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The Lost Art of Dying: Reviving Forgotten Wisdom
A Columbia University physician inspires us to rethink death and offers insights on how we can learn to embrace the art of dying well in this wise, clear-eyed book that is as compelling and soulful as Being Mortal, When Breath Becomes Air, and Smoke Gets in Your Eyes.
As a specialist in both medical ethics and the treatment of older patients, Dr. Lydia Dugdale knows a great deal about the end of life. Far too many of us die poorly, she argues. Our culture has overly medicalized death: dying is often institutional and sterile, prolonged by unnecessary resuscitations and other intrusive interventions. We are not going gently into that good night—our reliance on modern medicine can actually prolong suffering and strip us of our dignity. Yet our lives do not have to end this way.
Centuries ago, in the wake of the Black Plague, a text was published offering advice to help the living prepare for a good death. Written during the late Middle Ages, Ars moriendi—The Art of Dying—made clear that to die well, one first had to live well. When Dugdale discovered this Medieval book, it was a revelation. Inspired by its holistic approach to the final stage we must all one day face, she draws from this forgotten work, combining its wisdom with the knowledge she has gleaned from her long medical career. The Lost Art of Dying is filled with much-needed insight and thoughtful guidance that will change our perceptions. Dr. Dugdale offers a hopeful perspective on death and dying as she shows us how to adapt the wisdom from the past to our lives today.
Part of living well means preparing for the end, Dr. Dugdale reminds us. By recovering our sense of finitude, confronting our fears, accepting how our bodies age, developing meaningful rituals, and involving our communities in end-of-life care, we can discover what it means to both live and die well.
Illustrated with 10 black-and-white drawings throughout, The Lost Art of Dying Well is a vital, affecting book that reconsiders death, death culture, and how we can transform how we live each day, including our last.
As a specialist in both medical ethics and the treatment of older patients, Dr. Lydia Dugdale knows a great deal about the end of life. Far too many of us die poorly, she argues. Our culture has overly medicalized death: dying is often institutional and sterile, prolonged by unnecessary resuscitations and other intrusive interventions. We are not going gently into that good night—our reliance on modern medicine can actually prolong suffering and strip us of our dignity. Yet our lives do not have to end this way.
Centuries ago, in the wake of the Black Plague, a text was published offering advice to help the living prepare for a good death. Written during the late Middle Ages, Ars moriendi—The Art of Dying—made clear that to die well, one first had to live well. When Dugdale discovered this Medieval book, it was a revelation. Inspired by its holistic approach to the final stage we must all one day face, she draws from this forgotten work, combining its wisdom with the knowledge she has gleaned from her long medical career. The Lost Art of Dying is filled with much-needed insight and thoughtful guidance that will change our perceptions. Dr. Dugdale offers a hopeful perspective on death and dying as she shows us how to adapt the wisdom from the past to our lives today.
Part of living well means preparing for the end, Dr. Dugdale reminds us. By recovering our sense of finitude, confronting our fears, accepting how our bodies age, developing meaningful rituals, and involving our communities in end-of-life care, we can discover what it means to both live and die well.
Illustrated with 10 black-and-white drawings throughout, The Lost Art of Dying Well is a vital, affecting book that reconsiders death, death culture, and how we can transform how we live each day, including our last.
Audible Audio
First published January 1, 2020
About the author
Lydia S. Dugdale
3 books11 followersLydia Dugdale, MD, is an internal medicine physician and Associate Director for the Program for Biomedical Ethics at Yale School of Medicine.
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June 15, 2024
My Journey Book of 2024
“In other words, how do we choose our ending.” – Karen Robert (me)
12-19-24 – UPDATE: If you have already read this review in its entirety, skip to end to find out what I have since learned, and for another update since November. If not, please read review first, so you will understand why reading the review first will make better sense before reading the updated information. Thank you. 🙏
I didn’t share this book with you as “currently reading” on Goodreads on purpose. It was personal. I wasn’t even sure I was going to write a review. But there was too much about what I was experiencing and what this book was sharing that I couldn’t remain silent any longer about my personal journey. I needed to talk. To someone. Why not you.
The title says a lot. We as a humanity don’t have a good relationship with death. We fear it. We fight it. We demonize it. We typically avoid it. We certainly don’t want it. And yet, the author tells us…
“The art of dying well starts with the art of living well.”
So, how do we do this dying well anyway? Does the author provide answers that help?
In some ways I can answer this with my own journey.
Why my preoccupation with death?
A couple weeks ago, I learned there was something growing inside of me that does not belong here. And, now I am faced with what to do about it. There is no easy answer to this dilemma. Everyone has their own fight or flight mode of action. And, until one is in close conversations with their own care team of medical professionals and community partners (the friends and family we keep close) the answers are not always clear.
All I could think about while I was considering my options was those I loved. Was I ready to say goodbye to them if something did not go well?
The author noted that palliative-care doctor Ira Byock “suggests that, in addition to arranging financial and legal matters that, there are five phrases for ‘relationship completion:’ “I forgive you,” “Forgive me,” “Thank you,” “I love you,” and “Goodbye.”
I was grateful that my husband and I had already managed our financial and legal affairs years ago. Was I ready to attend to my ‘relationship completion?’ without really knowing if I am technically dying yet?
I believe in present moment living. I live in the moment. Be. Here. Now. And yet, so much of what I am experiencing felt like it was planning for an inevitable future that didn’t feel that far away. It felt like it was becoming sooner than later than I was ready to accept. Was I being morbid? Or practical?
As the author shares examples about many of her patients who struggled with letting go, I couldn’t help but think about our father.
I remember when our father suffered through his Waldenstrom macroglobulinemia. A form of lymphoma cancer. He had it for 11 years. He was so obsessed with his dis-ease, in finding a cure, that he allowed the doctors to do any procedure on him. Which led to more surgeries to correct the problem created by the presumed chemical cures that were supposed to have helped him.
He was so afraid of dying he forgot how to live.
He wasn’t there for his children or his grandchildren. Or his wife (our mother). When the doctor in the hospital told him there was nothing more they could do for him, and he could go home to hospice care, he instead chose to finally give up. He died within 24 hours in the hospital. There was no closure for any of us. It was a lonely death. And, it was an emotional time for us as a family.
His illness and his death made an indelible impression on my brother, sister and I. I know I am facing my own mortality now. But I choose to live each day, in wonder, grateful for another day, happy to be here now in this moment. I know that I am not obsessed about keeping myself alive by medical technologies or chemistries. I do not want my body to be shriveled up and in pain the way my father was, so he could live another day in his obsession about his dis-ease. That to me was not quality of life.
The author brings up the word finitude a lot. The definition: the state of having limits or bounds. But I think what she refers to when she talks about finitude here is simply, “the end.”
In other words, how do we choose our ending.
She says, “finitude on a small scale – the rickety knee, the bifocals – ought to stir in us a need to prepare for that final finitude.”
She also tells us that those of us that do experience health “scares” from which we recover are typically “altered by our confrontations with illness.”
I can certainly relate to what she shares. Going through the multitude of tests to eventually learn about what was growing inside of me, certainly opened my eyes to inspire me not only to expect the unexpected, but also to contemplate how I might address my broken flawed body within. To prepare for the inevitable. To possibly contemplate…dying? Yes, that is a question mark. Because I still don’t have an answer to what will happen next. That will be a discussion for me and my General Surgeon this week. And, I recognize too, that none of us really have an end date, do we?
When do we actually mutter the words, “I’m dying?” And, if we do, does it mean we set it in actual motion because we believe it to be true, or is it actually true?
I am not a religious person. I am a spiritual being having a human experience. I also recognize that at this stage of my life that I have lived the majority of my years. So, I am closer to the end, whenever that may be. So, what will it be in the end?
The author tells us it will not be tidy. She reminds us that death can in fact, be chaos. And, that we should consider that death creates emotions for those of us preparing for it. Even, if we still have our faculties, and those who surround us – with love and who are our many caregivers – whether they are our medical team or our friends and family. She mentions the existential questions – and believe me, it is easy for those to rear their ugly head, too.
Like: “why did she have to suffer? Why the untimely death? Where is God?” Even, does it matter where we die? I have one son who lives with his family in Texas. I have one son who lives with his family in Oregon. I live on the central coast in California next to the beautiful Pacific Ocean. I happen to love my home. Still, in the end, is it about being at home or being with family?
Also, the author asks…
“…if dying ends in death, can we say that our physical location, once we are dead, matters to us any longer?”
And, then of course all the technical details of preparation for after the death.
I wanted to know how this happened to me, but I don’t know that there really was an easy answer to that question. I just know I had a fall last year, fractured my rib that didn’t heal, and ended up with a lot of tests and then discoveries that led me here now. Would I have discovered this had I not fallen? Who knows?
*This book provides some insights into the tasks of living well. It is not a perfect read, but it gets the discussion started, about talking about death. Mostly, that each of us can decide now, before we are actually faced with death to make these decisions on our own about how to best prepare for it.
