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How We Die


When physicians also write beautifully, we can be blessed by their wisdom.

In reading about the Connecticut tragedy yesterday, I came across a question that must be haunting the entire nation:“Did the children suffer when they were shot?” And I remembered the source of a comforting response.

It appeared in one of my all-time favorite books, How We Die, by Sherwin B. Nuland, MD. The subtitle for the book is “Reflections on Life’s Final Chapter,” and it is an enormously enjoyable read. When physicians also write beautifully, we can be blessed by their wisdom.

I remembered a chapter titled “Murder and Serenity,” which focused on the story of a nine-year-old girl who was viciously murdered by a paranoid schizophrenic. What irony that this event also occurred in a small Connecticut town. Pretty Katie Mason was visiting a fair with her best friend, her mother, and sister. When she was briefly separated from mother and sister, the killer struck.

He grabbed Katie by the hair, threw her to the ground and immediately began stabbing her in the face and upper body with a knife with a seven-inch blade. It took three men and a policeman to subdue the killer.

Katie died of acute hemorrhage in her mother’s arms. Joan Mason’s account of the event focused on the unforgettable expression on her daughter’s face. She said it was not a look of terror but of surprise. At first there was a glimmer in her eyes, and then they glazed over; and then Joan knew, as she put it, that “she was no longer in her body, that she was somewhere else.” She would later describe Katie’s expression as a look of “innocent release.”

Dr. Nuland was a surgeon, and he practiced in a hospital nearby but was not involved in this case. He wrote that the description of Katie’s dying tranquility is common in the case of trauma, a moment of “serenity and languorous comfort in the face of what would seem to be frightful and agonizing wounds.” The prototype is the aftermath of some powerful narcotic painkiller used in surgery, which in the proper dosage can even produce a degree of euphoria.

Dr. Nuland is convinced that the body itself knows how to make those morphine-like substances and release them in the moment of need. They are what we call endorphins, and they are secreted by the hypothalamus, an area of the brain called “periaqueductal gray matter,” and the pituitary gland. In the case of Katie Mason, Dr. Nuland was sure that nature had stepped in once again with the “right spoonful of medicine to give a measure of tranquility to a dying child.”

How We Die was published in 1994, and it helped me with the horror of 9/11. I hope that the comforting perspective will help others now as well. Would that none of us ever again have occasion to remember it.

2 Responses to “How We Die”

  1. Elizabeth Robechek

    I am wondering, when children watch their friends and teacher be murdered as the bullets get closer to themselves, if they have experience innocent release. Maybe they would, not so sure…….


  2. Kate

    Thanks. I will forward this comforting message to a few friends who are suffering today.