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Bianca Nogrady, The end: The human experience of death (Review)

November 6, 2013

Bianca Nogrady, The end book coverHave you thought about your death? About how and where you want to die? These are the questions Australian science journalist Bianca Nogrady asks us to consider in her recent book, The end: the human experience of death. I’m not a morbid person, but when Nogrady contacted me to ask whether I’d consider reviewing her book, The end, it didn’t take me long to say yes. Like Nogrady I did witness, a couple of years ago, something I would call “a (pretty) good death”. That I felt it was so, intrigued me. I was therefore interested to read what Nogrady had to say.

And what she had to say was fascinating from beginning to end. In her introduction, she says:

This book could just as easily have been Everything you wanted to know about death but were afraid to ask. Death is fascinating, compelling, and it consists of much more than simply the end of a biological life-form. In seeking to understand death, we are seeking to understand life.

The rest of the book is structured logically according to the sorts of topics we are likely to ask about, starting with why we die, and then moving on to issues like defining death, where, when and how we die, spiritual and out-of-body experiences, and religion. Nogrady looks at these issues from all the likely points of view –  medical, sociological, psychological, philosophical, legal and ethical. She organises her information well, and the chapters (and subchapters) flow very naturally from each other.

So far, I have probably made it sound like a well-organised rather dry read – but that’s not how it is. Not only did Nogrady do a lot of secondary research (as the Notes at the end attest) but she also interviewed a lot of people. As a result, the formal information garnered from her research is supported by people’s stories, which also add colour and life to the facts. Many are of course sad – we are talking death after all – but this is not a sad book.

The most complicated section of the book is the second chapter on “Defining Death”. Nogrady takes us carefully through the different “definitions” – specifically, cardiac death and brain death (which, I learnt, can be further subdivided into “whole brain death” and “brain stem death”). She shows how the definition issue has been complicated by medical advances enabling us to keep the body alive and, of course, by the organ transplant process. Royal North Shore Hospital’s Intensive Care Specialist Dr Ray Raper suggests that death is:

a continuum; a graded box with one end as ‘being alive’ and the other end as ‘being dead’ … If you look at the domains of the transition between life and death, they’re spiritual, functional and structural and they’re biological, and the most important ones are the functional ones.

Death, in other words, is a process. If your fingernails are still growing when you are in the coffin, then, says Arizona State University Professor of Philosophy Joan McGregor, the questions needing answers relate to what are we preserving and why do we value it. I’ll leave this discussion here because there is no single solution – or not at present anyhow. This is murky ground indeed, but Nogrady manages to traverse it with clarity. I will probably have to read the book a few times though for the concepts to stick!

She also discusses euthanasia, teasing out misconceptions. She explains the differences between physician-assisted suicide, voluntary euthanasia and terminal sedation. She also explores the rise in palliative care as a profession, covering related issues like death doulas and volunteer workers in palliative care hospitals (or hospices). And of course she talks about near-death experiences, and those death-time phenomena that science can’t explain such as clocks stopping, machines behaving erratically, and deathbed visions.  The final chapter discusses faith and belief. Death is cultural, but, as she discovered, there is as much similarity as there are differences in end-of-life rituals.

It’s a funny thing to say, I suppose, but this is an enjoyable book. It’s neither superficial nor so detailed that you get bogged down. There is a lovely balance between expert opinions and anecdotes. I can imagine reading it again – or parts of it. It’s a shame, though, that there isn’t an index, which seems to be common in non-fiction books aimed at a general market. I guess it’s all about cost.

Australian Women Writers ChallengeIn her epilogue, Nogrady returns to her own experience, to how the death of her grandmother had caused her to want to better understand death. Writing the book, she says, made her think about “the value of planning, or at least thinking about how we want to die”. Death is, after all, a “one-way journey”. We do it alone, and it may well be, she argues, our best chance “find out who we are at the core”. One man who spent a long time thinking about his death, because he had a degenerative, terminal disease, was Australian public intellectual Donald Horne whose last book, written with his wife Myfanwy, was Dying: A memoir. He wrote:

My final drifting away, via a morphine dose, I would want to be among my memories, with Myfanwy whom I love holding my hand.

Think about your death, plan for it, is Nogrady’s final message to us. If you’re ready to take up her challenge, The end would be a good place to start.

Bianca Nogrady
The end: The human experience of death
North Sydney: Vintage Books, 2013
260pp
ISBN: 9781742752051

(Review copy supplied by the author)

9 Comments leave one →
  1. ian darling permalink
    November 7, 2013 12:56 am

    Very interesting post on an interesting sounding book. I suppose literature is saturated with the human response to death. Did yyou ever read Tolstoy’s story “The Death Of Ivan Illich” and Chekhov’s “Ward Number 6”. The Chekhov story is a response to the Tolstoy – on what death and life might mean. Both are magnificent short stories.

    • November 8, 2013 7:57 am

      Oh thanks Ian … No it is a gap in my novella, which I love, reading that I haven’t read those. My mum is reading the Tolstoy now so I should try to read it.

      You’re right about literature … So many poems too. A few of those would have been nice on the book, but you can’t do everything. She does argue against Dylan Thomas’s Rage, rage exhortation though suggesting that when your time comes, you should go with it and experience it properly, if you have the opportunity.

  2. November 7, 2013 6:28 am

    Sounds like a good book. People don’t like to think about their own mortality though so don’t, myself included, think about it. I do hope that I die at home, quietly and in my sleep. I don’t want to be in a hospital hooked up to a gazillion beeping machines. It seems though that these days very few actually get to make that decision which is very sad.

    • November 7, 2013 8:14 am

      Yes, I agree, Stefanie. Part of the thing is to have an Advanced Care Directive … that specifies how you want the end to be handled. Not all of us will get the choice … But it’s good to do what you can to ensure you do.

  3. November 7, 2013 12:14 pm

    I had the weirdest things happen in connection with this post. I need to tell you – we should Skype soon.

    Very interesting review of what seems a fascinating book. Made me think of a lot of what we discussed in Sociology of Death and Dying at UVA all those years ago (two UVA references in one week!)

  4. Lithe lianas permalink
    November 8, 2013 5:27 pm

    This sounds like an excellent book – I wanna read it!

    As an octogenarian with a nonagenarian husband we are quite prepared, after a life of more ups than downs, though with one big down, to ‘go gentle into that dark night’. We naturally hope it will be a gentle death but do not dwell on the fact that it could be not far away. I feel sad for those who fear death as did the fictitious Ivan Ilyich – a ‘Pharisee’ if ever there was one who thought living by the rules was all that was required of him. If, when you die others are kind to your faults and can count some virtues you will have done pretty well.

    Meantime we are remembering the good times.

    • November 8, 2013 6:46 pm

      Lovely comment, thanks LL. I think you would enjoy – funny word that in this instance – the book.

  5. November 9, 2013 8:09 pm

    This week I read a beautiful tribute by Laurie Anderson to her husband and soul mate Lou Reed in Rolling Stone magazine and it included an uplifting description of his last moments – how he was prepared, calm and graceful. While almost painfully intimate, it was a very universal and humane piece, truly admirable.

    • November 10, 2013 11:14 am

      Such pieces are special aren’t they, Catherine. And yet, as you say, painfully intimate – something you partly want to keep to your self and partly want to share.

      Donald and Myfanwy Horne’s Dying is a book, not an article, but it had a similar impact on me.

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