Making peace with fate

Chicoan Molly Amick spent most of the summer of 2016 in her home state of Pennsylvania caring for her mother, Irene, who was terminally ill with breast cancer. Molly’s goal that trip was to say goodbye to her mother, help set her affairs in order and carry out her final wish—to die at home.

When her mother’s death was imminent, Molly and her husband, Sterling Ogden, gathered all of Irene’s treasured blue glassware around her and lit dozens of candles, bathing the room in a gentle azure glow. Molly sang softly and offered comforting words until her mother took her last breath. Then the couple hand-bathed Irene in lavender water, dressed her in the outfit she’d chosen for this occasion—her favorite China-blue nightgown and matching bathrobe—smudged the room with sage, and called her home health care worker and her longtime partner.

When they arrived, the small party gathered around the departed and shared a bottle of wine to toast her life before calling the crematorium to collect her body. Molly’s mother had carefully prearranged and paid for her after-life care and memorial, even dictating which poem should be read and that Molly play “Amazing Grace” on her ukulele.

Molly related that experience, in vivid detail, while sitting across the table from me on the front porch of my old house in the Avenues. Molly, Sterling and her son, Atticus, lived next door, and my wife, Kate, and I had grown close to them during our nine years as neighbors. We’d had hundreds of conversations on that porch over the years, but that one stands out. I knew then that Molly wasn’t just describing her mother’s passing, but her vision for her own impending death.

In June 2015, upon visiting a doctor for a baseline mammogram at the age of 50 and having exhibited no symptoms, Molly was diagnosed with stage 4 triple-positive breast cancer, which had already metastasized to her liver.

Molly, who died March 31 at the age of 53, was a nurse practitioner for 22 years, a self-avowed “research junkie,” and an advocate for what she called “a self-determined death.” She believed in a dying person’s right and responsibility to take control of his or her medical treatment, time left and final arrangements, even if the choices defied medical recommendations or mortuarial norms. She felt that by focusing on spiritual and psychological needs, it was possible to die “a good death.”

She also was a childhood leukemia survivor who’d endured chemotherapy treatment as a teenager. Armed with that previous experience, two decades of experience as a health care provider, her “gut instincts” and piles of research about different cancer treatment models, she made an informed decision to eschew chemotherapy and other major interventions suggested by some providers. Instead, she developed her own treatment regimen focused on boosting her immune system and preserving quality of life, made peace with her fate, and resolved to die the way she’d always lived—on her own terms.

Throughout her illness, Molly insisted her experience with cancer not be referred to as “a battle.”

“One of the most unhelpful things going on right now is this warfare, battle-mode approach to ‘fighting’ cancer,” she said. “Cancer isn’t a time to go to battle; it’s time to treat your body as well as you can, and as nurturing as you can. The battle mode puts health providers in this heroic situation where they’re expected to pull out all the big guns for you, and it puts the client in the role of being this warrior.

“Nobody talks about a quality of life or a quality of death, there’s just the battle,” she continued. “Then someone dies, and nobody talks about it. There’s just this empty space and everyone walks away. This fucking battle model is a useless metaphor in this country, because it’s just slammed any discussion about other treatment options, or of choosing a quality death. … [Terminal health care] shouldn’t all be about trying to buy more time, but about what a person really wants and what works for them.”

Molly was well-known locally as a compassionate health care provider, activist, gardener, artist, mother, wife and friend. She was an advocate for the underprivileged, penned guest comments for this publication and spoke at local government meetings. In her last years, she retired early, traveled, watched her son grow to adulthood and found her artistic voice, among other bucket-list accomplishments.

One of Molly’s late-life goals was to share her two experiences with cancer and her philosophy on health care and death and dying, with the hope of helping others take control of their own treatment. Those efforts included interviews with her friend and local journalist/activist Bill Mash to create a series of audio and video segments, and speaking to me.

It was under that circumstance that I met with Molly just weeks before she passed, at the table in her dining room where we’d shared meals at birthday parties and solstice celebrations and neighborhood get-togethers. Though she was in the midst of an upswing, her health was precarious—there was an unspoken understanding that it could be our last conversation. The fact it was “on the record” felt surreal, but her frank, disarming nature and good humor quickly alleviated any discomfort. Her wit and wisdom were wholly intact, and she remained a consummate storyteller; the only outward evidence of her diminished physical state was a sling holding one arm in place, and a walker parked nearby.

During our two-hour conversation, Molly offered a rundown of her life story, which she characterized as “long, varied and blessed” in spite of her terminal illness. Recurrent themes of her narrative included education, activism, travel, social justice, health care, community, self-discovery and a boundless joie de vivre. She spoke at length about her illness, course of treatment, experience as a health provider and the politics of the American health care system. She said much of her character qualities, and late-life decisions, were informed by her early experience with acute lymphocytic leukemia, with which she was diagnosed shortly after her 14th birthday.

