As a person faces the final days, weeks and months of life, amid the many feelings that fill the heart and mind, often a dominant need is to find as much peace within oneself as possible.

Some people, of course, face death with great serenity, having already made peace with themselves and others in their life. But for many, the news that time is very limited will bring a flood of anger, grief, fear, regret and more.

While no one knows with certainty what happens after we die, many have taken this final journey toward death and have left us ideas and approaches on how we can make our last days meaningful for us, and for those who love us. A common point in these recommendations is that, as we face our own death, it's good to remain as actively engaged in thinking and doing and living as we can, every day, to the best of our abilities. Playing a central role in how we die can be the final act of self-caring we do, a final closing of life's circle.

Control Your Physical Condition

It is very important that as much as possible, your physical needs — to be free of pain, to be relatively comfortable, to be in an environment (at home or elsewhere) that is right for you — are managed well. This is the time to work closely with your health care team and family or friends caring for you to make a plan to control your symptoms and see that you are as comfortable and pain-free as possible.

Don't accept anyone telling you that "nothing more can be done" to ease pain and other symptoms. Management of pain can be done very, very well — and if your health care provider isn't doing this, then it is time for you (or your family caregivers) to insist that other experts be consulted to help you. No one should die in pain. It is simply not necessary. While it may not be possible to feel really well as your physical condition continues to decline, neither is it necessary to suffer.

Take the help. As much as possible, it's good to let others help and support you — even in intimate and personal ways — including your health care team, family and friends. This is difficult for many people, especially those who have been strong, well and independent for many years. Many are used to giving the care, not receiving it — and making this transition can be difficult. One way to approach letting others care for you, especially family and friends, is that your acceptance gives them an opportunity to show their love for you. Throughout your illness, it's likely that many people have offered to help, without quite knowing how. Now, you and your closest caregivers can put those willing hearts and hands to work — to help not only you, but those who provide your daily care.

Grieve Your Losses

While not everyone facing the end of life may feel a sense of grief and loss at having to leave the world, most people do grieve at this time. Even if we have a belief in a happy afterlife, as many people do, we can still feel sad, mourning the days we will not have, the loved ones we must leave, the earth's beauty, and much more. Some are also sad about what has happened to their bodies — mourning gradual loss of function and control.

It's likely that you are already well-acquainted with grief. When you received your diagnosis, you probably felt some of the emotions most associated with grief — anger, loneliness, despair, fear, a sense of being overwhelmed and lost. Some of these feelings may be with you now, and perhaps more painful than ever.

If possible, don't withdraw from the world. If you become severely depressed and withdrawn, or overcome with anxiety, enjoying nothing about life, seek and get help for depression from your health care team. Help is available for depression and anxiety, and there is no reason to spend your final days in emotional pain. For more information, see the sections on Depression and Anxiety.

People who are expert in helping to ease grief say that one of the best ways to help yourself is to do what you can do for yourself, while you live. Completing some of the tasks that we need and want to do, if possible, at the end of life can help bring meaning and richness to our final days.

Find Reconciliation

If there are relationships in your life that cause pain — if there are words left unsaid to another, an apology not made, for example — you may feel deeply troubled and burdened by this. If possible, consider reaching out to bridge these damaged relationships, to say what must be said, and to heal old wounds.

Of course this may not always work. In some cases, people may not respond positively, despite best efforts. Nonetheless, comfort can come from knowing that you have done what you can to heal the relationship, or make the apology.

Sometimes you may not be able to reach people you want to find. They may be dead, or unreachable for many reasons. In instances like these, have a quiet conversation with yourself or someone close to you and talk about what is wrong and how you wish you could have healed the problem. This may help ease your sense of regret.

One of the hardest lessons of illness that many learn is that some people you thought would be there to help and comfort you have, instead, disappeared from your life. This is very painful, and it is not much comfort to know that almost everyone facing serious illness has had a similar experience. This loss can add to your grief at the end of life — and if you can, decide to let this particular sadness go. These individuals fled from what they could not face (yet someday must), and there is nothing you can do about this except to forgive it, and move past it within yourself.