Maybe even have this long discussion with those who matter, like I am having with you. Thank you for reading my review/discussion.
Hand Over Heart ❤️🩹Breathe
*And, to be honest, the book was probably a quicker read, than my review! 😉
Special Note: The author includes beautiful artist renderings at the end of her book by artist Michael W. Dugger which translates each of her chapters through his visual drawings.
UPDATE provided 7/28/24: Reading has been a great diversion for me since I was faced with the news after my first CT scan, and writing my review of this book to try and release my feelings about it. There were so many unknowns at the time. My primary care physician sent me off to specialists, who then sent me off to do more tests.
I had 15 tests/procedures since late April this year. 5 blood draws, 4 CT scans, an electrocardiogram, 2 ultrasounds and a biopsy. It wasn't until Wednesday, July 24 - that I finally discovered what I have. A low grade, Non-Hodgkins Lymphoma. The good news is that it is slow growing and it was caught early. I meet with an oncologist this coming Friday, August 2 to determine our next steps.
The other good news is that I feel calm and I am hopeful.
I am also grateful for all the wonderful words of encouragement and warm and thoughtful hugs and caring thoughts from all of you! Thank you! ☺️
UPDATE August 16, 2024: After meeting with my Hematologist/Oncologist on August 2, he felt that my Marginal Zone Lymphoma – Stage 3, (always interesting to find differing names for it), was treatable with I.V. immunotherapy and chemotherapy. I opted not to do the chemotherapy. He accepted my wishes.
I had my first treatment yesterday. But before I share about that experience, I need to be honest about the process of acceptance of this cancer, I am experiencing. And, the best way I can is through books.
Do you wonder sometimes if you pick books to read or if they pick you at the right and perfect time?
I was reading this one book, “What you Leave Behind” by Wanda M. Morris, (I have reviewed this one, if interested), about imperfect real estate developers that weren’t exactly nice people doing not exactly nice things to really good people. So, that wasn’t the part of the story that got to me. It was the underdog character, who was fighting them that appealed to me. Her story. She was experiencing grief through the recent loss of her mother. One of the things that the character said that I could appreciate…
“When you are a grown woman, people expect you to power through the grief. You’re an adult, you’re supposed to know that death is a part of life. And if you looked at me, on the outside, I was all that. But on the inside, I was a broken mess.”
In that moment, that character got me. Because I could relate to everything she shared. On the outside I am strong. On the inside, I don’t feel a thing. My feelings haven’t emerged about what is happening to me. The character also shared…
“A cancer diagnosis comes right before a car accident. It’s like a nonstop battle with the universe to see if you’re strong enough to fight your way through the layers of misfortune and heartache.”
There are those who won their battle with cancer. And, there are those still in the midst of their battle with cancer. The battle for me is just beginning. And, I still don’t know how I feel about having cancer.
So, here I was yesterday, August 15, hooked up to my I.V. immunotherapy lifeline treatment. (Remember: No chemotherapy.) Knowing that this was supposed to take me to the other side of cancer – the possibility of remission. My first treatment. 3 more to go.
What was I feeling? Nervous? Anxious? Nauseous? Overwhelmed? Hopeful? Shall I leave you with a cliffhanger – like a book?
No! I would never do that to you! I hate cliffhangers! I was all those things going in. But to be honest, the therapy and staff were phenomenal, so that I felt safe, comforted and grateful that I am on my way to healthy. And, I truly believe that.
Besides a wise man once said…
“Never tell me the sky is the limit when there are footprints on the moon.”
I continue to appreciate all of your powerful healing energy. Thank you so much for sticking around with me on this journey. 😊
UPDATE provided 10/17/24: After 6 immunotherapy sessions (no chemo), another PET CT and bloodwork, let’s begin with the good news.
The Non-Hodgkins Lymphoma is in remission.
And now, for the rest of the news.
The tumor mass located near my lungs and thymus is still present in my body. So, what does this mean? We need a biopsy. Even though it has been thought to be benign, my doctor wants to be sure there is no active lymphoma within the mass.
So, that is where I am at.
I am now awaiting word as to when the biopsy will occur, and/or if it can occur, because of the mass’ precarious position. We will know more and next steps after the hopeful biopsy result.
I am so grateful that there is good news here. And so very grateful for all of your thoughts, and prayers and kind words over these past few months. Thank you. ☺️
Hope. Here now. Life is a gift. Let us breathe it in.
Hand Over Healing Heart ❤️🩹Breathe
UPDATE provided 11/8/24: On Thursday, October 31, 2024, I went in to my local hospital for a biopsy of my tumor mass which is located near my lungs and thymus. This was conducted by a specialist known as an Interventional Radiologist. Did you know that there was even this kind of medical position? I have been learning so much about the medical profession since my cancer diagnosis. I can’t begin to tell you how grateful I am for my care team!
Anyway, as I mentioned in my October update, my Oncologist wanted to be sure that I did not have an active lymphoma present. This was a risky in hospital procedure because they had to sedate me and go through one of my lungs to get to the mass. The doctor mentioned prior to the surgical procedure that there was a 20% possibility that my lung could collapse, and if it did, they would have to insert a tube and keep me overnight for observation. Fortunately, that did not occur!
On November 7, 2024, I met with my Oncologist and finally found out (after six months of not knowing) what this tumor/mass was when he shared the biopsy results with me. My tumor/mass is a benign cancer known as a Thymoma. Thymoma is a rare cancer that affects the thymus gland, an organ located between the lungs. The thymus supports the immune system's development during childhood and helps the body fight illness throughout a person's life. And, as I mentioned, fortunately it is benign. A thymoma tumor typically grows slowly and is unlikely to spread.
Because I am an unusual case with two separate cancers, my Oncologist will be presenting my case to our County Tumor Board later this month (November, 2024) to get other specialists opinions on the best course of action for me. He will call me and give me the results of that discussion.
For now, my good news is that my non-Hodgkins Lymphoma is in remission and my Thymoma is benign. My Oncologist’s current plan is to follow up with me with a PET CT and bloodwork in December 2024 with discussion in early January 2025 before determining if a maintenance plan will be necessary, or if I will just be a watch and monitor patient. Of course, it will also be interesting to hear what the other specialists think should happen, as well.
At present, I feel good! And hopeful, that nothing more needs to happen, other than me being just a watch and monitor patient.
As always, thank you so much for your thoughtful words and support. ❤️🩹
Update provided 12/19/24:
Let’s recap my cancer journey thus far. September (19) was my last of six immunotherapy sessions. (No chemo.) I had a PET CT in October (7) to determine whether the immunotherapy sessions had worked. We learned that the somewhat good news was that nothing had changed with my tumor mass which was located near my lungs and thymus. The better news was that my Non-Hodgkins Lymphoma went into remission. But my Oncologist felt that my tumor mass needed to be biopsied to make sure that there was no active lymphoma present. So, the biopsy took place at the end of October (31) and my tumor mass was finally identified as a benign Thymoma cancer. My Oncologist took this information to the County Tumor Board in mid-November and they determined that the best course of action was that the Thymoma should be resected. (A dangerous, risky surgery. Especially if the Thymoma became a malignant carcinoma.)
Which leads me to the past few days.
I had my bloodwork done on Wednesday, 12/11. I had a PET CT on Monday, 12/16. On Tuesday, 12/17, I met with my Surgeon. On Wednesday, 12/18, I met with my Oncologist. And today I offer the results…
For a benign unchanging Thymoma cancer, not even my surgeon would have the surgery performed on him! (Thank goodness, and phew!!!)
My test results came back that my Thymoma hasn’t changed, thus I don’t need to be seen by the surgeon for another 6 months with just a CT scan check-up. My Oncologist will follow-up with me in 3 months for bloodwork only, since my Non-Hodgkins Lymphoma continues in remission. The bloodwork is coming back fairly normal, with some areas out-of-range, which is somewhat to be expected for those individuals with cancer (even if it is benign or in remission). At the same 6-month mark, my Oncologist will also read the CT scan to determine my continued good health status. (Positive thinking is always the best course of action, don’t you think?)
Both anticipate that if everything continues to look, as expected, my need to see both doctors will be a visit that will be scheduled further into the future. The only reason to come sooner would be if I felt the need. Besides, Thymoma may be an uninvited guest in my body, but as long as it behaves, I can live comfortably with it.
Needless to say, I feel a sense of calm, and peacefulness and hope. My Christmas presents came early this year! 💝 May your new year be filled with radiant good health! Happy Holidays to all!
Hand Over Healing Heart ❤️🩹I actually feel like I can Breathe 😮💨
“In other words, how do we choose our ending.” – Karen Robert (me)
12-19-24 – UPDATE: If you have already read this review in its entirety, skip to end to find out what I have since learned, and for another update since November. If not, please read review first, so you will understand why reading the review first will make better sense before reading the updated information. Thank you. 🙏
I didn’t share this book with you as “currently reading” on Goodreads on purpose. It was personal. I wasn’t even sure I was going to write a review. But there was too much about what I was experiencing and what this book was sharing that I couldn’t remain silent any longer about my personal journey. I needed to talk. To someone. Why not you.