Doctors back then told her she had a 30 percent chance of survival, but Molly recalled feeling certain she would beat the odds. Her treatment at Children’s Hospital of Pittsburgh included chemotherapy, regular transfusions, spinal taps, and a great deal of pain. She went into remission after six weeks of aggressive therapy, then continued to receive intermittent transfusions on a decreasing basis for two years, followed by three more years of testing and follow-ups.

“I’d puke my way through the three-hour ride to Pittsburgh [from my hometown of State College, Penn.], and then puke my way back,” she said. “It was brutal, and [the treatment] is still brutal. It also really took me out of my peer group, right around puberty time, which was hard.

“On the other hand, I’d look in the mirror. I looked like a concentration camp victim, but that really internalized my sense of self. I realized I was not a reflection, that the self is internal.

“That set a tone of always doing what I wanted to do,” she continued. “I’ve never really wasted much time on what I don’t want to do. Leukemia was sort of a blessing in my life, in some ways … it taught me to not worry about what other people think.”

This strong sense of self led teenage Molly to learn more about feminism and become active in social justice issues, including reproductive rights, AIDS awareness and social equality. She excelled in high school, where she applied her blossoming philosophy to her scholastic endeavors, including editing an award-winning yearbook she insisted afford equal weight and page space to men’s and women’s athletics.

Molly attended Dartmouth College on a three-quarters scholarship, acquiring a bachelor’s degree in literature before going on to earn her first of three master’s degrees, in mass communications, from Pennsylvania State University. She also traveled extensively, working on a documentary about women farmers in Kenya and other African nations, teaching English in Japan, and backpacking across Spain.

As she related her life story, Molly emphasized how each experience led to the further development of her worldview. Coming from “a working-class, white-bread community,” Ivy League Dartmouth made her more aware of class issues; she said she and other poor whites, people of color and LGBTQ students were relegated to run-down dorms on the edge of campus, while the children of wealthy “elites” lived in more luxurious digs. In Africa, she became more aware of flaws in white-male-dominated Western culture. In Japan, where she said some restaurants wouldn’t serve her, and groups of schoolchildren chanted “gaijin!” (meaning “outsider” or “barbarian”) as she walked by, she felt what it was like to be a minority.

After realizing that “employers were more interested in my waitressing skills than my degrees,” Molly attended Vanderbilt University, where she obtained another master’s degree, as a family nurse practitioner. That brought her to live in Chico in 1997 to practice at a health clinic in Los Molinos as part of a federal loan-payback program. She worked there seven years and, after becoming pregnant with Atticus in 1999, moved on to a series of private practices and health clinics in Chico. Molly and Sterling started dating in May 2007, and married in 2008.

As she continued practicing medicine, Molly became acutely aware of the confluence of mental and physical illness. She found an online program at Fresno State University that allowed primary care nurse practitioners to become psychiatric nurse practitioners, and earned her third master’s degree in 2013. A proponent of the client-based wellness-recovery model of mental health care, she worked at Chico’s Iversen Wellness & Recovery Center and collaborated with Butte County Behavioral Health and Northern Valley Catholic Social Service to develop programming there.

Prior to her illness, Molly and Sterling often discussed their long-term plans, which included Molly’s possible segue into local politics; she even plotted a possible Chico City Council run for this November. Then, for the second time in her life, cancer changed everything.

After Molly’s 2015 diagnosis, she said a number of oncologists and health care providers suggested she immediately start chemotherapy, which she was reluctant to do in light of her earlier experience. She began poring through medical journals and outcome-based study results, and found her research validated her gut feeling—that chemotherapy showed little efficacy for her type of cancer.

“Not all breast cancers are equal,” she said. “With some types, [various treatments] can add 10 to 20 years to your lifespan, but you’re not going to get those same results with triple-positive or triple-negative cancers. My research showed me chemo would cost half-a-million dollars, plus pain and suffering, with no bang for the buck.”

An early conversation with an oncologist, who insisted she pursue chemotherapy, further validated her misgivings: “After telling him [I wanted to consider other options], the first thing he did was call me a ‘nihilist,’” she said. “I said it wasn’t nihilism … [but that] his recommendations weren’t effective at treating my particular form of cancer. Then he told me ‘I just had to believe’ and I said, ‘Well, that’s not how I’ve ever practiced. … it’s medicine, not a belief system.’”

The conversation got worse from there, she said, with the doctor attempting to guilt-trip her by saying she wouldn’t live to see her son’s high school graduation.

Molly said the most effective treatment she found was a European model based on hormone blockers administered via monthly injections, and boosting the immune system, but that FDA regulations don’t allow the same cutting-edge treatment in America until a patient has failed at least one round of chemotherapy. After reluctantly participating in a few sessions of radiation therapy, Molly struck up a conversation with a fellow nurse practitioner who recommended an oncologist who would be willing to treat her with a similar, albeit less-effective form of hormone therapy than the European treatment, which remained out of reach.

