Last week I talked about my friend Karen and her move into that place called hopeful reality as her options for treatment ended and she chose a clinical trial for her advanced endometrial cancer. She began the clinical trial on Monday, July 23, her 56th birthday, with high hopes that the drug would begin to do its magic and slow the growth of what she knew was a very aggressive tumor. But there wasn't even time for the drug to get a good foothold before pain meant a hospitalization and fever of unknown origin that indicated an infection somewhere that the doctors couldn't determine. By Thursday, Karen was on antibiotics and morphine, hoping a few days of each would allow her medical team to analyze and fix the problem. But as often happens with cancer, the problem was the cancer. On Sunday, I spent the night with her and we talked about how hope had changed from months to long enough to say goodbyes. With her pain under control and her fever close to normal, she discussed ways that she might have a week to travel to her favorite city in New Mexico where she had lived for a number of years. She wanted to breathe the air and say goodbye to the mountains she had hiked so often. Then she would return to hospice. Today she finished a week of radiation treatments, and her plan is to leave this weekend for her final trip to say goodbye to friends and places. We worry for her and her health as she takes this final trip, but we honor her need to go.