The title says a lot. We as a humanity don’t have a good relationship with death. We fear it. We fight it. We demonize it. We typically avoid it. We certainly don’t want it. And yet, the author tells us…
“The art of dying well starts with the art of living well.”
So, how do we do this dying well anyway? Does the author provide answers that help?
In some ways I can answer this with my own journey.
Why my preoccupation with death?
A couple weeks ago, I learned there was something growing inside of me that does not belong here. And, now I am faced with what to do about it. There is no easy answer to this dilemma. Everyone has their own fight or flight mode of action. And, until one is in close conversations with their own care team of medical professionals and community partners (the friends and family we keep close) the answers are not always clear.
All I could think about while I was considering my options was those I loved. Was I ready to say goodbye to them if something did not go well?
The author noted that palliative-care doctor Ira Byock “suggests that, in addition to arranging financial and legal matters that, there are five phrases for ‘relationship completion:’ “I forgive you,” “Forgive me,” “Thank you,” “I love you,” and “Goodbye.”
I was grateful that my husband and I had already managed our financial and legal affairs years ago. Was I ready to attend to my ‘relationship completion?’ without really knowing if I am technically dying yet?
I believe in present moment living. I live in the moment. Be. Here. Now. And yet, so much of what I am experiencing felt like it was planning for an inevitable future that didn’t feel that far away. It felt like it was becoming sooner than later than I was ready to accept. Was I being morbid? Or practical?
As the author shares examples about many of her patients who struggled with letting go, I couldn’t help but think about our father.
I remember when our father suffered through his Waldenstrom macroglobulinemia. A form of lymphoma cancer. He had it for 11 years. He was so obsessed with his dis-ease, in finding a cure, that he allowed the doctors to do any procedure on him. Which led to more surgeries to correct the problem created by the presumed chemical cures that were supposed to have helped him.
He was so afraid of dying he forgot how to live.
He wasn’t there for his children or his grandchildren. Or his wife (our mother). When the doctor in the hospital told him there was nothing more they could do for him, and he could go home to hospice care, he instead chose to finally give up. He died within 24 hours in the hospital. There was no closure for any of us. It was a lonely death. And, it was an emotional time for us as a family.
His illness and his death made an indelible impression on my brother, sister and I. I know I am facing my own mortality now. But I choose to live each day, in wonder, grateful for another day, happy to be here now in this moment. I know that I am not obsessed about keeping myself alive by medical technologies or chemistries. I do not want my body to be shriveled up and in pain the way my father was, so he could live another day in his obsession about his dis-ease. That to me was not quality of life.
The author brings up the word finitude a lot. The definition: the state of having limits or bounds. But I think what she refers to when she talks about finitude here is simply, “the end.”
In other words, how do we choose our ending.
She says, “finitude on a small scale – the rickety knee, the bifocals – ought to stir in us a need to prepare for that final finitude.”
She also tells us that those of us that do experience health “scares” from which we recover are typically “altered by our confrontations with illness.”
I can certainly relate to what she shares. Going through the multitude of tests to eventually learn about what was growing inside of me, certainly opened my eyes to inspire me not only to expect the unexpected, but also to contemplate how I might address my broken flawed body within. To prepare for the inevitable. To possibly contemplate…dying? Yes, that is a question mark. Because I still don’t have an answer to what will happen next. That will be a discussion for me and my General Surgeon this week. And, I recognize too, that none of us really have an end date, do we?
When do we actually mutter the words, “I’m dying?” And, if we do, does it mean we set it in actual motion because we believe it to be true, or is it actually true?
I am not a religious person. I am a spiritual being having a human experience. I also recognize that at this stage of my life that I have lived the majority of my years. So, I am closer to the end, whenever that may be. So, what will it be in the end?
The author tells us it will not be tidy. She reminds us that death can in fact, be chaos. And, that we should consider that death creates emotions for those of us preparing for it. Even, if we still have our faculties, and those who surround us – with love and who are our many caregivers – whether they are our medical team or our friends and family. She mentions the existential questions – and believe me, it is easy for those to rear their ugly head, too.
Like: “why did she have to suffer? Why the untimely death? Where is God?” Even, does it matter where we die? I have one son who lives with his family in Texas. I have one son who lives with his family in Oregon. I live on the central coast in California next to the beautiful Pacific Ocean. I happen to love my home. Still, in the end, is it about being at home or being with family?
Also, the author asks…
“…if dying ends in death, can we say that our physical location, once we are dead, matters to us any longer?”
And, then of course all the technical details of preparation for after the death.
I wanted to know how this happened to me, but I don’t know that there really was an easy answer to that question. I just know I had a fall last year, fractured my rib that didn’t heal, and ended up with a lot of tests and then discoveries that led me here now. Would I have discovered this had I not fallen? Who knows?
*This book provides some insights into the tasks of living well. It is not a perfect read, but it gets the discussion started, about talking about death. Mostly, that each of us can decide now, before we are actually faced with death to make these decisions on our own about how to best prepare for it.
Maybe even have this long discussion with those who matter, like I am having with you. Thank you for reading my review/discussion.
Hand Over Heart ❤️🩹Breathe
*And, to be honest, the book was probably a quicker read, than my review! 😉
Special Note: The author includes beautiful artist renderings at the end of her book by artist Michael W. Dugger which translates each of her chapters through his visual drawings.
UPDATE provided 7/28/24: Reading has been a great diversion for me since I was faced with the news after my first CT scan, and writing my review of this book to try and release my feelings about it. There were so many unknowns at the time. My primary care physician sent me off to specialists, who then sent me off to do more tests.
I had 15 tests/procedures since late April this year. 5 blood draws, 4 CT scans, an electrocardiogram, 2 ultrasounds and a biopsy. It wasn't until Wednesday, July 24 - that I finally discovered what I have. A low grade, Non-Hodgkins Lymphoma. The good news is that it is slow growing and it was caught early. I meet with an oncologist this coming Friday, August 2 to determine our next steps.
The other good news is that I feel calm and I am hopeful.
I am also grateful for all the wonderful words of encouragement and warm and thoughtful hugs and caring thoughts from all of you! Thank you! ☺️
UPDATE August 16, 2024: After meeting with my Hematologist/Oncologist on August 2, he felt that my Marginal Zone Lymphoma – Stage 3, (always interesting to find differing names for it), was treatable with I.V. immunotherapy and chemotherapy. I opted not to do the chemotherapy. He accepted my wishes.
I had my first treatment yesterday. But before I share about that experience, I need to be honest about the process of acceptance of this cancer, I am experiencing. And, the best way I can is through books.
Do you wonder sometimes if you pick books to read or if they pick you at the right and perfect time?
I was reading this one book, “What you Leave Behind” by Wanda M. Morris, (I have reviewed this one, if interested), about imperfect real estate developers that weren’t exactly nice people doing not exactly nice things to really good people. So, that wasn’t the part of the story that got to me. It was the underdog character, who was fighting them that appealed to me. Her story. She was experiencing grief through the recent loss of her mother. One of the things that the character said that I could appreciate…
“When you are a grown woman, people expect you to power through the grief. You’re an adult, you’re supposed to know that death is a part of life. And if you looked at me, on the outside, I was all that. But on the inside, I was a broken mess.”
In that moment, that character got me. Because I could relate to everything she shared. On the outside I am strong. On the inside, I don’t feel a thing. My feelings haven’t emerged about what is happening to me. The character also shared…
“A cancer diagnosis comes right before a car accident. It’s like a nonstop battle with the universe to see if you’re strong enough to fight your way through the layers of misfortune and heartache.”
There are those who won their battle with cancer. And, there are those still in the midst of their battle with cancer. The battle for me is just beginning. And, I still don’t know how I feel about having cancer.
So, here I was yesterday, August 15, hooked up to my I.V. immunotherapy lifeline treatment. (Remember: No chemotherapy.) Knowing that this was supposed to take me to the other side of cancer – the possibility of remission. My first treatment. 3 more to go.
What was I feeling? Nervous? Anxious? Nauseous? Overwhelmed? Hopeful? Shall I leave you with a cliffhanger – like a book?
No! I would never do that to you! I hate cliffhangers! I was all those things going in. But to be honest, the therapy and staff were phenomenal, so that I felt safe, comforted and grateful that I am on my way to healthy. And, I truly believe that.
Besides a wise man once said…
“Never tell me the sky is the limit when there are footprints on the moon.”
I continue to appreciate all of your powerful healing energy. Thank you so much for sticking around with me on this journey. 😊
UPDATE provided 10/17/24: After 6 immunotherapy sessions (no chemo), another PET CT and bloodwork, let’s begin with the good news.
The Non-Hodgkins Lymphoma is in remission.
And now, for the rest of the news.
The tumor mass located near my lungs and thymus is still present in my body. So, what does this mean? We need a biopsy. Even though it has been thought to be benign, my doctor wants to be sure there is no active lymphoma within the mass.
