The Smooth River is the remarkable story of how a well-known public relations expert and her husband met her stage 4 pancreatic cancer head-on. With vigor and strength, they deployed all they and medicine had to offer. But, in contrast to narrow conventional approaches, the couple developed a far more expansive view of what strength means in response to a crisis for which there are no medical cures. They called this the Smooth River.
This clear-eyed transcendent perspective was so vital that they wouldn’t let anything disrupt it—not cancer’s lethal march, not the strongest chemos and their failures to work, not the frequent episodes of severe pain, not how society expected them to think or act, not the process of dying itself.
The Smooth River demonstrates how to treat one’s life as bigger—and far more important— than any medical condition, any tragedy, any setback of any kind. With effusive warmth, refreshing candor and practical detail, it describes how to personalize Medical and Life Plans that affirm the value of a patient's being and guide their loved ones. Its invaluable lessons show how to face the possibility of dying with sanctity and comfort, to view it as an opportunity for personal growth, finding inspiration and intense beauty in the experience—in life itself. There are lessons in the Smooth River approach for everyone.
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.
Great for fans of: Patricia Weenolsen’s The Art of Dying, Nina Riggs’s The Bright Hour: A Memoir of Living and Dying.
Production grades
Cover: A-
Design and typography: A
Illustrations: N/A
Editing: A
Marketing copy: A
Clarion Rating: 5 out of 5
The Smooth River is a self-help book that shows how to live a full life, even in the face of death.
Richard S. Cohen’s The Smooth River is a self-help book rooted in a painful but hope-filled personal story.
Cohen’s wife, Marcia, died of pancreatic cancer. This book is his account of the time after her diagnosis, which is shared with the express intent to help others who are facing similar situations with overwhelming odds. Marcia lived only 160 days after her diagnosis, but thanks to the attitude and approach she created with deep intention—as well as her professional expertise in crisis management—they were days of love, peace, and dignity.
The Cohens’ approach, called the Smooth River, embraces composure, adapting to difficult realities, enjoying small things, and seeing love and beauty even in the process of dying. Their story balances enduring hope with practicality, knowing that the two are not at odds. 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. While Marcia “lost” her battle with cancer, in the conventional sense, her story shows that she, and even her husband, gained so much through the experience and the choices they made.
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 book demonstrates a broad view of the idea of treatment, including traditional medical approaches, like chemotherapy; spiritual approaches, like meditation; and everyday, interpersonal ideas, like airing concerns freely.
The narrative elements balance well with the clear, concise explanations of key medical and mindset perspectives. 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 Cohen is the narrator, Marcia’s voice and values permeate the book: blunt honesty, warmth, resolute hope, and clear thinking. It’s clear through their unified voices that the couple communicated well and often in the years before her diagnosis, but especially during those trying days. 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.
Reviewed by Melissa Wuske
October 15, 2021
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 booklist 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.
Click link below for Richard S. Cohen's article in Lake Oconee Health: Dedicated to Your Health and Wellness.
Before they knew of the Smooth River book, CancerCare requested that Richard speak on Cancer Out Loud: the CancerCare Podcast to share the uplifting approach Marcia and he developed in managing Marcia's Stage 4 Pancreatic Cancer. His discussion with Allyson, an oncology social worker, is entitled Season 4 Episode 2: Walking Along the Water and can be heard by clicking here. CancerCare is a leading national organization providing free professional support services to anyone affected by cancer.
