Perhaps you’ve noticed that what matters most can change as we age. As my circumstances change; so too my perspective, and what I hold most dear. For example, staying up late to watch TV is less satisfying than it used to be. Instead, waking at dawn to peace and quiet, has become one of life’s great pleasures. I’m sure that you have your own points of reference.

The Law of Impermanence

Working at the hospital, my health and well-being, and contact with family and friends, deeply influence what’s important to me. Good health, mobility, active relationships, feeling safe and secure – create a variety of options, and a diverse ‘menu’ of activities to choose from. Remove any of these pillars, and all is subject to change. With good fortune, the changes are gradual. With misfortune, my options can change in a heartbeat. Most of us get lulled into thinking that our good fortune will last indefinitely. The law of impermanence says otherwise.

The Courage to Look Ahead and Talk About It

Those of us who work in healthcare know all too well how quickly one’s fortunes can change. One bad fall, one ‘small’ breast lump, and everything shifts. On a moment’s notice, our world can get much smaller, and our options painfully fewer. To look ahead and consider such a time takes courage. Yet it turns out to be a wise approach, and good medicine to think ahead and imagine what would be most important if my options become more limited than they are today. To consider this is one thing, to talk about it is another.

Being Mortal

In his landmark bestseller, Being Mortal, Dr. Atul Gawande poignantly captured the trajectory of his father’s terminal illness and end of life. Most instructive was his father’s shifting definition of “what’s important,” and the father’s rapport with his loving family. In the face of increasing pain and uncertainty, Dr. Gawande, Sr., made it clear to his family that he would endure any life-prolonging treatment, so long as he could still eat chocolate ice cream while watching his favorite sports team on TV. His message was clear, and his family obliged.

Planning’s Good, Yet Plan to Adjust Course in Real Time

Several studies and recent debate have brought the value of Advance Care Planning into question. Consensus has it that ‘checking the boxes’ in an Advance Directive, while in good health, and then filing the document away to be done with it, can create a false sense of security.

Instead, a newer paradigm suggests the value of routine conversations with loved ones about our values, goals and preferences surrounding serious illness. The trust and understanding that naturally develops during these conversations is decidedly more useful when it comes to making shared decisions about treatment options in real time. While it’s okay to plan, it’s very difficult to anticipate and prepare for all possible scenarios surrounding serious illness. Ultimately, given ample discussion, I trust myself, my healthcare agent, and my doctors to make joint decisions that most faithfully represent my values and preferences.

Choosing Quality of Life

At each stage of life, let alone during advanced illness, if I can remember to ask, “what’s most important right now?” – then I have a chance to identify what might be of true support, while maintaining a say. While the particulars are bound to change with age and declining health, asking the question remains of the utmost importance. Why? Because for many of us – to maintain a semblance of control and autonomy, speaks of dignity, and quality of life.

Palliative Care, Advance Care Planning, and Serious Illness Communication are each designed to identify and foster quality of life – unique as each of our definitions of that might be. The more we’re willing to talk about what matters to us – our hopes, fears, and preferences, the more likely that our lives – and our care – will reflect our wishes.

Let The Conversation Begin

We’re each up against one of our culture’s most self-defeating taboos: discussing end of life. It’s time to change that – by courageously thinking about it, then initiating The Conversation.

Start wherever you are. Hopefully you have enough time to proceed gradually. Take it one step at a time. You’re already underway.

Before talking to anyone, gather your thoughts, perhaps by writing down what you’re hoping to ask or convey.

There’s no right way to start The Conversation. Hopefully it will unfold naturally, perhaps even humorously. Please trust yourself, and the people that you’ll be talking with. It’s all about what works best for you.

Knowing your health, think about certain situations that could arise regarding advanced illness. Be willing to discuss these situations, and any related fears or concerns.

You don’t have to cover everything in the first conversation. It’s a process that hopefully leads to choosing a healthcare agent and developing a clear understanding with them of what’s important to you.

Try finishing this sentence: “What’s important to me through the end of my life is…” Be prepared to share this in conversation.

Remember that nothing you say, or even write down, is permanent. You can change your mind as need be.

Once you start The Conversation, as uncomfortable as it may be, I encourage you to keep talking until it becomes more comfortable, maybe even routine. The more willing you are to talk, the better your family and friends will understand what matters to you.

If you meet resistance, such as, “please don’t talk about such things…” – ask about the person’s reservations. Try and reassure them and explain why this is important to you. It may be hard going at first but let me tell you – so worth it in the long run!

A Medical Advice Disclaimer 

The content of this blog is for informational and educational purposes only. No aspect of its contents is intended to substitute for professional medical advice, consultation, diagnosis, or treatment. The author is a spiritual care provider, not a doctor. Always seek the advice of your physician or other qualified health care provider with questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it based on something you have read here.

Next Post: Learning More About Serious Illness Communiucation

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Until next time, ‘Safe Journeys,

DSW

* My sincere gratitude to The Conversation Project for it’s inspiration and guidance.