So, that is where I am at.
I am now awaiting word as to when the biopsy will occur, and/or if it can occur, because of the mass’ precarious position. We will know more and next steps after the hopeful biopsy result.
I am so grateful that there is good news here. And so very grateful for all of your thoughts, and prayers and kind words over these past few months. Thank you. ☺️
Hope. Here now. Life is a gift. Let us breathe it in.
Hand Over Healing Heart ❤️🩹Breathe
UPDATE provided 11/8/24: On Thursday, October 31, 2024, I went in to my local hospital for a biopsy of my tumor mass which is located near my lungs and thymus. This was conducted by a specialist known as an Interventional Radiologist. Did you know that there was even this kind of medical position? I have been learning so much about the medical profession since my cancer diagnosis. I can’t begin to tell you how grateful I am for my care team!
Anyway, as I mentioned in my October update, my Oncologist wanted to be sure that I did not have an active lymphoma present. This was a risky in hospital procedure because they had to sedate me and go through one of my lungs to get to the mass. The doctor mentioned prior to the surgical procedure that there was a 20% possibility that my lung could collapse, and if it did, they would have to insert a tube and keep me overnight for observation. Fortunately, that did not occur!
On November 7, 2024, I met with my Oncologist and finally found out (after six months of not knowing) what this tumor/mass was when he shared the biopsy results with me. My tumor/mass is a benign cancer known as a Thymoma. Thymoma is a rare cancer that affects the thymus gland, an organ located between the lungs. The thymus supports the immune system's development during childhood and helps the body fight illness throughout a person's life. And, as I mentioned, fortunately it is benign. A thymoma tumor typically grows slowly and is unlikely to spread.
Because I am an unusual case with two separate cancers, my Oncologist will be presenting my case to our County Tumor Board later this month (November, 2024) to get other specialists opinions on the best course of action for me. He will call me and give me the results of that discussion.
For now, my good news is that my non-Hodgkins Lymphoma is in remission and my Thymoma is benign. My Oncologist’s current plan is to follow up with me with a PET CT and bloodwork in December 2024 with discussion in early January 2025 before determining if a maintenance plan will be necessary, or if I will just be a watch and monitor patient. Of course, it will also be interesting to hear what the other specialists think should happen, as well.
At present, I feel good! And hopeful, that nothing more needs to happen, other than me being just a watch and monitor patient.
As always, thank you so much for your thoughtful words and support. ❤️🩹
Update provided 12/19/24:
Let’s recap my cancer journey thus far. September (19) was my last of six immunotherapy sessions. (No chemo.) I had a PET CT in October (7) to determine whether the immunotherapy sessions had worked. We learned that the somewhat good news was that nothing had changed with my tumor mass which was located near my lungs and thymus. The better news was that my Non-Hodgkins Lymphoma went into remission. But my Oncologist felt that my tumor mass needed to be biopsied to make sure that there was no active lymphoma present. So, the biopsy took place at the end of October (31) and my tumor mass was finally identified as a benign Thymoma cancer. My Oncologist took this information to the County Tumor Board in mid-November and they determined that the best course of action was that the Thymoma should be resected. (A dangerous, risky surgery. Especially if the Thymoma became a malignant carcinoma.)
Which leads me to the past few days.
I had my bloodwork done on Wednesday, 12/11. I had a PET CT on Monday, 12/16. On Tuesday, 12/17, I met with my Surgeon. On Wednesday, 12/18, I met with my Oncologist. And today I offer the results…
For a benign unchanging Thymoma cancer, not even my surgeon would have the surgery performed on him! (Thank goodness, and phew!!!)
My test results came back that my Thymoma hasn’t changed, thus I don’t need to be seen by the surgeon for another 6 months with just a CT scan check-up. My Oncologist will follow-up with me in 3 months for bloodwork only, since my Non-Hodgkins Lymphoma continues in remission. The bloodwork is coming back fairly normal, with some areas out-of-range, which is somewhat to be expected for those individuals with cancer (even if it is benign or in remission). At the same 6-month mark, my Oncologist will also read the CT scan to determine my continued good health status. (Positive thinking is always the best course of action, don’t you think?)
Both anticipate that if everything continues to look, as expected, my need to see both doctors will be a visit that will be scheduled further into the future. The only reason to come sooner would be if I felt the need. Besides, Thymoma may be an uninvited guest in my body, but as long as it behaves, I can live comfortably with it.
Needless to say, I feel a sense of calm, and peacefulness and hope. My Christmas presents came early this year! 💝 May your new year be filled with radiant good health! Happy Holidays to all!
Hand Over Healing Heart ❤️🩹I actually feel like I can Breathe 😮💨
July 11, 2020
A doctor's viewpoint on death. I've already read a couple of books about death written by another author Caitlin Doughty, which I loved. This book was fine but compared to the others I read, it just wasn't as good. I did learn a few new things about how hospitals work, but there were a lot of big questions asked in this book, with no attempt to offer answers.
August 4, 2020
This is an excellent book by a medical doctor about the ways we used to die and how we could improve things today. Dugdale goes into the practices that were once employed and how they helped not just the dying but those who attended them in accepting, understanding and preparing for their own eventual deaths. She talks about the patients and their families who have had her repeatedly resuscitate them when it is clearly too late and prolong their deaths by miserable days hooked up to machines. She also talks about how hospitals were never a place for dying (or even being sick) until recently, and how she believes they should only be a place for urgent care. She presents a detailed look into some rituals that are used after deaths and how healing and helpful they can be for everyone involved, and also offers guides to know when it's wise to keep on with interventions and when it's not, among many other things. She also tells the stories of the deaths of many people she's known as a doctor and a loved one over the years, and uses these to teach lessons in preparing well for death. The book is not gloomy despite its title, and offers an interesting and helpful look at a topic we all need to think about, like it or not. I'll definitely keep much of it in mind moving forward.
I read a digital ARC of this book for review.
I read a digital ARC of this book for review.
July 15, 2020
I really enjoyed The Lost Art of Dying. Which feels weird to say considering the dark and depressing subject matter! I’ve always been fascinated with death and this book offers an in-depth look into topics such as how to “die well” and the ways in which different cultures/religions prepare the dead for burial. We have become so afraid of death that we avoid any talk or mention of dying, so much so that we fail to prepare for the inevitable. This is a great book for anyone who wants to explore the messy reality of dying, how to process their own finitude, and reflect on the over-medicalization of death and how this came to be. I couldn’t put this book down (even if it made me have a small existential crisis) and I think it’s such an important subject that should be openly discussed more often!
Thank you so much to TLC Book Tours and HarperOne for my gifted copy in exchange for an honest review!
Thank you so much to TLC Book Tours and HarperOne for my gifted copy in exchange for an honest review!
January 29, 2022
The Lost Art of Dying: Reviving Forgotten Wisdom by L.S. Dugdale, MD (Harper One 2020) (155.937) (3616).
I strongly recommend this book to any readers who knows someone who has died or who expects to die themselves one day.
Historically humans were exposed to (if not surrounded by) the dead. Death was a normal state. The concept of ars moriendi - “The art of death” - was a familiar volume in medieval times. The art of a “good death,” argues author/physician Lydia Dugdale, has been forgotten in the twenty-first century, but it must be resurrected.
It appears that Dugdale wrote this most timely little volume to desensitize people to death and dying. Make no mistake: L.S. Dugdale is as fine a writer as I have run across in a long time. She makes her points in clear, cogent, concise, and convincing fashion. She’s easy to read, and easier still to follow.
Here are some highlights:
“Dying well means grappling with our existential questions and not avoiding them. The ars moriendi attends to the metaphysical as well as the physical.”< (p.150)
"Some religions make a point of encouraging reflection on human brokenness.” (p.130)
Health care professionals are “No longer considered ‘healers,’ we are called ‘providers’ - the purveyors of death-delaying goods to our consumer patients.” (p.149)
From the chapter called “Ritual,” the author poses the question of who should care for the physical remains of our dead:
“I wish to return to the theme of caring for the bodies of the dead. The question is this: whether or not we embalm, is it not curious that we willingly pass off responsibility for intimate rituals associated with attending to dead bodies? Shouldn’t we be the ones to care for the bodies of our loved ones?” (p.161)
She advocates patience and hopefulness as keys to a good life and thus a good death:
“Impatience, the ars moriendi taught, can be moderated through the lifelong cultivation of the virtue of patience. The transformation does not happen instantly when a person wills it. Patience must be practiced. Like any habit, you have to commit to exercising patience over and over again.
So too with the other virtues that the ars moriendi commended the dying to cultivate. The tendency to despair as death approaches can be remedied through a lifetime of exercising hopefulness.” (p.206)
Finally, she shares an allegorical tale about death:
“The Legend of the Merchant of Baghdad:
“A merchant sends his servant down to the market. The servant quickly returns. He is agitated and frightened. He says to his master, “Down at the marketplace I was jostled by a woman in the crowd, and when I turned around I saw that it was Death that jostled me. She looked at me and made a threatening gesture. Master, please lend me your horse, for I must hasten away to avoid her. I will ride to Samarra and there I will hide, and Death will not find me.
