Dr. Sherwin Nuland speaks at Sinai Forum about learning to deal with the realities of death and patients.

MICHIGAN CITY - Death in real life is not nearly so romantic or heroic as it is in soap operas, Dr. Sherwin Nuland told the Sinai Forum on Sunday night.

Recently diagnosed with prostate cancer, the surgeon, teacher, medical historian and best-selling author spoke unflinchingly and occasionally humorously about the things physicians fear most - death.

It's true, he said: No one is more afraid of death than physicians.

When he was training young surgical residents at Yale University hospitals, Nuland confessed, he didn't spend much time with them in the room of the patient who likely was nearing death.

Instead, he briskly moved his students to the room of another patient on whom "I had done a wonderful-ectomy," he said. It was not praise for his surgical skill he was seeking. Rather, consciously or not, he was encouraging his students to spend their time with patients who would respond to treatment and get well.

Only in his mid-50s did he realize how much it means to a dying patient to have someone sitting by his bedside and holding his hand.

Hospitals generally are not set up to minister to dying patients.

"Hospitals are doctor places," he said, "a little less for nurses and a lot less for patients."

Nuland was inspired by the physician who treated his mother, making house calls and just by his presence bringing order out of chaos even in the face of his mother's impending death.

He was as idealistic as any young medical student, and he continued to see that idealism in generations of medical students.

"But in medical school," he said, "we beat the idealism out of them. Medicine is more and more scientific and less and less about the human being."

Fear of death is at least one motivating factor for physicians, he said.

Nuland supports hospice and the concept of palliative care, which is treatment whose goal is no longer a cure, but a method of keeping a patient as comfortable as possible when it is clear further treatment likely will cause only suffering.

Most Americans have been protected from the realities of death because Americans so often die in intensive care units, where families are permitted to visit for only short periods of time. The reality is that dying can be painful and miserable, some of it caused by a vain attempt at a cure, he said.

Nuland cannot think of a nobler human venture than making a commitment to accompany another human being on his journey toward death.

No one wants to die alone, he said.

While he does not believe in an afterlife, Nuland said he's a big believer in immortality that comes from the lives every human being touches and affects.

A nurse who works in a shelter for seriously ill homeless men once told him getting to know a patient, even for a few days, helps him know he has made a connection and that someone will remember him.

Immortality is about remembering, Nuland said.

Homeless people should not be forced to beg for comfort and care in their dying days, he said.

Since he was 16 and on his high-school debate team, Nuland has supported universal health care.

None of the plans he has seen from political candidates goes far enough, he said.

"Medicare is a grand success," he noted.

Universal health care could work like an extension of Medicare. It should be free to everyone, and it should not depend on volunteers.

"We need nothing in this country more than we need universal health care," he said.

Nuland's appearance was sponsored by the Bankoff Endowment for the Forum and the Duneland Health Foundation.

Barbara Bankoff, daughter of Dr. Milton Bankoff, one of the founders of The Medical Group, said, "My father also was committed to kindness and compassion."

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