My wife and companion of nearly 50 years is dead. She used to say that when I was home, the house was pretty quiet. As a health care educator and patient advocate, much of my time was spent at my computer in my study. But on the rare occasions when I traveled for work, the house was “too quiet” for her. If I didn’t before, I would understand what she meant now.

We are now approaching the one-year anniversary of the date when our family doctor grew concerned with Maren’s unusual involuntary weight loss following hip replacement in January 2025. X-ray imaging of her GI system was followed by CT scan, then MRI, then an esophageal CT scan. By September, we knew something was seriously wrong and had localized it to her pancreas.

We contacted an internist, then an oncologist. The dread words were said: pancreatic cancer. She underwent preparatory vaccination for common viruses that would normally be filtered out by the spleen. She was scheduled for surgery during Thanksgiving week. After one surgeon resigned from the local health care system over professional differences, another quickly took over her care.

She went into surgery on December 3, 2025. A tumor about 27 mm long, twice the size anticipated from the best imagery available, was removed with about a third of her pancreas plus her spleen. Nearby lymph nodes were probed for cancer cells. Mixed squamous cell adenoma and carcinoma cells were found in 10 of the 12 nodes. This form of cancer is very aggressive and relatively rare. It is invariably fatal.

She came home December 13 to refrigerators and freezers well stocked by our visiting daughter’s cooking. We’ve not run out since, thanks to repeat visits and the delicious soups and broths prepared and dropped off by neighbors. And of course, the creations of a local professional chef and his team. Maren went from cooked out to cooked “for,” and she couldn’t have been happier with the result.

In January, Maren again underwent a CT scan. The pancreatic tumor had recurred, of almost equal size in just a month. Several signs indicated it had spread to her liver and kidneys. We met with an oncologist. He agreed that chemotherapy with any agent likely to be well tolerated would also extend her life by only a few weeks to months at best, with no prospect of cure. And Maren might pay for a marginally longer life with less quality of life. She said no.

Flash forward four months. Maren passed quietly in her sleep this week at about 2:30 a.m. Remarkably, though she had some discomfort when we needed to change her clothing and sheets, and major mental disorientation, she had no pain. In the last two weeks of her life, she was prescribed liquid morphine sulfate and an anti-anxiety agent. She also received medication to prevent the buildup of secretions in her lungs. We had nearly 24-hour assistance from home nursing aides, and daily visits by nurses to monitor vital signs.

For many families, home hospice care can be greatly superior even to hospice facilities. Though both types of care are suffering from labor shortages in many parts of the U.S., home care is emotionally more supportive in familiar surroundings, with the patient’s pets, family, flowers and scents of normal life all around. It can also be less stressful for health care nurses and aides. High patient loads in health care facilities can lead to less effective or compassionate care for patients. Burnout is all too frequent in health care professionals, and this type of care exposes them to the constant presence of death.

Maren and I were fortunate in many ways. Although our family has met the cost of private nursing aides, the cost of home hospice nursing and for a year of follow-on family care will be met by Medicare. Unlike too many American families these days, we will not be bankrupted by health care costs. I also have additional health care insurance from the 21 years I served in the U.S. military. Those years were the best investment I have ever made.

During the last six months of Maren’s life, we hosted several visits by close friends and family. In her last days, many called from as far away as Germany, the country of her birth. Even when she could no longer respond to their voices, I was told by nurses and a relative who was once a paramedic, that she could hear and register these quiet one-way conversations subconsciously. The outpouring of love was enormous and deeply sustaining for both Maren and me. Our friends assured Maren that she had permission to pass through her quiet transition, to whatever might lie beyond. I would continue to have their support.

This week and next, I am catching up on sleep and helping family and friends through their own process of transition and letting go. My online profile is a bit lower for a few days as I reach out to people who knew and loved the force of nature to whom I was married for 47 years. She touched a tremendous number of people.

Maren’s care circle is now my care circle, and very much appreciated.

I am also relearning lessons from which others might profit. One lesson is that any task that two people have commonly done together can take five times as long when done by one. I’m facing a lot of those tasks in the next few weeks as I clear out the inevitable clutter that accumulates in closets and drawers over a period of 50 years. I will need to be sensible about managing my own time and energy. I am not particularly famous for accepting help with such tasks. But others also need to offer help as they reach for closure. Both my physical energy and my emotions will benefit from letting them help.

A second lesson is one often heard from grief counselors: For a year, I won’t make large decisions about my living arrangements. At age 82 and in relatively good health despite a few infirmities of my age, the odds are that I may live well into my 90s. Ongoing productive work and sustaining human relationships will matter in the years I have left. And I have long known that I am a caregiver personality. But I will take my time considering changes to my living conditions.

Finally, one observation from a very upbeat song Proud Mary, popular in the early 1970s: “Big wheel keeps on turnin’, Proud Mary keep on burnin’, rollin’ on the River.” Life rolls on. We can choose to live it well.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.