Donna Smith, MD, is Executive Medical Director and Associate Chief Medical Officer, Virginia Mason Franciscan Health and Chair of Honoring Choices Pacific Northwest’s Advisory Council.

Did you have a chance to see one of the adaptations of Honoring Choices Honoring Choices PNW produced for National Healthcare Decisions Day? The play by Elizabeth Coplan was fabulous and it was easy to empathize with all of the roles in the play!  Each character is consumed with their immediate processing of the life limiting diagnosis.  In those situations, there is so much to process, it can be overwhelming for everyone involved.  

Over the years, I have had guided conversations with the people I love – and they have been wonderful and foundational for what’s to come. I have been especially grateful for having initial conversations prior to any specific concerns or life events; when a life limiting diagnosis has arrived, we have already opened the door about values, preferences and tradeoffs.  We were continuing a conversation rather than starting anew. I think of the initial conversation with a once brilliant family member and how it served as much appreciated groundwork for follow up conversations, particularly when progressive cognitive decline prevented abstract thinking.  

 Having a record of a previous conversation is a gift, a starting point to be considered in a new context when unanticipated serious illness happens. So that instead of feeling overwhelmed, individuals and their loved ones can move on to the next act – whatever that may be.