While much has been written about successfully “fighting” cancer and other diseases, author Richard S. Cohen realized these inspirational stories didn’t speak for those with a terminal diagnosis. In his poignant, insightful memoir of his wife Marcia Horowitz’s diagnosis of terminal stage 4 pancreatic cancer, the author shares how they faced what became their last 160 days together.
Cohen uses the metaphor of a smoothly running river to explain their approach, aptly naming it the “Smooth River Approach.” He writes that “it simply means thoughtfully assessing a situation—medical or otherwise— understanding the realities involved, making adjustments…and preparing for all reasonable outcomes.”
Cohen and Marcia, a crisis intervention PR consultant, created a Medical Plan and a Life Plan. The Medical Plan used the best available clinical knowledge, which Cohen details from the first CT scan to chemotherapy and the eventual use of hospice care in the final days. Along with practical insights on dealing with the healthcare system, he provides commonsense discussions of do-not-resuscitate orders, insurance and legal matters, as well as the medical community’s tendency to frame disease as a win/lose fight.
The Life Plan, however, is the core of the author’s touching memoir. Marcia’s desire for peace and calm in her last days imbued the couple with a sense of normalcy and purpose. Cohen movingly describes riverside walks, watching a grandson at play, brief travel and the creation of a foundation that fosters relationships among people of diverse backgrounds—all giving meaning to Marcia’s final days and setting an example for others. As she stated, “We’re all going to die. I’m just going sooner than I expected, but I have a lot to be thankful for.”
Cohen’s hope is that his and Marcia’s journey will not only provide guidelines to improving end-of-life care, but may help individuals with all sorts of significant challenges. The Smooth River concept serves as practical inspiration to make life meaningful—as the current moves us toward what we all inevitably share.
Also available as an ebook.