The merchant agrees, lends his horse, and the servant wastes no time in galloping off. Later that day, the merchant himself heads down to the market and finds Death standing in the crowd. He asks her why she made a threatening gesture at his servant that morning.
Death replies, “That was not a threatening gesture. It was only a start of surprise. I was astonished to see him in Baghdad, for I have an appointment with him tonight in Samarra.”
This story reminds us that none of us escapes our appointment with death. The solution is neither to flee it or to seek it out. Rather, we must each prepare for Samarra. Death is part of life. The art of dying well must necessarily be wrapped up in the art of living.” (p.207-8).
Here’s a little closing trivia that was too good to omit:
There is a “frailty index” that hospitals use to measure the elderly.
Don’t expect too much from CPR; only about ten to twenty percent of resuscitated patients survive to leave the hospital (p. 195-6).
Every reader will benefit from reading this little book.
My rating: 7.75/10, finished 1/28/22 (3616).
December 31, 2024
“In failing to die well, we fail to live well. By avoiding questions of the meaning of death, we avoid questions of the meaning of life. By avoiding finitude, we ignore infinitude” (147).
Dr. Dugdale discusses ancient rituals and preparations for death that have helped people mourn and accept death throughout centuries. Many of these practices have been lost, and as a result, society as a whole is avoidant of death, and many people end up dying unnecessarily highly medicalized deaths that lack meaning.
As a physician and church member, she discusses many of her experiences that lead her to believe that the hospital is not always the best place to die, and she encourages people to prepare for their own deaths, and die surrounded by their community.
Dr. Dugdale discusses ancient rituals and preparations for death that have helped people mourn and accept death throughout centuries. Many of these practices have been lost, and as a result, society as a whole is avoidant of death, and many people end up dying unnecessarily highly medicalized deaths that lack meaning.
As a physician and church member, she discusses many of her experiences that lead her to believe that the hospital is not always the best place to die, and she encourages people to prepare for their own deaths, and die surrounded by their community.
January 8, 2022
only because there were moments that i wish had been further expanded upon, and a variety of historical, cultural, and spiritual perspectives beyond the author's and those in the author's proximity that i would have loved to see taken into account. but definitely a "clear-eyed...compelling and soulful" book in every sense of those words.
June 22, 2024
As a nurse and former case manager there have been so many times that I’ve wanted families to ask some of these very questions! This book is thought provoking for my own thoughts on dying well and what I would like that to be.
December 6, 2021
While enlightening and straight-forward, I feel like this book ended up beating a dead horse by the end. It was only 200 pages, taking me only about three hours to finish, but the three main concepts of the book were explained well enough in the first three chapters (about half the book). Perhaps because I am very familiar with the process of hospitalization of dying patients, as I worked in the EMS field for three and a half years, I feel like this was a bit redundant in the back half.
Read
November 6, 2020The Lost Art of Dying provides a simple, and compassionately disarming, framework for how death has been historically considered from sociological, theological, and medical angles, and asks how we might benefit when reflecting on our personal encounters with the dying process. The deposit of wisdom in Dugdale’s retrieval of the ars morendi philosophy assumes a distinctively Augustinian character in my reading, as the virtues espoused throughout are littered with personal anecdotes of how practical commitments throughout one’s life can shape the desire for a more authentic reckoning with dying before that taking that last bow. Whether it’s her encouraging of humility through the inclusion of family when rehearsing for one’s final moments or her reimagining of ancient rituals such as tahara or shivah in Jewish communities for a more generative mourning process, there’s a pattern in Dugdale’s writing that decenters the singular experience of mortality in favor of an intentionally communal one. The result is an assuaging of fear with an invitation to thankfulness, an art that surely demands a lifetime to master.
November 10, 2024
Great information. Lead to some great discussions between my wife and I. Little repetitive at the end.
June 4, 2024
A wonderful thoughtful book about dying and what that means to Americans now and what it has meant to people in previous times and other cultures. As a nurse and a pastor’s wife, I found this explanation, and really history of health care and death, so helpful to think about.
July 6, 2020
Summary: A physician challenges our over-medicalized treatment of the dying, advocating a recovery of the "art of dying," which also makes it possible to live well.
He died three times in one night. Mr. Turner was an elderly man dying of metastatic cancer that had invaded much of his body. But the family insisted everything be done to keep him alive. So when he "coded," much of the hospital mobilized to resuscitate him. Chest compressions broke frail ribs. Breathing tubes were inserted. Injections of powerful drugs were injected to restart the heart. This happened twice more that night. The final time, the team worked twenty minutes to no avail. Mr. Turner was pronounced dead. The author, one of the physicians on this team asks whether this is a good way to die.
This incident, during her residency, began a process of questioning about what it meant to die well, leading to her discovery of the Ars Moriendi, The Art of Dying, a fourteenth century handbook arising out of the plagues, when anyone might expect to die an early death. Dying well begins with recognizing one's finitude, reckoning on and appropriately planning for one's death. Dying well happens best in community, where the dying acknowledges wrongs and seeks forgiveness, where love is expressed, and where bystanders rehearse their own death. Dugdale also talks about how context matters, and the preference where appropriate care can be given, for death at home, and in the hospital, only when that affords the best care.
Often our inability to die well, and the actions that hinder dying well reflect our fear of death. She confronts the real terror, even for the religious, of the unknown void of death. Dugdale's counsel is that each of us has to wrestle with what it means to die into life. In an extended reflection on the Isenheim Altarpiece, she considers what happens to the body in disease and death--its corruption into dust. She describes the reality summarized in one terrified patient's words--"I don't know what I believe"--and the vital work of facing the existential questions of meaning to both live and die well.
Her final chapters describe the rituals that follow death, and the wisdom in the Jewish tradition around grief. She concludes with some recommendations that might form a modern Art of Dying. Think twice about hospitalization. Discern when further treatment is futile. Live well at the end through good, and early, palliative care when death is imminent. Reconsider resuscitation. Start giving away your stuff. Live with purpose. Die in community.
The book concludes with a series of ink drawings by Michael W. Dugger, similar to the woodcuts in the original Ars Moriendi around the themes of each chapter of the book. They are a fitting way to invite us to reflect once more on this book's message: we desperately need to recover the art of dying well. It isn't to be found in the over-medicalized, hospital-centric practices of our modern way of death. Nor is it to be found in the denial of our finitude, our efforts to suppress our fears.
This book gives much to think about in our current pandemic, including the terrible tragedy of how it results in lonely deaths. A blessing upon the caregivers who treat the dying with dignity and compassion! It also makes me wonder if our inability to pursue for an extended time the disciplines that guard our health and that of our neighbors reflects the fact that we haven't done the work of preparing to die well. We act as if we are invulnerable. We risk our lives for a night of clubbing. To not adequately reckon with death is to not adequately treasure the gift of the life we have, the community with whom we share it, and betrays the thinness of our efforts to consider the existential questions of life. All this suggests that this book could not have come at a better time.
________________________________
Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher. The opinions I have expressed are my own.
He died three times in one night. Mr. Turner was an elderly man dying of metastatic cancer that had invaded much of his body. But the family insisted everything be done to keep him alive. So when he "coded," much of the hospital mobilized to resuscitate him. Chest compressions broke frail ribs. Breathing tubes were inserted. Injections of powerful drugs were injected to restart the heart. This happened twice more that night. The final time, the team worked twenty minutes to no avail. Mr. Turner was pronounced dead. The author, one of the physicians on this team asks whether this is a good way to die.
This incident, during her residency, began a process of questioning about what it meant to die well, leading to her discovery of the Ars Moriendi, The Art of Dying, a fourteenth century handbook arising out of the plagues, when anyone might expect to die an early death. Dying well begins with recognizing one's finitude, reckoning on and appropriately planning for one's death. Dying well happens best in community, where the dying acknowledges wrongs and seeks forgiveness, where love is expressed, and where bystanders rehearse their own death. Dugdale also talks about how context matters, and the preference where appropriate care can be given, for death at home, and in the hospital, only when that affords the best care.
Often our inability to die well, and the actions that hinder dying well reflect our fear of death. She confronts the real terror, even for the religious, of the unknown void of death. Dugdale's counsel is that each of us has to wrestle with what it means to die into life. In an extended reflection on the Isenheim Altarpiece, she considers what happens to the body in disease and death--its corruption into dust. She describes the reality summarized in one terrified patient's words--"I don't know what I believe"--and the vital work of facing the existential questions of meaning to both live and die well.
Her final chapters describe the rituals that follow death, and the wisdom in the Jewish tradition around grief. She concludes with some recommendations that might form a modern Art of Dying. Think twice about hospitalization. Discern when further treatment is futile. Live well at the end through good, and early, palliative care when death is imminent. Reconsider resuscitation. Start giving away your stuff. Live with purpose. Die in community.
