The Smooth River by Richard S. Cohen, (c) 2021, ISBN 9781737-503408; 266 pages; $14.99
By Donald H. Harrison
SAN DIEGO — After New York City public relations practitioner Marcia Horowitz received the diagnosis that she was suffering from Stage 4 pancreatic cancer, she and her husband, author Richard S. Cohen, discussed how they would prepare for her death, which came 160 days later. They decided that they would have both a medical plan and a life plan, both of which they would pursue with equanimity.
The medical plan was for Marcia to put herself in the care of oncologists with particular expertise in pancreatic cancer and who, just as importantly, were willing to treat her as a human being, not simply as a disease wrapped up into a patient. Furthermore, while they wanted the best possible care for Marcia, which was available in New York City, they wanted to minimize the time that Marcia would have to commute from their home in Westchester County. Their solution came when they chose New York Presbyterian Hospital for its oncology expertise and its regional facility, Lawrence Hospital, in Bronxville. She could travel to New York City for major appointments, but remain in Westchester County for fluid administration and emergencies.
The life plan involved savoring the time they had together rather than making an all-out effort to “win the battle” against cancer. “A win is not necessarily defeating the cancer,” Cohen writes. “A win is having lived a good life, one to be proud of at any level. … Within its limits, we felt we had no choice but to distill the wonders of life, identify our core values and live them out.”
Cohen commented: “Religious leaders, psychologists, and advisers of all kinds constantly counsel us to change how we view a problem so that we may unlock constructive ways of addressing it. The ability to adjust to new circumstances and try a different perspective in the face of challenge is part of the package we humans are born with. We just need to free ourselves from our habitual conduct and tap into the potential we already have. Smooth River thinking can be adopted by anyone at any time under virtually any circumstances. It simply means thoughtfully assessing a situation — medical or otherwise — understanding the realities involved, making adjustments, taking constructive action within the confines of what is feasible, and preparing for all reasonable outcomes. It may mean accepting hard realities and making the best of a situation. It may mean making the best of your life, one shortened by illness.”
Before Marcia received her diagnosis, she and Richard had obtained a vacation home in Florida, which required considerable construction. During Marcia’s 160 days, as her pain permitted, they traveled to the home in Clearwater twice to be able to enjoy it together, however briefly. They also developed a routine at their home in Westchester County, which involved short walks, enjoying the view from the sun room of their house, watching television, and engaging in quiet conversation in which no subject was taboo, especially not the prospect of dying nor death itself. They speculated about the hereafter, and decided what should be done together in the here and now.
The couple decided that rather than wallowing in self-pity, they should utilize Marcia’s final days to leave a legacy of good. After forming Marcia’s Light Foundation, they sponsored a luncheon at a local mosque that would bring fellow Jews together with Muslims for an inter-religious gathering. They also developed bonds with the Hispanic and African American communities, contributing for the guidance and support for students seeking careers in health care and other fields.
“The simple equation that worked for us was to design enduring projects that our family could collaborate on during Marcia’s life, demonstrate her values and our love for her while she was still alive, offer a vision of how we could carry her legacy forward, and provide ourselves with the foundations to do so. We found it rewarding to direct our efforts to helping others, thereby doing good and instilling a higher purpose in our lives–higher than cancer.”
Eventually, Marcia’s chemotherapy treatments failed to work, and the cancer broke down “the vital mechanisms that enabled Marcia’s body to function properly and remain alive,” Cohen wrote.
“If our thinking had been derived from ‘ordinary mind’ (i.e., prone to to automatic, habitual reactions), we would then have been in a panicky freefall. But we had left behind ordinary mind months before. In our Smooth River mind, what might have been a nosedive felt more like a paraglide. We wanted Marcia’s remaining time to be a gentle decline, first absorbing new insights from a high-elevation view of life, and then gradually descending to earth and eventually beneath it…”
Personally, I had some misgivings when I agreed to read and review this book. I thought it might be depressing, but in fact, it was an interesting field guide to approaching the end we all will eventually face. I recommend this book for a general audience, not just for those who are dealing with a terminal illness.
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Donald H. Harrison is editor of San Diego Jewish World. He may be contacted via donald.harrison@sdjewishworld.com
Thank you, Donald, for this thoughtful review. I am so gratified that you got so much out of the book, which is intended to help others, using Marcia’s and my experience as a case study from which to derive important life lessons. Medical professionals, patients and their loved ones — everybody in fact — should softly understand the finite nature of life so that we can live out our remaining time, whatever the length, as meaningfully as we can.