationship, the belly and I,” the surgeon wrote in “Wisdom of the Body.”
One of his four children, Victoria Nuland, is the U.S. assistant secretary of state for European and Eurasian affairs.
Dr. Nuland observed that by writing “How We Die,” he became so acquainted with the end of life that “instead of my belonging to death, death now belongs to me.” He argued that “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.”
As for how to live before that time comes, his philosophy was perhaps revealed in the epigraph that he chose for his memoir of his father. It was a line attributed to the Jewish philosopher Philo of Alexandria.
“Be kind, for everyone you meet is fighting a great battle.”