She said many providers—and even some friends and acquaintances—remained outspokenly critical of her choices throughout her experience.

“My whole goal was quality of life, and I knew I could get two to three good years,” she said. “I wasn’t looking for a cure, I was looking for a good life, and a lot of people wouldn’t accept that.”

Molly remained steadfast in her resolve: “I was able to wrap my mind around the fact I had limited time left … the small time frames help you focus on what you really need and want to do. And it’s been incredibly satisfying and meaningful.”

After deciding to opt out of extreme treatment, Molly and Sterling got their financial affairs in order and were able to retire early. From then on, they committed to spending their final days together to the fullest.

“It’s been amazing,” she said of her choice. “I watched Atticus graduate from high school …. I never had any doubt I would do that. The last three years have been the best times in Sterling and I’s life together. We traveled to Europe, we did part of the Pacific Crest Trail, I went to Mexico with my girlfriends and Santa Fe with my sister. It’s been wonderful, and I never would have been able to do any of it had I been consumed with chemo and all that shit.”

Though she’d anticipated getting involved in politics before learning her time was limited, Molly said she was instead able to segue into being an artist, one of her lifelong dreams. She first tried painting and journaling to chronicle her experience with cancer, but found the former too time-consuming and the latter “just awful.”

“I’ve always kept journals and wrote poetry, but I couldn’t write about this experience at all,” she said. “It was like junior high poetry, like sobbing into my journal. I looked at it and thought, ‘This is just stupid.’”

She happened upon her chosen medium by accident. Shortly after diagnosis, her friend Kandis Horton-Jorth invited her over to experiment with paper art made from a collection of vintage cocktail napkins she’d acquired. Molly said no, but Horton-Jorth eventually coaxed her out of her self-pity cave with promises of companionship and wine, and sent her home with some glue and a pile of napkins.

“I picked them up a couple of weeks later and was looking at these silly napkins and thought, ‘Oh, shoot, look at these … there’s a skeleton, and there’s the Buddha and there’s the Tree of Life.’ Who would’ve thought the universal themes of life and death could be found on something you blow your nose on and throw away. I started cutting, developed my own technique, and everything just jived.”

Molly’s artwork became increasingly valued and respected since that epiphany, culminating in her final art show on March 4, at Chico’s Beatnik’s Coffee House and Breakfast Joint. Family members from all over the country were in town that weekend to say their goodbyes, and hundreds of Chicoans attended. All of the roughly two dozen pieces on display were sold and patrons ordered nearly two dozen more full-size prints. Molly intended for profits from the nearly $10,000 in sales made that day, and future profits from her art, be used to start a charitable fund to provide small cash grants for underprivileged people to pursue life-enhancing goals, like traveling or taking guitar lessons. Sterling and some of Molly’s friends are currently working to carry out those wishes.

Fortunately, that meeting at Molly’s house wasn’t our last. About a week later, her health was still strong, and she came to visit my wife and me in our new home.

A week after that, while visiting San Diego, I awoke to a Facebook message from Sterling saying Molly had passed late the night before. I called to express my condolences, and he told me about her final days. I was instantly reminded of that conversation on the porch about her mother’s death.

Molly knew it would be her last day alive, and told Sterling so that morning. As per her prearranged instructions, he, Atticus and Molly’s sister Mickey gathered around her weakened body. They each read part of a ritual she’d prepared, smudged the room with ceremonial sage she’d grown in her garden, and everyone said their goodbyes. After she passed, Sterling and Mickey bathed her, dressed her in the clothes she’d already chosen, and Atticus joined them for a toast.

Sterling counts the days since Molly’s death, and has been working with her friends and family to put together a memorial—aka the Remembrance and Soul Release Dance Party—which she also partly planned. Though still grief-stricken, he stands by Molly’s decisions, and expresses joy rather than grief when he talks about their final years together—road-tripping through the Pacific Northwest, riding bikes in Amsterdam, and dancing all night in Paris on their eighth wedding anniversary during the 2016 summer solstice.

“She practiced a way of dying filled with ancient tradition and focused on acceptance,” he said. “When I look back on her life, even her early death, I don’t see it as a tragedy, because I know that our years together were just a small part of a very big life.”

During my interview with Molly, she shared the story of an elderly patient who was very upset that a doctor had told him to stop working on his farm, and that he should instead spend his days resting in his recliner. She said, “Well, do you have a problem with dying while you’re out walking the fields?” His reply: “Hell no! That’s how I wanna go!” So, she told him to go out and walk in his fields.

“Am I going to die?” Molly asked. “Yes, I’m going to die. People know that their lives are finite. We all know nobody gets off the planet alive. But people also want a self-determined death. It doesn’t have to be about buying more time, it can be about saying, ‘This is what I want and this is what works for me.’

“It’s OK to say, ‘I’m OK with dying and this is how I want to do it.’ I don’t want to do it with all the medical hoopla, I’d rather be in the dirt with my trowel, because that’s what’s important to me.”