THE SMOOTH RIVER

In this debut memoir and self-help book, Cohen offers advice on how to approach life after a terminal diagnosis.

The author and his wife, Marcia, had been married 37 years in 2019 when she was told that she had stage 4 pancreatic cancer, and just 160 days later, she passed away. But before then, Cohen and his spouse, who specialized in crisis management, developed a way of thinking that they came to call the “Smooth River.” Over the course of this book, the author draws on his personal experience to explain this concept, which they used to convey to medical staff the necessity of a “well-ordered and tranquil ending.” This multifaceted approach recognizes how society rewards those who fight and disparages those who give up. However, rather than emphasize the idea that a person must “fight” cancer, the author suggests that society should show greater consideration to how that person wishes to be treated. It’s a gentle, open-minded approach to end-of-life management that involves setting flexible goals and cultivating positive thoughts, such as “We’re all going to die. I’m just going sooner than I expected, but I have a lot to be thankful for.” Cohen also highlights the importance of “seeing one’s life as bigger than one’s condition.” The book offers practical and specific advice along the way, noting the benefits of keeping an event log and addressing whether one should have a do-not-resuscitate directive. Appendices feature Marcia’s own log and book list as well as a list of useful online resources, such as palliative care organizations.

Cohen’s writing achieves a rare balance, as it’s both practical and sensitive in character. The author is unafraid to confront the grim truth of end-stage cancer but seeks out positivity at the same time: “While we may not be able to control how, if, or when we get [cancer]; how it behaves; or how effective treatment will be, we do have a choice.” Cohen’s message is particularly powerful in how it advocates the agency of patients and their family members at a time when they may feel powerless: “We could confine our focus to [Marcia’s] health alone and stay in a dark place, or we could try as best we could to make this time really count.” Cohen conveys deeply distressing moments with poetic beauty, as when he envisions Marcia’s final moments: “as she crossed the divide, I would be there to take her in when she was no longer able to breathe. And then, by way of some ethereal transference, I would breathe for her and carry on.” In this book, the author courageously and movingly approaches a subject that many readers would prefer not to face, and, in doing so, he effectively presents the reality of life after a terminal diagnosis. This tender and startlingly lucid work offers patients and their loved ones a wealth of knowledge, and it may also show physicians a new way to help people learn to cope with the prospect of dying.

A heart-rending but informative end-of-life guide.