You may find this chapter helpful if you recognize yourself (or someone you care for) in some of these statements:

• A doctor says you have a “serious” or terminal illness. This includes cancers that have reached stage four, meaning they’ve spread.

• An organ vital to sustaining life—your heart, brain, kidneys, lungs, or liver—is slowly failing.

• You are in the early stages of an incurable disease that worsens over time, such as amyotrophic lateral sclerosis (Lou Gehrig’s disease, or ALS).

• Doctors refuse to discuss your prognosis, or say your disease has a poor or dire prognosis. (Prognosis just means a forecast of your health prospects, but in medicine it’s often a euphemism for “You are approaching the end of your life.”)

• Your doctors use terms like chronic, progressive, serious, advanced, late stage or end stage. (They mean incurable, worsening, worse yet, and approaching the end of life.)

• Doctors want to discuss goals of care. (This is medical shorthand for exploring what matters most to you, and how medicine can help you accomplish it, when time is short and cure is not in the cards.)

• You have a gut sense that following this medical appointment, your life will be forever divided into before and after.