Sherwin B. Nuland

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

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.

Cancer cells are fixed at an age where they are still too young to have learned the rules of the society in which they live. As with so many immature individuals of all living kinds, everything they do is excessive and uncoordinated with the needs or constraints of their neighbors... they are reproductive but not productive.

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 writings and the recommendations of the earliest medical scientists and the new breed of clinicians between the mid-fifteenth and early seventeenth centuries were based on the supposition that sufficient study and experimentation would elucidate not only the origins of disease, but its treatment as well.

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.

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.

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.

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.

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 final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life, but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.

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