A Guide to First Steps

How do you come to realize that medical problems will lead to death? Sometimes, it happens when the physician reports a diagnosis. Sometimes, recognition dawns as energy wanes and episodes of worsened symptoms or complications come more frequently. Most adults live many months with a fatal illness and die from slowly worsening conditions. At some point, though, you realize that death is coming. This may be a difficult time, but it can end up strengthening your spirit, and your remaining time can be comfortable and meaningful.

People differ in their focus at such times. There is no one right way to live in the shadow of death. However, here are some suggested first steps for those facing a serious illness:

• Find someone to confide in. Keep in mind that most people feel alienated, angry, or unfairly burdened at some point.
• Talk about your feelings, if you can. Weeping or lashing out at fate are often part of living through this process.

You may not be able to get a precise forecast from your physician, but you do need a general sense of what to expect. The following questions can help you get started:

• "What is the longest amount of time that I could reasonably hope for, and what is the shortest that my family should be prepared for?"
• "What does this illness tend to do? What kinds of complications arise?"
• "What treatments help? How much do they help? What will it be like for me to undergo treatments?"
• "What will my last few weeks or months be like?"

These are hard questions to ask and to answer. You may find it useful to tell your nurse or doctor what you expect might happen, and then ask for corrections and further explanation.

Sometimes you may have trouble sorting the important from the trivial. Here's a question that often helps you see what is really important: "If you knew that you were likely to die soon, what is it that would be left undone in your life?" Your answers to this question are often what you should focus on.

• Share your feelings, fears, and hopes.
• Discuss your illness and the care you'll need.
• Start a pattern of talking with your family about the challenges you face.
• Try to talk some about the time when you will be gone. It makes it easier on your family to know that you care for them even then.
• Make some specific plans for the time near death.

Think a bit about your work, your estate, and your responsibilities. Often you'll realize that you need to update your will, settle old debts, arrange for care for children or parents, or just help ensure that some activity you have loved well will continue.

• Don't waste energy and time on "keeping up appearances."
• Don't fret over medical matters.
• Do make plans to do the things that matter to you.

Even while survival is uncertain, say good-bye to loved ones, thank them, ask their forgiveness, and share love and memories.