The book concludes with a series of ink drawings by Michael W. Dugger, similar to the woodcuts in the original Ars Moriendi around the themes of each chapter of the book. They are a fitting way to invite us to reflect once more on this book's message: we desperately need to recover the art of dying well. It isn't to be found in the over-medicalized, hospital-centric practices of our modern way of death. Nor is it to be found in the denial of our finitude, our efforts to suppress our fears.
This book gives much to think about in our current pandemic, including the terrible tragedy of how it results in lonely deaths. A blessing upon the caregivers who treat the dying with dignity and compassion! It also makes me wonder if our inability to pursue for an extended time the disciplines that guard our health and that of our neighbors reflects the fact that we haven't done the work of preparing to die well. We act as if we are invulnerable. We risk our lives for a night of clubbing. To not adequately reckon with death is to not adequately treasure the gift of the life we have, the community with whom we share it, and betrays the thinness of our efforts to consider the existential questions of life. All this suggests that this book could not have come at a better time.
________________________________
Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher. The opinions I have expressed are my own.
April 17, 2023
Dying. We all do it. And yet, the concept of our own death is so unfathomable.
Modern, western society has completely sanitized death and swept it under the rug. We rarely have to see it or experience it with someone as they are going through it.
I appreciate this book for stripping back all of the layers and laying death bare, as people experienced it for centuries before our era.
I can’t say after reading this book that I’m exactly prepared to die, but I certainly understand the art of dying well and the fact that you cannot die well without living well.
I have a lot to address and questions to answer. This book is an excellent reminder of our mortality and how to come to peace with it.
I’d recommend this book for anyone, especially anyone experiencing a long term illness or caring for someone who is.
Modern, western society has completely sanitized death and swept it under the rug. We rarely have to see it or experience it with someone as they are going through it.
I appreciate this book for stripping back all of the layers and laying death bare, as people experienced it for centuries before our era.
I can’t say after reading this book that I’m exactly prepared to die, but I certainly understand the art of dying well and the fact that you cannot die well without living well.
I have a lot to address and questions to answer. This book is an excellent reminder of our mortality and how to come to peace with it.
I’d recommend this book for anyone, especially anyone experiencing a long term illness or caring for someone who is.
October 1, 2024
Fantastic book. Short enough for anyone to pick up, contemplate their mortality, and change their life. No, seriously, living well and dying well are intimately connected. This book talks about both in ways that are accessible and deep. I highly recommend it to anyone who plans to die at some point.
June 21, 2023
A few interesting points about death but nothing groundbreaking. People need to talk more about dying. Reflect on your own mortality today and every day :)
August 30, 2020
I appreciated the physician’s perspective here, rooted in the humanities, theology and history. As a historian, I’m familiar with the ars moriendi and its great to see someone make use of it and connect us to this long tradition.
Her main point is we need to talk and prepare for this more, and root ourselves in community as we live. I might like more of a manual for the conversations to have with our loved ones as we age/get ill, but that wasn’t the point.
I also suspect that as a Christian, she is reminding those who don’t value the sorts of rituals, values and community of the Christian faith that those are important. She wants to point people to the importance of life and death and those issues beyond the materiality of our bodies.
I’m reading this in companionship with Swinton on Dementia and it was great to to be pushed to think about what gives human values and to be chastised for focusing too much on productivity.
I read it with my nurse husband and her stories provoked lots of conversations about what happens in hospitals. I was also very aware that she’s very much coming from a medical perspective and the NURSING view of human/patient care is different and she basically ignores nurses throughout the narrative. Perhaps if doctors listened more to nursing theory they would have more of the corrective that she’s going for.
Her main point is we need to talk and prepare for this more, and root ourselves in community as we live. I might like more of a manual for the conversations to have with our loved ones as we age/get ill, but that wasn’t the point.
I also suspect that as a Christian, she is reminding those who don’t value the sorts of rituals, values and community of the Christian faith that those are important. She wants to point people to the importance of life and death and those issues beyond the materiality of our bodies.
I’m reading this in companionship with Swinton on Dementia and it was great to to be pushed to think about what gives human values and to be chastised for focusing too much on productivity.
I read it with my nurse husband and her stories provoked lots of conversations about what happens in hospitals. I was also very aware that she’s very much coming from a medical perspective and the NURSING view of human/patient care is different and she basically ignores nurses throughout the narrative. Perhaps if doctors listened more to nursing theory they would have more of the corrective that she’s going for.
June 28, 2024
It’s an interesting primer for thoughtful contemplation. It makes me want to be more purposeful about how to live and eventually die. More books to come to get there but this was a good intro to the topic.
May 14, 2023
This was a really interesting and thought-provoking read. It strikes me that how one approaches their own death says A LOT about how they lived their life.
February 3, 2022
4.5 stars.
I've been looking for this book - that is, a book that addresses this topic, of how to prepare for death - for a long time. Randomly found it while browsing a delightful indie bookstore in Estes Park.
Dr. Dugdale - a physician, medical ethicist, and co-founder of the Program for Medicine, Spirituality, and Religion at Yale - lays out a compelling premise: we* have forgotten how to die. For hundreds - rather, thousands - of years, death has been an unavoidable part of life. While of course we haven't discovered the fountain of youth, U.S. culture has successfully swept death under the rug, so to speak; banishing death from homes to hospitals, banishing deathcare from family and friends and faith communities to hospice and nursing homes and funeral homes and other professionals; and so extending longevity, and reducing rates of mortality, that the vast majority of us live to be elderly.
*The U.S./Eurocentric cultures
None of these things are inherently bad, but taken together, along with U.S. culture's obsession with youth, it does mean that many of us are more unprepared for death than our ancestors ever would have dreamed. The solution, at least according to Dr. Dugdale? Return to some of these ancient practices, as described in a common Middle Ages text called the Ars moriendi. The biggest takeaways are to a) face our finitude, our mortality. Reckon with the fact that, modern medicine notwithstanding, we will die one day; b) cultivate a community - family, friends, faith communities, whoever is meaningful in our lives and who can assist us as we begin to decline; and c) to start questioning medical interventions once we reach a certain stage (and age) in our lives. Quality over quantity of life, you might say.
What keeps this book from being 5 stars for me? Dr. Dugdale makes no effort to hide her Judeo-Christian viewpoint, and that's fine with me (actually, I find it refreshing that she makes no efforts to hide it and rather includes it in many relevant ways; I'm tired of reading books that I think will not have a particular religious lens based on their descriptions and then it ends up being very strongly Christian-centric). However, I am interested in learning more about what all/many faith communities believe about death and their deathcare rituals, so would have loved more inclusion here. Additionally, she seems to doubt that folks who are spiritual, rather than religious, can have as vibrant of communities and as strong of beliefs and tenets as religious communities, which I find to be untrue. Lastly, she's not a fan of medical aid in dying and seems to think people who choose this option aren't capable of squarely facing their death, whereas I think this is an important option for people to be able to have on the table.
I've been looking for this book - that is, a book that addresses this topic, of how to prepare for death - for a long time. Randomly found it while browsing a delightful indie bookstore in Estes Park.
Dr. Dugdale - a physician, medical ethicist, and co-founder of the Program for Medicine, Spirituality, and Religion at Yale - lays out a compelling premise: we* have forgotten how to die. For hundreds - rather, thousands - of years, death has been an unavoidable part of life. While of course we haven't discovered the fountain of youth, U.S. culture has successfully swept death under the rug, so to speak; banishing death from homes to hospitals, banishing deathcare from family and friends and faith communities to hospice and nursing homes and funeral homes and other professionals; and so extending longevity, and reducing rates of mortality, that the vast majority of us live to be elderly.
*The U.S./Eurocentric cultures
None of these things are inherently bad, but taken together, along with U.S. culture's obsession with youth, it does mean that many of us are more unprepared for death than our ancestors ever would have dreamed. The solution, at least according to Dr. Dugdale? Return to some of these ancient practices, as described in a common Middle Ages text called the Ars moriendi. The biggest takeaways are to a) face our finitude, our mortality. Reckon with the fact that, modern medicine notwithstanding, we will die one day; b) cultivate a community - family, friends, faith communities, whoever is meaningful in our lives and who can assist us as we begin to decline; and c) to start questioning medical interventions once we reach a certain stage (and age) in our lives. Quality over quantity of life, you might say.
What keeps this book from being 5 stars for me? Dr. Dugdale makes no effort to hide her Judeo-Christian viewpoint, and that's fine with me (actually, I find it refreshing that she makes no efforts to hide it and rather includes it in many relevant ways; I'm tired of reading books that I think will not have a particular religious lens based on their descriptions and then it ends up being very strongly Christian-centric). However, I am interested in learning more about what all/many faith communities believe about death and their deathcare rituals, so would have loved more inclusion here. Additionally, she seems to doubt that folks who are spiritual, rather than religious, can have as vibrant of communities and as strong of beliefs and tenets as religious communities, which I find to be untrue. Lastly, she's not a fan of medical aid in dying and seems to think people who choose this option aren't capable of squarely facing their death, whereas I think this is an important option for people to be able to have on the table.
