Lessons from the Front Line
One of The Best Indie Books of 2021.
Kirkus Reviews -- One of The Best Indie Books of 2021, A Starred Review
"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."
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BookLife Reviews/Publishers Weekly
"Cohen’s sensitive, stirring account of the 160 days between his wife’s diagnosis with stage 4 pancreatic cancer and her last breath finds “beauty within crisis” and invites readers to take inspiration from the “Smooth River” approach to ending a life that Cohen and his wife, Marcia Horowitz, arrived at in those last months. “Normalizing end-of-life matters—and dispelling societal distortions that avoid addressing them—are critically important,” Cohen notes in an introduction, and the narrative that follows exemplifies his argument. Once treatment options had been exhausted, the couple determined to face Horowitz’s probable final days with clear eyes and open hearts, making the most of each day, thinking of her life not as a tragedy cut short but as fully lived.
In short, they prepared for her to “leave this world in peace.” In crisp prose suffused with feeling, Cohen contests the societal tendency, shared by many doctors, to view terminal disease as a “fight” to be won or lost. That’s not to say that Horowitz, a crisis management expert, didn’t “fight” in the traditional sense, consulting with numerous experts, undergoing chemo, and pursuing all viable options. But Cohen argues, with both persuasive and emotional power, “A win is not necessarily defeating the cancer. A win is having lived a good life.”
That’s the current that courses throughout: their dedication to ending a life well, on their own loving terms. The book memorializes that life while showcasing a healthy approach to preparing for hard possibilities. The couple developed and held to both a Medical and Life Plan, which Cohen details throughout. Cohen movingly covers the medical practicalities—choosing navigating the system; handling “a thin-skinned, sensitive doctor”; dealing with “chemo brain”—while emphasizing the Life Plan, especially the urgency of filling time well, with heart-to-heart talks, simple pleasures, and the embrace of loved ones. Bursting with life, The Smooth River leads by example.
Takeaway: An inspiring, beautifully written account of living a life of purpose when faced with a terminal illness."
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5 out of 5 Rating: "The Smooth River goes against the grain of many typical cancer mantras that center on fighting, winning, and never giving up. Instead, it embraces the wisdom of assessing the odds and, when it’s appropriate, accepting the finite nature of life ... The bold, honest, chronological narrative provides the 'unvarnished information' they sought from doctors and other advisors. The book doesn’t shy away from uncomfortable emotions and harsh statistics. It shows the principles they used to create a medical plan and life plan—a true body, mind, and spirit approach to what it means to find healing ... The narrative is the most engaging and transformative element of the book, and the story is told with excellence—compelling scenes, precise diction, well-crafted characterizations ... While the emotions are raw—Marcia passed away in early 2020—the book keeps an appropriate distance from sentimentality while giving voice to the many emotions of grief. The appendix includes a list of books that Marcia read that influenced her life and perspective, which is a gift to readers who want to live like she did. The Smooth River is a self-help book that shows how to live a full life, even in the face of death."
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Jordan Berlin, MD, Associate Director for Clinical Research, Ingram Professor of Cancer Research, and Professor of Medicine, Vanderbilt-Ingram Cancer Center
"While we work on more effective means to diagnose and treat pancreatic and other cancer, Smooth River demonstrates how to elevate one's being over the turmoil. This wonderful book gives voice to those who don’t want to define themselves by the ravages of serious illness."
Eugene H. Hirsh, MD, Clinical Associate Professor of Medicine, Retired, Emory University School of Medicine
"It is difficult for anyone, even those who have experienced the death of a spouse, to empathize fully with another widow/widower. Yet, Richard Cohen brings us as close as one might get to that experience through his remarkable book. With love, compassion, creativity, honesty and openness, a full picture of an approach to this loss is revealed. That picture, as we are shown, includes a thoughtful and determined avoidance of despair and rejection of powerlessness. The Smooth River guides the couple through shock and confusion, through grief and to resolution in the all too brief time before an anticipated end. This is an important book for care receivers and care givers - families and physicians/medical personnel alike."
Laura Hanlon, M Ed, LCSW, Bereavement Coordinator
"The Smooth River is a great guide for people who have to navigate through serious illness or for those who want to better understand the experience and derive inspiration from it."
"The Smooth River is both a memoir and a practical guide on how to approach end-of-life with a terminal cancer diagnosis.
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.
IR Verdict: 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."
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"The Smooth River serves as practical inspiration to make life meaningful -- as the current moves us toward what we all inevitably share."
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4 out of 4 Stars: "The Smooth River...is an exceptional combination of memoir and guidebook ... The writing style was excellent and proficient, making for a lovely read ... Smooth River thinking can teach readers how to face the probability of passing away with peace and comfort ... [U]nlike the usual “beating cancer” approach, this book explored the true essence of a patient’s cancer journey in greater depth ... I would recommend this book to all those people whose loved ones may be affected by a fatal illness in hopes that they gain strength from it. In addition, aspiring doctors and medical students may also find this book very helpful."
5 out of 5 Stars: "A Must Read". "The writing was excellent and ... a great book that anyone can read. It talks about destigmatizing death and allowing for all to have mindful and normalizing end of life talks, education and considerations... [T]he book made me cry and want to create my own life plan. It truly is a great book that I would expect to be at oncology centers, in hospice, and good for anyone to read."