When author Richard Cohen’s wife Marcia received the devastating news that she had stage 4 pancreatic cancer, the couple chose to face the illness head on. With such a bleak prognosis they knew that Marcia’s time was short and so chose to adapt to a way of living that they termed the “smooth river” approach. This was a “moving, living, transcendent outlook” which came from both a place of strength and of realism. Their journey, begun in the darkness of what Marcia understood to be “the probability of imminent death”, is documented in this wonderfully moving, often poetic book. It is a memoir, a love story, a meditation on death and a practical guide to end-of-life care.

The “smooth river” philosophy foregrounds the wishes of the patient, allowing maximum agency for patient’s decisions regarding treatment plans and lifestyle choices. This is not a book that talks about “battling” a disease rather one that focuses on adjusting the lens through which we view living and dying. At a time when decision making can often be deferred to others, the couple ensured that Marcia’s wishes were always centered and that they remained “the architects of the big picture.”

THE SMOOTH RIVER includes a lot of practical guidance for anybody who finds themselves in a similar position. There are useful strategies and practical tips ranging from choosing a doctor to the importance of keeping a log. These real world examples are clear and informative. The sections relating to medical conditions and treatments are explained in layman’s terms with precision and clarity. Though the book refers to the practicalities of the health care system in the USA, the couple’s philosophies and strategies are valid for readers around the world. The “smooth river” outlook is an eminently transferable way of approaching end-of-life care for patients, families and care givers.

In addition to the wealth of knowledge relayed in THE SMOOTH RIVER it is also a book which includes passages of great beauty. Cohen is a writer capable of moving from the practical to the poetic with ease. The love that the couple shared is imbued throughout the text and the inherent sadness of their developing situation is often punctured by moments of acute, heartbreaking tenderness. As Cohen writes, “the closer we got to death, the more intense and beautiful life became.” For all its focus on death and dying THE SMOOTH RIVER is a testament to a life lived to its fullest right until the very end.

THE SMOOTH RIVER is a clearly written guide to end-of-life care and contains a wealth of relatable, practical advice. It is also an astute contemplation on life and living containing passages of extraordinary beauty.

~Kent Lane for IndieReader