Modern Death: How Medicine Changed the End of Life by Haider Warraich

Review published on August 16, 2017.

Haider Warraich, a physician originally from Pakistan, trained at Harvard and is now a fellow in cardiovascular medicine at Duke University in North Carolina. Like Ed Yong’s I Contain Multitudes or Atul Gawande’s Being Mortal, Modern Death is a learned but engaging book that intersperses science, history, medicine and personal stories. Warraich addresses death as a biological phenomenon – perhaps more complicated than one might expect – but also as a social one that has undergone great changes in recent decades.

“The vast majority of people die in places where inert tones provide the palette, disinfectant the aroma, alarm bells the soundtrack, and open-back johnnies the wardrobe.” So Warraich describes a typical hospital or nursing home decline. Compare this to a century ago, when most births and deaths occurred in people’s homes. Although dying at home is on the rise, the author notes that patients’ wishes often have to cede to circumstances. Moreover, there’s inequality at work: affluent whites are more likely to die at home. In the United States, a disparity is seen in life expectancy as well, with just 300 miles separating the nation’s longest (Fairfax, Virginia – 82 years for men) from its shortest (McDowell, West Virginia – 64).

The very definition of death has become less straightforward as medicine has advanced, Warraich notes. Cases like that of Karen Ann Quinlan in the 1970s made the average person aware that physical life can continue even after the brain has died. Yet there is still much we don’t understand, and the idea that brain death could be reversible hasn’t been completely ruled out. The author recounts his own experience of treating a patient who collapsed of a heroin overdose but temporarily regained a pulse (known as the “Lazarus phenomenon”).

The first half of the book is about death as a medical reality, while the second focuses on particular social aspects of death: religious beliefs, the burden on families and other caregivers, the debate over euthanasia and physician-assisted suicide, and the pros and cons of using social media to share one’s journey towards death. Relatives of the ill or dying will find plenty of useful information here on designating a health-care proxy and setting up a living will and/or DNR order – just bear in mind that much of this may be specific to the United States.

If the book is reprinted it could do with more careful proofreading as there are numerous minor errors, whether typos or wrong word choices (“deference” in place of “deferral,” for instance). In some places Warraich mixes his metaphors and ends up with unintentionally awkward phrases, like “decapitation has digestible parables” and “the raison d’être of religion stems from the existential curve ball imbued so deep within us.”

Nevertheless, this is quite a fascinating book with a vital message that Warraich delivers passionately: we must bring death into the public conversation so that it holds less fear for patients and doesn’t equate to failure for doctors. After all, it’s inevitable for each of us.

Rebecca Foster 4/4

Modern Death: How Medicine Changed the End of Life by Haider Warraich
Gerald Duckworth & Co Ltd 9780715652398 hbk Jul 2017

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