She Was Dying of Cancer. How Should She Live?

Kate Dietrick walked amid rows of 19th-century graves, stopping to read the epitaphs carved into headstones. The ground, soft from a recent thaw, gave a little under her feet. A gust of wind ruffled her short hair.

Kate, who is 42, had spent the morning shopping for a gravesite. This one seemed promising: The cemetery belonged to the synagogue she had joined after converting to Judaism, in 2021. Its congregation was the oldest in the state — a detail that Kate, who dealt in history for a living, appreciated. And it was covered with tall, leafy trees that made it feel peaceful.

Still, the thought of being there alone unsettled her. She had no children, and though she and her husband had been married almost 10 years, it was perfectly likely that after she died, he might remarry, live a long life and be buried with someone else.

“I’m not going to be there, so I don’t know why I’m so bothered by it,” she said. “But it does feel a little lonely.”

Kate has Stage 4 breast cancer. Or, more specifically, Kate is currently living with and dying from Stage 4 breast cancer. That’s the truest way to put it, she says: It’s been almost four years since her diagnosis, so the disease almost resembles a chronic illness — except the specter of death hovers much nearer.

She hopes to make it five years. Five years would be long enough for her and her husband to celebrate their 10th wedding anniversary with a cruise down the Danube. Long enough to celebrate her niece’s 8th birthday. Long enough, maybe, to hear a new Taylor Swift album.

Kate has felt the clock ticking in moments big and small: When she and her husband, Nate Ordansky, closed the door on having a child. When she quit the committees she served on as an archivist at the University of Minnesota Libraries — and then rejoined them because she still wanted to advance her career. When she debated whether to buy nice clothes, not knowing how long she’d use them.

“Unless I get hit by a bus, this is going to be the thing that I die from,” she said. She just doesn’t know when.

Twenty years ago, the words “Stage 4” almost invariably meant “end of life.” A cancer had spread far from where it formed, attacking distant parts of the body and often making treatment impossible. For some, that remains true today. But for a growing number of people, a Stage 4 diagnosis is not the immediate death sentence it once was.

New therapies that target specific genes and parts of the immune system, as well as new regimens of existing cancer drugs, have given many patients far longer than the handful of months they might have once hoped for. More than a third of people diagnosed with metastatic disease now live for at least five years, compared with 17 percent in the 1990s, according to the American Cancer Society.

When Kate was first diagnosed with Stage 2 breast cancer in 2020, she thought, “I’m going to die immediately.” Her oncologist assured her she wouldn’t. Treatment would be difficult, no doubt — including chemotherapy drugs that made her violently ill, radiation that burned her, and a surgery that left her body scarred and unfamiliar.

But there was also “the dangle of hope — there was an end,” Kate said. “And even though it was a little ways off, I could see it.”

After treatment, her hair grew back and she was able to think about things besides cancer, join in carefree chatter at happy hours with girlfriends. She and Nate bought a house upstate, by Lake Superior, allowing themselves to dream about the future.

Then the cancer came back. “There is no end,” Kate said. “The end is death.”

Still, Kate’s doctor said that, with treatment, she should expect to live years, not weeks or months. How many? She wanted to know. He couldn’t say.

The time was a gift. But it left her in excruciating limbo. Should she and Nate stop saving money and start checking off destinations on their bucket list? Go on a farewell tour to say goodbye to friends and family around the country? Live life as usual and just hope for the best?

Patients with advanced cancer increasingly face these types of dilemmas, said Dr. Arif Kamal, an oncologist at Duke University and the chief patient officer at the American Cancer Society.

“What they’re grasping for,” he said, “is, in the midst of uncertainty of what’s going to happen, am I doing the right thing?”

For a while, what Kate did was feel angry. She was angry about not having a baby when everyone she knew was having babies. Angry her friends might live another 40 years and she wouldn’t. And she was angry at herself for feeling this way at all, when she wished she could be happy for those around her.

Nate was angry, too: that his wife had cancer, that the world could carry on, that the two of them wouldn’t grow old together. What the hell am I supposed to do? he thought. The question ran on loop in the back of his mind.

The weekend after Kate’s Stage 4 diagnosis, she and Nate drove to their house upstate. In good times, they would have hiked and dipped their feet in the lake to feel the shock of cold water on their toes. But this time they just sat, staring at the water in silence.

A few months later, they sold the lake house. It was an acknowledgment of their new reality: Kate would be tethered to a hospital for scans and treatments, and she wanted to be nearer to her friends and family.

But they also bristled at any suggestion that they might simply resign themselves to Kate’s dying. “There’s no reason to sit and wallow,” Nate said. “That’s no way to live.”

So they sold their house in town, too, to buy a bigger place where they could keep building their lives. Kate could pursue her letterpress and bookmaking hobbies in the basement. Trudy, their Cavalier King Charles spaniel, could run in the backyard. Maybe they wouldn’t have children sitting on stools at the countertop, but they could host friends and family for Shabbat dinners.

Kate’s diagnosis still left Nate with existential questions. His life had been wrapped up with hers for 13 years. The house was “a two-person house,” he said. “Where am I going to live? What am I going to do with myself if I don’t have this relationship?” She suggested that he might find a new partner. He wasn’t so sure. “It’s not something I would count on,” he said.