February 13, 2025
Lovely. Highly recommended.
I do quibble with her universal 'we' - no, Dr. Dugdale, there are plenty of people who will disagree with many of your generalizations. However, she is exploring with the reader some very important ideas. If you don't want to die in misery, and if you want your loved ones to feel less regret, less anger, etc., read this book, and plan for a better exit.
" it is reasonable... to leave open the possibility of dying well in the hospital, [and] it is also prudent to strategize about how to avoid it."
" we also desire any sort of existential or ideological safety... [it] may be religious in nature but is certainly not limited to religion. We reinforce our ideological security by associating with the like minded: the similarly educated, politically persuaded, and socioeconomically classed."
"Death creates chaos on every level - emotional, existential, practical. There are questions of decorum. Is it acceptable to weep with joy if this offers an end to suffering? And how much happiness is permissible during those first postmortem days?"
"The more frail individuals are, the less likely they will recover well from even minor illnesses, not to mention major surgeries for prolonged hospitalizations. And for every day they spent in bed, they lose muscle mass, which is why hospitalizations as short as a few days often lengthy and elderly incredibly weak. ... prolonged hospitalization leads not only to physical deconditioning and decreased strength, but also to increase risk of exposure to hospital-acquired infections. It may even lead to death itself."
A study of terminal cancer patients revealed that "even when the prognosis is grim and patients are dying, they might live longer when they opt for less aggressive medical care and choose instead to prepare for death."
Determine what you value, what you mean by 'quality of life.' Talk to your family carefully and specifically about when and where you want to say goodbye. File your intentions with your primary care doctor, and with your palliative care team or hospice provider.
I do quibble with her universal 'we' - no, Dr. Dugdale, there are plenty of people who will disagree with many of your generalizations. However, she is exploring with the reader some very important ideas. If you don't want to die in misery, and if you want your loved ones to feel less regret, less anger, etc., read this book, and plan for a better exit.
" it is reasonable... to leave open the possibility of dying well in the hospital, [and] it is also prudent to strategize about how to avoid it."
" we also desire any sort of existential or ideological safety... [it] may be religious in nature but is certainly not limited to religion. We reinforce our ideological security by associating with the like minded: the similarly educated, politically persuaded, and socioeconomically classed."
"Death creates chaos on every level - emotional, existential, practical. There are questions of decorum. Is it acceptable to weep with joy if this offers an end to suffering? And how much happiness is permissible during those first postmortem days?"
"The more frail individuals are, the less likely they will recover well from even minor illnesses, not to mention major surgeries for prolonged hospitalizations. And for every day they spent in bed, they lose muscle mass, which is why hospitalizations as short as a few days often lengthy and elderly incredibly weak. ... prolonged hospitalization leads not only to physical deconditioning and decreased strength, but also to increase risk of exposure to hospital-acquired infections. It may even lead to death itself."
A study of terminal cancer patients revealed that "even when the prognosis is grim and patients are dying, they might live longer when they opt for less aggressive medical care and choose instead to prepare for death."
Determine what you value, what you mean by 'quality of life.' Talk to your family carefully and specifically about when and where you want to say goodbye. File your intentions with your primary care doctor, and with your palliative care team or hospice provider.
February 4, 2025
I have lived long enough to know that my default position about dying is that it happens to other people. Our society re-enforces that belief by making it seem that the only people who die made bad choices. Of course deep down we know this is rubbish but deep down is exactly where we don’t dwell when it comes to death.
A couple years ago I decided that I would challenge this way of handling dying for myself. My parents are dead, I don’t have children, and once I turn 65, go on Medicare, collect Social Security, dying is the last of my life experiences. Seems like one worth staying up late for. It’s not that I am ready yet. Deep down when I go there, I recognize I am pretty scared and to be honest, I don’t think that is likely to lessen that much. But other sensations can co-exist with fear but first I need to normalize the fear. So to get more comfortable with the fear of dying, I meditate on it everyday which gets me to books like ‘The Lost Art of Dying.’
This book is a gloss on what was a belief system that lasted from medieval time until the late nineteenth century when death rates plunged and medicine and technology got people confident that they were conquering this death thing. With COVID and the increasingly fragile condition we’ve placed the planet in, there seems to be a movement of humility now about death. This book is a helpful reminder to embed in our communities, families, language culture, and art - a collective memento mori.
A couple years ago I decided that I would challenge this way of handling dying for myself. My parents are dead, I don’t have children, and once I turn 65, go on Medicare, collect Social Security, dying is the last of my life experiences. Seems like one worth staying up late for. It’s not that I am ready yet. Deep down when I go there, I recognize I am pretty scared and to be honest, I don’t think that is likely to lessen that much. But other sensations can co-exist with fear but first I need to normalize the fear. So to get more comfortable with the fear of dying, I meditate on it everyday which gets me to books like ‘The Lost Art of Dying.’
This book is a gloss on what was a belief system that lasted from medieval time until the late nineteenth century when death rates plunged and medicine and technology got people confident that they were conquering this death thing. With COVID and the increasingly fragile condition we’ve placed the planet in, there seems to be a movement of humility now about death. This book is a helpful reminder to embed in our communities, families, language culture, and art - a collective memento mori.
July 17, 2020
I found what was different about this book compared to other cold-shower confrontations with mortality was a consistent allusion to beauty and the rightness of things despite outward chaos and decline. "... beauty in decay," is a phrase in the book. In a way I guess this represents a kind of faith we can all agree on.
There is a lyrical chapter on fear which is one of the best essays on the topic I've read.
There is a lyrical chapter on fear which is one of the best essays on the topic I've read.
February 14, 2021
We will all die someday. It's not something we should court but it is inevitable. If we will all die, then how will die? I don't mean what will we die of, but how will we approach our own deaths? Will we be prepared to die well? Or will we fear death? We will go kicking and screaming, asking that everything is done to keep us alive? As a pastor, I have been present for death. I've seen it resisted and welcomed. As for me, in the end, I do have the hope of the resurrection to hold me up.
In the medieval period, during the Bubonic Plague, as people died in massive quantities, the question of dying well became important. Out of this context came the "Ars Moriendi," manuals that spoke of the art of dying. Might we need similar manuals in our day? L. S. Dugdale, a medical doctor, and ethicist suggests that we would benefit from such a manual.
"The Lost Art of Dying" is not a specifically religious book, but the author acknowledges the role that religion plays in the art of dying. In fact, it appears that highly religious people seem to struggle with death and seek to put it off, asking for extreme measures more than others. That is odd. So, yes we need to know how to die well. Though she also notes that the medical profession has contributed to our culture's avoidance of death. Surely there is something to be offered that can extend life.
Dugdale begins with a chapter titled death that tells the story of a family that wouldn't let go and asked for continued resuscitation of their father even though there was no hope of survival. One of the elements of the story is our belief that CPR can rescue the dying, but the reality is that for most people CPR as administered in a hospital only succeeds in a small percentage of cases (not like we see on TV). There is a lot of similarity between Dugdale's book and Atul Gawande's Being Mortal: Medicine and What Matters in the End. Thus, in her words, the medical system has become in many ways a conveyor belt. It doesn't allow for a thoughtful deliberative approach. It reacts to the situation at hand. It's out of this conversation about modern death that the author takes us back to the 14th century, the plague, and the "ars moriendi."
As the book progresses, Dugdale invites us to consider the fact of finitude (chapter 2), the need for community and the challenge of dying alone (chapter 3), the context of dying, so often in hospitals (chapter 4). She speaks to the fear of death (chapter 5), the nature of the body, and the reality of aging (chapter 6). Then there is a chapter on the "Spirit," (chapter 7). It's here that she addresses some of the religious questions about the nature of life and death. Though a scientist, she understands the importance of faith to conversations about death. In fact, she notes that even as we become less religious, spirituality is on the rise. Here she notes that the "ars moriendi" deals not only with the physical but the metaphysical as well. To die well involves ritual. Those rituals include the medical (pulling the plug) and the spiritual (funerals). She speaks of the ritual of preparing the body, reminding us of what the process is of preparing the body for burial. This chapter (chapter 8) is very important, especially for clergy to consider.
The final chapter is simply titled "Life." (chapter 9). She writes that "if the ars moriendi teaches us anything, it's that the work of living well is what enables dying well. The tasks of living well include living each day in the context of community with a view to finitude" (pp. 180-181). This chapter is practical in some ways -- speaking to questions such as whether to be hospitalized when death approaches or what to do about resuscitation -- but it also speaks of living with the virtues. It offers a wonderful summation of the message of living well and dying well. In that, it is an art.
In the opening chapter, Dugdale notes that an early version of the ars moriendi was illustrated, so that whether one is literate or not one can contemplate the art of dying. With that in mind, she commissioned artist Michael Dugger to create ink renderings that illustrated the message of the nine chapters that simulated the original woodcuts. So the book concludes with the artwork with brief commentary taking us back to the chapters the art illustrates.
