September-October 2018 | Health

Taking Her Own Advice

Mona Hanford of Bethesda was working on a book about preparing for the death of a loved one when she found out she had cancer

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Photo by Skip Brown.


As Mona Hanford sits at the dining room table in her Bethesda home on a recent afternoon, a hive of activity unfolds. The neighbors who came over with lunch are on their way out as another friend walks through the door.

“Come on in,” Hanford calls out to the woman, who’s here to help her organize family photos into a book titled “A History of Mimi.” (That’s what her grandchildren call her.) Hanford’s bridge partner just checked in by phone, and a friend is unloading a box of dinner supplies in the driveway. Someone brings meals for Hanford, 75, nearly every day so she doesn’t have to cook.

“It’s a little crazy in here,” Hanford, a recently published author, admits.

Her friend and co-author, Adrienne Hand, is sitting nearby taking a call. “Mona’s life is always like this,” she says, laughing.

Hanford, an end-of-life activist who’s volunteered with local hospices and counseled families on how to prepare for a loved one’s death, decided last October to write the book she’d been contemplating for years. She’d helped nurse her husband, Bill, through eight years of a debilitating illness before he died at home, with hospice care, overlooking the lush backyard he loved. She’d retired from her career as a development officer for nonprofits and was finally ready to write a guide to the conversations families need to have about death. The slim paperback—titled The Graceful Exit, 10 Things You Need To Know: Face Reality, Make Wise Choices and Find Hope at the End of Life—was released in March and immediately landed on The Washington Post’s paperback nonfiction best-seller list, a rare feat for a self-published book.

She and Hand, the daughter of Hanford’s best friend, finished it faster than they’d planned. About a month into writing the book, Hanford had routine minor surgery and was shocked to learn soon after that she had endometrial cancer. The cancer was stage 4, she was told, and had already spread to her lungs. She’s since had more surgery and is receiving chemotherapy, but her doctors emphasize that treatment may contain, but won’t cure, the disease.

“God clearly has a sense of humor,” Hanford says. “I’m living the book I wrote.”


Hanford, pictured at home, wrote The Graceful Exit with her friend Adrienne Hand (left). Photo by Skip Brown.


The diagnosis came out of nowhere. Hanford felt like she was in good shape, taking water aerobics classes three times a week at the YMCA in Bethesda and walking her two rescue dogs every day. “I was feeling great, really peppy,” she says. She’d recently taken her grandson to Canada to celebrate his 10th birthday. Her hospice work and activism, along with her friends, two grown children and six grandchildren, kept her busy. She’d travel to board meetings in Minnesota for the Collegeville Institute for Ecumenical and Cultural Research, and was an active member of the Cosmos Club in Washington, D.C.

“I worked out with a personal trainer, and 10 days later I not only find out I have cancer, but serious cancer,” Hanford says. Her son, Troy, was with her at the appointment with a pulmonologist; her daughter, Tania Neild, was on the phone from her home in Bronxville, New York. “I was sitting in a chair, pale white,” Hanford says. “My son and I were both totally quiet. It was hard to imagine going from the peak of health to cancer. I’m usually Miss Chatty, but when I get hit hard, I just absorb.”

This can’t happen, she remembers thinking, I need more time for my dreams. She had a book to finish, she says, and she still wanted to get end-of-life care information into hospital rooms so patients would have easy access to it. Within a few hours of finding out that she was sick, Hanford’s strong religious faith—and the lessons she’d learned about preparing for death—helped calm her.

“You have to play the cards you’re dealt,” she says. “My cancer wasn’t caught early. I’m not going to buy into the fantasy of miracle cures.”

Hanford’s interest in life’s final journey came from personal experience. She and Bill took care of his parents for 11 years when her in-laws lived nearby in Bethesda. Her mother-in-law’s last two months were spent in hospice care, which made a strong impression on Hanford. “It was lovely and peaceful, and she died with grace,” she recalls. Hanford, who’d been working as a development director at St. Patrick’s Episcopal Day School in Washington, D.C., which her kids attended, began volunteering as a hospice counselor in 1999. She later joined the board of Hospice Care D.C., now known as Capital Caring, as well as the board of The Washington Home & Community Hospices.

As she spoke with families about the impending death of a loved one, Hanford saw their denial firsthand. In 2015, she developed a five-part course called The Hope Initiative, which was designed to support people making end-of-life decisions, and she later helped Suburban Hospital and caregiving groups adopt it. “A friend’s father was 97 and in the hospital,” she says. “I suggested hospice care at home. She said, ‘Oh, Mona, no one’s suggested he’s dying.’ ” By the time the doctor leveled with the family, the man only received hospice care for three days before he passed away.

“That is such a pattern,” Hanford says. “I’m trying to change all that.”

As a first-time author, Hanford’s timing is fortunate. She’s tapping into a wave of interest in end-of-life discussions, prompted by aging baby boomers. Pulitzer Prize-winning columnist Ellen Goodman continues to see a growing interest in The Conversation Project, which she co-founded in 2010 after failing to find out about her mother’s wishes before her death. About 70,000 people in 30 countries have participated in the Death Over Dinner movement since it began in 2013. Now celebrity chefs host “death dinners,” where people share their wishes for their final days over a good meal.

Hanford welcomes these efforts. According to a 2005 AARP survey, only 10 to 20 percent of respondents had put their wishes in writing or talked to doctors or family members about them. In their research for the book, Hanford and Hand found that almost no one is brave enough to sidle up to an aging parent and ask how they’d like their death handled. Hanford says despite surveys indicating that 75 percent of people do not want to die in a hospital, that’s where most die. She says she and her husband “were able to say our final goodbyes and our ‘I love yous’ in his hospital bed in our family room. This so often is not the case in the craziness of an ICU.”

Hand believes the book’s popularity signals a need for help in navigating the emotional specter of such a taboo subject. The book, which is part memoir and part how-to, includes documents called the Five Wishes, which detail the medical treatment an individual wants, the level of comfort care that person chooses and information about the medical next of kin. “Americans believe death is failure,” Hanford says. “It’s very hard news to accept, so we just don’t face it. Families cling to the promise of medicine as limitless.”