Easing Your Spirit

An individual's spiritual journey can take many forms and go in many directions. For some, organized religious faith is a central part of the spirit and values that shape them. If this is important to you, make full use of the spiritual comfort of your faith.

For others, contemplation of art and music or nature brings them close to their spiritual center. Often finding one's spiritual core has to do with achieving a sense of place in the universe, of oneness with the pulse and the wheel of life, where we are born, and live, and then pass on as the next generation takes it place. Being "spiritual" does not necessarily mean being "religious" in the conventional sense — although these feelings often coexist in each of us. Every day if possible, spend some time pursuing whatever activity that is meaningful to you to help you find peace.

Speak of Your Love

For some people this may not be necessary — but for many others who do not routinely tell those closest to them how much love and caring they feel, it is time to make some effort to do this. You may think, "Oh, they know I love them" — but somehow nothing can replace actually saying the words, from the heart. It has been said that "thank you" and "I love you" are the most treasured words in the world, in every language.

Enjoy the World Around You

People facing death have often said that the natural world can seem even more beautiful and intense at this time. If possible, go outside, even if only for a short time, and enjoy nature's beauty. And, of course, there is also beauty to be found around you, inside — in the smile of your favorite person, the light coming in the window, the sound of birds in the morning. It's good to treasure the smiles, the sounds of nature and the light of the many days you have had, with joy and pleasure.

Keep an Active Mind

If possible, find ways to stimulate your mind. There are many methods — reading, listening to books on tape, listening to music, watching videos, chatting with others in person, on the telephone, and on the computer, to name a few.

Work? If your work is something that means a great deal to you, and if you are able to work, there is no reason to walk away until you feel it is time to do so. For some people, work may form the center of life, and leaving this core element in life before it is necessary is not useful. Your heart and your health will guide you in making this decision.

An organized life. Some people use some of the time they have at the end of life making sure that their personal matters, such as bills, insurance information, estate information and so forth are all organized and available to survivors who will need them. This process may include:

• creating or updating your will or living trust;
  
  
• preparing and signing an advance directive (see Making Decisions for more information) that includes both a living will (directions to your health care providers) and a durable power of attorney (naming a person to make health care decisions for you if you are unable to do so)
  
  
• making sure your next of kin can access safety deposit boxes, find titles to property, investment papers and materials, and so forth
  
  
• explaining your insurances — health and life — and providing materials about these
  
  
• information for your obituary (see In Remembrance for more information)

In general, it can be helpful to work with an attorney in gathering the materials your survivors will need, and to assist you in setting in place your final wishes and the documents to ensure that those wishes are carried out.

The life review. For many people, especially if there are children or much-loved others, there is a passionate desire to leave behind evidence that we have lived, that we have been part of the world, and that our lives mattered. Conducting what is often called a "life review" or "personal history" can fill this need — and leave something priceless behind for your family.

Life reviews can be done in any way that suits you best and fits with your abilities. For some people, writing an autobiography in a journal is a good approach. If you are not able to write or don't enjoy that, consider talking into a portable tape recorder, using as many tapes as you need to tell about your life. Another approach is to have a friend or family member videotape you talking about your life, probably holding multiple sessions to capture everything. And still another approach is simply to talk to someone you love and trust, while that person takes notes. What's important here is that you choose the approach that feels comfortable for you.

Life reviews are more than just a record of your life's events, but also a record of the soul of a living, breathing person — what you loved, what was important to you, the events that shaped your life, what you accomplished, and perhaps what was not accomplished.

Memories of a lifetime. The life review, in addition to creating something of enormous value for your loved ones, also is a gift to yourself. As you write or talk about your life, you'll find yourself reliving many experiences, good and bad — and through your laughter and your tears, gain a sense of the richness of life and all that you have experienced, even if you are relatively young. Most of us don't reflect back on our past lives very much while we are busy living on a day-to-day basis. This is a time to pause and think and remember, and to celebrate your accomplishments, the love you have given and received, the losses and gains — a real life, lived by a real person.

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