Receiving a terminal diagnosis is one of life’s most profoundly difficult moments — a collision of disbelief, fear, and uncertainty. With some diseases, there’s a glimmer of hope for a miracle; with others, the focus shifts to navigating the process ahead.

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When Rita Hunter first asked to meet with me, I had no idea she had been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease. As we settled into my office, she got straight to the point: “I want you to help me with this last part of my life.” I left our first session rattled, but we established a clear understanding over time.

 

She needed someone with whom she could be brutally honest — someone to discuss, without judgment, what she was willing and unwilling to endure.

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In our early sessions, we discussed how ALS was slowly taking over her body. I explained that she and her family were experiencing anticipatory grief — Rita was grieving the loss of her physical abilities, and her family was adjusting to the reality of her eventual death. She was extremely close to her daughter. She worried deeply that the caregiving would disrupt Christy’s life but eventually accepted it as an expression of their profound love.

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Intentionality defined Rita’s life, and she wanted to bring that same clarity to her death. She and I kept a journal listing her “non-negotiables” — the conditions under which she would feel ready to let go. These became a guide we revisited as her health declined. Together, we worked to craft a path that gave meaning to her final chapter. She said,

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“When I am no longer giving back to the world in some way, it is time for me to go.”

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One of the first significant changes was the loss of her hands as her fingers curled inward. To help her navigate this, I introduced her to a visualization exercise I call the treehouse.

 

Imagine yourself in your favorite place — a space of peace. Picture a treehouse nestled in a strong, beautiful tree. As you climb into it, notice how comfortable and safe you feel. Looking out through the branches, you can see yourself below — living with your illness, your grief, your longing for things to be different. Observe this version of yourself. Notice her struggles and pain. Can you find compassion for her? Ask her what she needs most right now. What would support look and feel like? Who could help her? Now, see if you can offer that support.

The treehouse helped Rita observe her emotions — her fear, grief, and resilience — without being consumed by them. It was a tool for processing her anticipatory grief.

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She also managed her grief by being proactive and preparing herself and her loved ones for her transition. This meant sharing stories, writing letters to her family to be delivered after her death, and clearly communicating the legacy she wanted to leave. For example, her love of travel inspired her to leave a legacy for her granddaughter, Clementine, hoping she would one day explore the world as she had.

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Rita’s story was one of courage, vulnerability, and intentionality — a reminder of the strength in embracing life, even as it draws close.

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In her final days, her body let her know when it was time, and she showed extraordinary grace. She was a gift to this community, and she was a gift to me. She taught me more than I could ever give to her. Rita had become a model of how to live fully, even in the face of an unchangeable reality. Her acceptance of her journey allowed her to focus on the things that mattered most: her family, her values, and her enduring legacy.

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Allison Daily is the Executive Director and Head Grief Counselor of Pathfinders.