A professional actuary, Nate was no stranger to uncertainty. He could tolerate not knowing what his and Kate’s future looked like, especially if more time was a possibility. “If the trade-off is that I get to be with Kate and we get to continue our life, then that’s a good trade,” he said.

The first treatment Kate’s doctor prescribed started working right away. And then it kept working. “Let’s stay the course,” her oncologist told her. For a while, Kate’s life felt ordinary. She and Nate would come home from work, take Trudy for a walk and lounge on the porch reading, occasionally interrupting each other to share a good detail.

In 2023, they celebrated their seventh wedding anniversary in Scotland, exploring lochs in mercurial weather. She hiked for miles — a glorious feeling of accomplishment for someone who felt her body had so deeply betrayed her.

At work, Kate would take a cart to the limestone caverns 82 feet underground, where she was surrounded by the effects of the deceased. She would harness herself in a stock picker and pull 50-pound boxes of documents and photographs off shelves, thinking about the questions she wished she could ask of people both famous and ordinary — a businessman who trained guide dogs for the visually impaired, a woman who enlisted in the Navy during World War II, a couple who fled Nazi Germany.

She started planning a new exhibit from the archives, on how people document and ritualize death. “The only way I would quit my job would be at the bitter end,” she said. She told her oncologist, “You’ve got to tell me when that time is.”

When that day came, she would do the farewell tour, the last trips, spend every day with her niece and nephews. How much time would she want? “I don’t know,” she said. “Six months? Three months? I don’t want three years — that seems too much.”

Until then, she would keep working, keep contributing to her retirement fund. She knew she would never use it the way she and Nate had dreamed of: visiting national parks, seeing more of Europe and buying a winter home in Palm Springs, Calif., where they could escape the Minnesota winters.

“If I die and you get my 401(k), that rolls into your money,” she told him one night. “Would it allow you to retire earlier?”

“With who?” he asked.

In the summer of 2024, Kate attended Camp Breastie, a retreat for women with breast cancer. She worried about whether she’d be welcome. “I’m everyone’s worst nightmare,” she said. She was the one whose cancer had come back, after all.

She befriended a few women who also had Stage 4 cancer. They stayed in touch after camp, complaining about hot flashes from their medicine and making cancer jokes on a group chat. The next summer, one of them, Elana, was too sick to return. The friends sent her postcards from camp. “Wish you were here!” they wrote.

Elana died shortly after. Her treatment had stopped working, and she had run out of options.

A couple of months later, Kate was feeling increasing discomfort in her hip. “There is imaging and biopsy evidence of disease progression,” her oncologist wrote in her medical record. He started her on a new treatment.

The drug made her constantly sick. She threw up in the car on the way to work, in the grass on campus, in the bathroom at work. Worst of all, it didn’t help. By December 2025, the cancer appeared to be growing in the bones and muscles around Kate’s pelvis.

One day in January, she was alone at home, and the cancer, now also in her lungs, was making it difficult to breathe. She began to panic, and then to sob, her body shaking uncontrollably. Is this what it’s going to be like at the end? Kate wondered. Am I going to die in pain? Trudy ran all over the house looking for the cause of Kate’s distress.

A planner by nature, Kate started to think about preparing for her own death around the time that Elana’s last treatment failed. She wanted to exert some measure of control — “to give some known to the unknown,” she said. She met with a death doula to learn about hospice, wrote out an advanced care directive and talked with Nate about funerals.

Over the winter holidays, Kate started to go through her things. She donated her art books to a local bookstore. She gave her martini glasses to her stepsisters. She set aside the American Girl doll she treasured as a child, perhaps to pass on to her niece.

But then, as she went through more of her possessions, Kate got mad. Maybe she’d never wear her wedding dress again, or the dress from her first date with Nate, when they went to the Minneapolis Institute of Art and she showed him her favorite painting, Jean-Baptiste-Camille Corot’s “Springtime of Life.”

“I was like, this is bullshit,” she told her death doula as she recounted the incident. “I still want this thing. Because I’m still alive.”

In April, on the sixth anniversary of her first cancer diagnosis, Kate, who was doing better on a new therapy, woke up with plans to celebrate. She treated herself to a scone from a bakery she liked and visited her favorite bookstore.

Then a notification popped up on her phone: Heather, another one of her Stage 4 friends, had died. She had gotten married only a few weeks earlier.

Ten days later, Kate sat in her living room, watching a livestream of Heather’s funeral in France. Kate sipped tea and cuddled her dog as she watched the family gather and lay flowers on the coffin. At the end of the ceremony, the officiant said a door would open and Heather would disappear from her loved ones’ lives forever.

During the service, Kate texted with her friends from camp, including the only other woman from their Stage 4 group who was still alive. “The door ceremony at the end was something I haven’t seen, it was lovely but very gut wrenching. The finality,” that friend wrote, adding: “Wondering how to go about my day like normal now.”

When the funeral was over, Kate closed her laptop. It was a sunny morning in the Twin Cities. The dog needed to go out, and she had an exhibit to plan.