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By Root 1039 0

never been seriously ill. Her parents had emigrated from Ireland and made their way to America in the aftermath of World War I. Mary and her husband were high school sweethearts, married when he was discharged from the army, and they had raised three daughters and a son. She was devoted to her family. Mary was the matriarch, running her household, and guiding the children’s education. She worked in the town library, where she took particular pleasure in helping young people discover books that she believed would speak to them. A woman of deep faith, Mary attended mass every Sunday, and on Thursday evenings she prepared and served meals in the parish soup kitchen.

“She was the eternal optimist,” her daughter Deidre told us. “If the house was on fire, then my mother would say, ‘We’ll be warm for the winter.’”

After the diagnosis of incurable biliary cancer, Mary told her family that she was ready to die: “I’ve had a great life.” This was the way of the world, she said, a fact that everyone would someday face. But Deidre insisted on a second opinion and took Mary to another medical center, where the doctors offered an experimental therapy. After an operation that removed some of the cancer around the bile ducts, a catheter was placed, and chemotherapy was infused directly into the remaining tumor.

“It was like a miracle,” Deidre told us. The cancer decreased dramatically in size. And for some eight years, the tumor didn’t disappear, but it didn’t grow, either. After the treatment, Mary retired from her job at the library, yet she seemed to be busier than ever. She volunteered at the local public school to assist in a reading program, organized a clothes drive each autumn at her church, and spent more time taking care of her grandchildren, lightening the load on her daughters.

But as the eighth year of remission drew to a close, she fell ill. It began gradually as discomfort in her right side, and then she developed fevers. The doctors performed blood tests and repeated her scans. The picture of her liver had changed. The doctors detected multiple new small, oval areas in her liver, which appeared to be abscesses.

Mary entered the hospital and was treated with intravenous antibiotics. The therapy seemed to improve her symptoms; her fever abated, and her energy level improved. She returned home. But after several months, the fevers and fatigue returned, and repeat tests showed more oval areas in her liver that were likely pockets of infection. Over the course of the next five months, Mary entered the hospital twice more for intravenous antibiotics. After each discharge, Deidre told us, Mary was weaker, forced to give up her volunteer activity at school, unable to stand on her feet to serve meals at church. She hardly had enough energy to read and spent most of her days in bed, dozing. Her world had begun to telescope, and Mary, still the family matriarch, gave clear guidance to Deidre and her siblings.

“She reminded us all that she did not want any heroics,” Deidre recalled. “She said she was ready to die when her time came. And that she wanted to die at home, with dignity.”

On her fourth admission to the hospital, intravenous antibiotics failed to bring down Mary’s fever and shrink the abscesses. The doctor suggested a drainage procedure, where a needle would be placed into several of the pockets of infection and the pus drained. Mary agreed. At first the procedure seemed successful, and her fevers abated. But after several weeks at home, her temperature rose again, and she was readmitted to the hospital. A repeat scan showed that the abscesses were enlarging. Her doctors also saw what they called “shadows,” and it was difficult to tell whether these dark areas in the liver were from the cancer growing or from the infection—or both. Again the medical team performed a drainage procedure, and Mary returned home.

Mary now spent nearly the entire day in bed, often dozing off after reading just a page or two of one of her favorite novels. “It seemed to us that the quality of her life was being lost,” Deidre reflected. “But