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Review of "How not to die: Surprising Lessons on Living Longer, Safer and Healthier" by


7 April 2012

I picked up the hardcover edition of this book at an airport bookshop a few years ago. Despite the serious subject matter, I found it entertaining and informative.

The author is chief medical examiner (forensic pathologist) for the District Nine Medical Examiner's Office in Florida presiding over 1,100 autopsies per year. She is also the host of Discovery Health Channel's television series "Dr G: Medical Examiner". My US hardcover edition's subtitle is "Surprising lessons on living longer, safer and healthier from America's favourite medical examiner".

An overview of the book

The book is short (about 260 pages in my hardcover version) with relatively large print and very easy to read. In 12 chapters the author goes through a number of reasons for premature death, illustrated with case studies from her experience. I have selected a few snippets below.

Introduction: Confessions of a Real-Life Forensic Pathologist

The author starts by recounting an experience from her first year at medical school which gave rise to her interest in the causes of death.

"Something was lodged in her windpipe. As I probed with my gloved fingers, I discovered that it was a piece of gum. Normally, this would be odd, except that I found it in a cadaver I was dissecting as a first-year medical student. Cadavers are preserved hulls of bodies, donated remains. Doctors-to-be become acquainted with them in anatomy classes. To us, they aren't people. We learn to depersonalise our cadavers, to think of them as structures and tissues, not as human beings. And in med school, they’re used to teach us anatomy, not how to find the cause of death. Cadavers don't usually give up clues. That's not their job.

But when this one died, she was chewing gum. This made me curious. How did she get to this point? Where did she come from? How did she die? I started asking if anyone could get me some history on my cadaver. The body, it turned out, was of a nun who died suddenly of cardiac arrest while chewing gum.

And so began my fascination with how people die."

Chapter 1 – Doctor Dread

The author points out that fear of going to the doctor or dentist can be fatal, starting with the example of someone who had a decaying tooth, avoided going to the dentist and was eventually killed by the bacterial infection that spread from the tooth to the rest of his body.

She stresses the importance of giving your doctor a full and accurate description of your symptoms.

"I once autopsied a woman who went to the doctor and described only one symptom: lower abdominal pain. Not long afterward, she died of meningitis. She had never mentioned any symptoms of meningitis, such as fever, headache, stiff neck, and vomiting, so the doctor treated her abdominal pain. The clues you provide are what guide your physician. In the absence of clues, it’s tough for your doctor to get it right."

The above quotation brings out something I realised many years ago. Even with the United Kingdom's National Health Service which is free at the point of use, educated middle-class people receive much better healthcare than do poor uneducated people with a poor command of English. The reason is very simple. The educated person can give a much more precise description of their symptoms to the doctor, including giving informative responses to any supplemental questions that the doctor may ask. They are also much better equipped to discuss alternative forms of treatment with the doctor.

Finally, and perhaps controversially, because the educated patient is able to have a much better dialogue with the doctor, the doctor is likely to invest more thinking time and to engage more closely with the patient and their symptoms. Clearly doctors should devote the same amount of effort to each patient subject to the extent of their medical needs. However doctors are also human beings and cannot avoid being affected by the difference between a patient who talks and thinks like them and a patient with whom they have trouble communicating.

Chapter 2 – Deadly Prescriptions

The author points out the obvious importance of being aware of the potential side-effects of medicines and communicating fully with medical advisers about such issues. Indeed almost everything she writes in the entire book is obvious, except to the many people for whom it is not obvious.

The author illustrates this with the example of the sudden unexpected death of a 49-year-old woman.

"Lisa's death was a real mystery to me from the start. From what I learned, this slim, dark-haired beauty seemed so healthy. She exercised every day. She religiously watched her diet and kept her weight around 118 pounds. She didn't drink, smoke, or take drugs. She hadn't mentioned suicide, nor was she depressed. Her husband, Peter, told me that at 2:30, the morning of her death, he was awakened by an audit found – a gasp. I suspected that the sound may have been Lisa's final breath.

Peter left for work as usual on Monday, thinking his wife was asleep. He didn't know she was already dead."

The author goes on to explain the detailed investigations she carried out, all of which drew a blank. Examination of the heart tissue revealed nothing, and nor did toxicology examination of the tissues, blood and other body fluids.

Eventually after several discussions with the husband, it emerged that Lisa had been experiencing mood swings, her hair had started to fall out and she had been experiencing heart palpitations. Further discussions revealed that Lisa had been taking as many as 40 vitamin and dietary supplements each day, spending over $200 per month on supplements, some imported from overseas because they were banned in the USA. In particular Lisa had been consuming seven times the recommended dose of DHEA (dehydroepiandrosterone), a naturally occurring hormone made by the adrenal glands that is a precursor to the body’s manufacture of oestrogen and testosterone. The author explains that large amounts of DHEA, especially when taken with other dietary supplements, can cause heart irregularities leading to arrhythmia. That can be fatal even on a first occurrence.

Chapter 4 – Highway to the Morgue

Car accidents are one of the leading causes of death. The author mentions a number of ways you can reduce the risk of getting killed on the road. As with the rest of the book, all are obvious but many people fail to practice them. I have picked just three to mention:

  1. Resist the urge to accelerate if you are approaching an intersection and the traffic sign is showing yellow (amber). Rushing through an intersection can lead to a crash.
  2. Avoid the risk of flying objects by putting all loose items into the boot of your car.
  3. Older drivers should drive more defensively and consider carefully whether or not they are still fit to drive.

Concluding comments

Despite the morbid subject, the many ways that people have managed to accelerate their death are explained in a manner that is not gruesome, keeps you absorbed and is quite entertaining and informative. Accordingly I found the book a real "page turner". It is worth reading purely for its entertainment value.

If reading the book makes you do even one thing differently (such as installing a carbon monoxide detector) it will have repaid its cost and the time spent reading it many times over.


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