We lose our words and thoughts when a doctor says those five words. Sometimes my clients look at their laps while all I hear is the fluorescent light humming overhead. We glance over at each other and take deep breaths.
For most people, “Get your affairs in order” means there isn’t much time left, and there are so many things we have to do while we still can. It’s a phrase doctors use because they can’t spell out a prognosis in blunt numbers, even though some may try. Nevertheless, this directive leaves most of us feeling lost in a fog, unsure what “affairs” or “in order” even means.
Who thinks clearly in the moments right after we’re told that we’re dying? Or a loved one is terminally ill? Acute stress floods our bodies with adrenaline, mixes in cortisol, and narrows our attention. All this inner chaos disrupts our memories and makes it hard for us to process new information.
Clients call me looking for answers and understanding. They describe hearing a doctor’s voice as if underwater. Some can’t even remember what was said during the appointment, even though it occurred earlier that very day.
Yet, those doctors delivered the most complicated advice of a person’s life.
It’s a mismatch that no one can really solve. The doctor isn’t wrong. Time is short, and death-related paperwork takes forever, but careseekers are in no state to tackle a to-do list.
The first thing I tell them is that their numbed reaction is normal. It doesn’t mean they’re in denial. Their nervous system is doing what nervous systems do. They must give themselves some grace and time to absorb this new reality. They may need to ask the doctor to repeat things, and it’s helpful to bring someone who can write everything down.
Then we can get started.
If you’ve been following along with my 2026 Monthly Guide to Dying Well, you know that we’re entering August and it’s time to get our affairs in order. I’m pleased to report that most of our to-do items can be to-done way before a diagnosis.
Here are a few categories that “affairs” usually falls into:
Legal documents. A will, if you don’t have one, determines who inherits property and, if there are children involved, who cares for them. A durable power of attorney is someone to make financial decisions if/when you are unable to. A healthcare proxy or medical power of attorney is someone to make medical decisions on your behalf.
Medical wishes. An advance directive spells out what kind of care you want or don’t want (resuscitation, ventilators, feeding tubes, etc.) if you can’t speak for yourself. Loved ones acting as proxies or POAs are often left guessing at the worst possible moment, and clear documentation spares them that particular agony.
Financial housekeeping. Bank accounts, insurance policies, retirement accounts, and property titles are often easier to manage, and less painful for survivors to untangle, when we update beneficiaries and grant them access to our accounts.
Personal wishes. Talk to loved ones, repair relationships, make funeral plans, and write letters to people who matter.
I will be publishing my “checklist for the dying” for more specific to-do items in a few weeks, so look for that here on Substack.
Even when my clients feel prepared, being told to get their affairs in order still comes as a shock. I’m sure it will happen to me, too, despite my working in this realm every day. Therefore, the most useful first step for all of us is to consider what our dying checklist might look like, write it down, and start to check items off of it now.
For those who’ve been diagnosed with a terminal illness, find one trusted individual (a spouse, adult child, close friend, or a social worker/hospital patient navigator/death doula) to manage the list while your own capacity is compromised.
From there, a workable order looks something like this:
Name a healthcare decision-maker. This prevents the most painful kind of confusion for family members later, and most hospitals can provide needed forms on the spot.
Write down medical wishes, even informally at first. A handwritten note about what matters to you (comfort over aggressive treatment, or the reverse) is better than nothing and can be formalized later.
Locate existing documents. Insurance policies, deeds, account numbers, etc. - find them before trying to create new ones. Many “affairs” are already in order and just need to be gathered.
Contact an estate attorney or use a reputable online template for a basic will if you don’t have one. Many states have free or low-cost legal aid for this specifically.
Say the things that need saying. This has no template and there’s no wrong way to do it.
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Hospital social workers, hospice care teams, death doulas, and patient navigators exist to help with this transition. Contacting them isn’t jumping the gun; it’s one of the most practical things you can do. Nobody expects this list to be finished right away.
When a doctor tells us to “get our affairs in order,” it sounds like a direction, but it’s really an invitation. We just have to ask for support and let others carry some of the weight while our own mind catches up.
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