I highly recommend this book to clergy as we will walk with those who are dying and with their loved ones. I also recommend it to anyone who is wrestling with the concept of death. We are a culture that seems unable or unwilling to face the reality of death. We don't talk about it, even loved ones want to have the conversation. Perhaps this book will ease that conversation. So, yes, take and read so that you can not only die well but live well also!
In the medieval period, during the Bubonic Plague, as people died in massive quantities, the question of dying well became important. Out of this context came the "Ars Moriendi," manuals that spoke of the art of dying. Might we need similar manuals in our day? L. S. Dugdale, a medical doctor, and ethicist suggests that we would benefit from such a manual.
"The Lost Art of Dying" is not a specifically religious book, but the author acknowledges the role that religion plays in the art of dying. In fact, it appears that highly religious people seem to struggle with death and seek to put it off, asking for extreme measures more than others. That is odd. So, yes we need to know how to die well. Though she also notes that the medical profession has contributed to our culture's avoidance of death. Surely there is something to be offered that can extend life.
Dugdale begins with a chapter titled death that tells the story of a family that wouldn't let go and asked for continued resuscitation of their father even though there was no hope of survival. One of the elements of the story is our belief that CPR can rescue the dying, but the reality is that for most people CPR as administered in a hospital only succeeds in a small percentage of cases (not like we see on TV). There is a lot of similarity between Dugdale's book and Atul Gawande's Being Mortal: Medicine and What Matters in the End. Thus, in her words, the medical system has become in many ways a conveyor belt. It doesn't allow for a thoughtful deliberative approach. It reacts to the situation at hand. It's out of this conversation about modern death that the author takes us back to the 14th century, the plague, and the "ars moriendi."
As the book progresses, Dugdale invites us to consider the fact of finitude (chapter 2), the need for community and the challenge of dying alone (chapter 3), the context of dying, so often in hospitals (chapter 4). She speaks to the fear of death (chapter 5), the nature of the body, and the reality of aging (chapter 6). Then there is a chapter on the "Spirit," (chapter 7). It's here that she addresses some of the religious questions about the nature of life and death. Though a scientist, she understands the importance of faith to conversations about death. In fact, she notes that even as we become less religious, spirituality is on the rise. Here she notes that the "ars moriendi" deals not only with the physical but the metaphysical as well. To die well involves ritual. Those rituals include the medical (pulling the plug) and the spiritual (funerals). She speaks of the ritual of preparing the body, reminding us of what the process is of preparing the body for burial. This chapter (chapter 8) is very important, especially for clergy to consider.
The final chapter is simply titled "Life." (chapter 9). She writes that "if the ars moriendi teaches us anything, it's that the work of living well is what enables dying well. The tasks of living well include living each day in the context of community with a view to finitude" (pp. 180-181). This chapter is practical in some ways -- speaking to questions such as whether to be hospitalized when death approaches or what to do about resuscitation -- but it also speaks of living with the virtues. It offers a wonderful summation of the message of living well and dying well. In that, it is an art.
In the opening chapter, Dugdale notes that an early version of the ars moriendi was illustrated, so that whether one is literate or not one can contemplate the art of dying. With that in mind, she commissioned artist Michael Dugger to create ink renderings that illustrated the message of the nine chapters that simulated the original woodcuts. So the book concludes with the artwork with brief commentary taking us back to the chapters the art illustrates.
I highly recommend this book to clergy as we will walk with those who are dying and with their loved ones. I also recommend it to anyone who is wrestling with the concept of death. We are a culture that seems unable or unwilling to face the reality of death. We don't talk about it, even loved ones want to have the conversation. Perhaps this book will ease that conversation. So, yes, take and read so that you can not only die well but live well also!
November 6, 2020
For those of us who are secretly confused and afraid of what those final moments/resuscitations attempts are going to be like to experience when we reach the end... Written by an ER surgeon who has seen lots and lots of hospital deaths from the other side of the bed, this is her informed and thoughtful ruminations on both what the experience of death is like currently in American culture, and what death was like/thought of as/treated as in less medically advanced times in the Western psyche (the chapter about first-hand accounts from people living through the bubonic plague are particularly interesting to hear about in our present, COVID pandemic situation...).
There is a lost "art of dying" culture/philosophy that has been a paramount part of the human experience since the dawn of civilization, and which we have summarily discarded in this god-toppling age of increasing scientific knowledge and mastery. Maybe science will find a way to stop us (or at least, the richest of us) from dying entirely someday, but consider that cancer cells occur when cells pervert their natural cycle of life to death and "live" beyond their intended life cycles. I'm not saying increasing rates of Alzheimer's and dementia in modern societies are a result of our bodies artificially outliving their natural, healthy/sustainable lifespans, but maybe there's something in facing and accepting that death is going to be a part of our life experience, and learning how to prepare for it and have a "good death." It's something to think about, at least, and this book is a well-researched, very readable, and fairly thorough (at least, as far as historical *western* attitudes about death are concerned; I'd love to see a second edition where Dugdale integrates a few additional chapters of well-researched eastern/Asian and other traditional philosophies on death) way to begin engaging with these ideas.
There is a lost "art of dying" culture/philosophy that has been a paramount part of the human experience since the dawn of civilization, and which we have summarily discarded in this god-toppling age of increasing scientific knowledge and mastery. Maybe science will find a way to stop us (or at least, the richest of us) from dying entirely someday, but consider that cancer cells occur when cells pervert their natural cycle of life to death and "live" beyond their intended life cycles. I'm not saying increasing rates of Alzheimer's and dementia in modern societies are a result of our bodies artificially outliving their natural, healthy/sustainable lifespans, but maybe there's something in facing and accepting that death is going to be a part of our life experience, and learning how to prepare for it and have a "good death." It's something to think about, at least, and this book is a well-researched, very readable, and fairly thorough (at least, as far as historical *western* attitudes about death are concerned; I'd love to see a second edition where Dugdale integrates a few additional chapters of well-researched eastern/Asian and other traditional philosophies on death) way to begin engaging with these ideas.
January 27, 2025
Worth reading for its many interwoven stories, but fairly superficial as either ars moriendi or history of the same. Mainly a description of 9 categories (one per chapter) which bear examination in preparing for death (e.g. finitude, fear, ritual), and which are loosely based on the medieval (and apparently early modern) ars moriendi tradition. The author draws on her own clinical experiences but without perseverating on herself, her inner life or her own virtues, as is common in the "Dr. Author, MD" genre. Would be a fine popular work to give to many patients to provoke reflection on dying, as it takes a relatively pluralist view of its topics, with clear but not exclusionary Judeo-Christian leaning. Perhaps this pluralism and the resulting lack of commitment to a positive view is the main way the book suffers with respect to it's implicit prescriptive aim. But the only other option without making it explicitly religious, given the subject matter, would be to take a more scholarly (e.g. as either history or social science) approach, which would defeat its purpose.
August 21, 2024
The title says it all.
This book explores how we became a culture that prolongs life even when it has reached its natural conclusion. A society that became accustomed to going to hospitals to fight against our finality. The example of having to revive the same elderly cancer patient three times in one night strongly makes the case. We need to face our mortality and become comfortable with dying. That means preparing for our own demise and also for our parents, elderly friends, and those with terminal illnesses. This book offers ideas based on old traditions and explores how our values and religious beliefs can be a source of comfort at the end of life.
This book explores how we became a culture that prolongs life even when it has reached its natural conclusion. A society that became accustomed to going to hospitals to fight against our finality. The example of having to revive the same elderly cancer patient three times in one night strongly makes the case. We need to face our mortality and become comfortable with dying. That means preparing for our own demise and also for our parents, elderly friends, and those with terminal illnesses. This book offers ideas based on old traditions and explores how our values and religious beliefs can be a source of comfort at the end of life.
February 21, 2024
Erin and I heard this author give a presentation on her book during Calvin University’s January Series this year, so I decided to follow that up by reading it for myself. It’s not as dreadful as the topic might sound to some. In fact, it’s quite thoughtful in the amount of research that was done, digging deep into human history in order to present what should be a compelling and important case for reevaluating how we live and how we talk about the end of life… which is coming for all of us, so why ignore it?
This entire review has been hidden because of spoilers.
May 4, 2025
One of the most important books I've read in a long time. Key insight: dying well means living well, especially in five key areas. The ars moriendi of the Middle Ages shows that people understood and practiced this. I think the author is right that the ars moriendi needs to be revived, that modern medicine and hospitals fill a vital role, but they are also limited when it comes to actually dying well. I don't think this book can be reduced to just another call to more virtuous living, though without reflection you could conclude that. Instead, at least for me, it surfaces a new reason to strive for virtue more whole-heartedly--because dying well depends on it.
August 13, 2025
An important book for anyone to read, but especially if you haven't yet experienced a major death in your life. Through my experience, I've learned there are a lot more important things to consider than just the length of the life of a person especially when they're declining. This book gives a great blueprint for entering your inevitable dying stage to make death more fulfilling. Nobody likes talking about it, but we all do it!
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