Have you had “The Conversation”? Don’t wait until you have a grave diagnosis.

600x340-Advance Health Care Directive - istock.png


I first had the conversation more than 20 years ago.

It happened around my grandparents’ kitchen table, where my grandfather had assembled his wife, his three grown children and me, one of his grandchildren. I was a 36-year-old registered nurse, working in cancer care and hospice, at the time. He specifically asked me to come to this family meeting, though I did not know why.

Papa had just been diagnosed with Lou Gehrig’s disease. The patriarch of our family, he was a World War II veteran who had worked for 30 years as an orderly at a local veteran’s hospital and enjoyed puttering around his house on a lake. Just 10 years into his retirement, at the age of 75, he began noticing weakness in his legs, which he initially had chalked up to getting older, until he saw a doctor.

We were all devastated by his diagnosis, and scrambling for answers.

That day, Papa was brave enough and wise enough to have the conversation. He had helped to take care of others with Lou Gehrig’s disease and he knew what the future held for him with the disease, also known as amyotrophic lateral sclerosis (ALS). Gradually and progressively, he would lose his strength and the ability to speak, eat, move and even breathe.

I remember clearly that he looked directly at me across the table, as he began telling us what he wanted and did not want in the weeks and months ahead.

He did not want to prolong the inevitable. He did not want a feeding tube. He did not want resuscitation.

What he did want was for us to keep him comfortable and to support my grandmother through the next months, and afterward.

Papa died peacefully three months later, in his own bed, surrounded by his family. The conversation was a gift he gave us that helped us through those challenging, final days.
Throughout my nursing career, I have been a strong advocate for honesty and accepting the reality of life. I know now my grandfather included me in the conversation around the kitchen table, because he knew he could trust me to respect his wishes and help those in the family who might have hesitated.

Through my work in hospice, cancer care and nursing since that time, I have witnessed many families who have had the conversation and many who have not. From my personal and professional experiences, I can assure you that having the conversation results in a much more peaceful experience for everyone.

Have you had the conversation? You don’t have to wait until you are facing a grave diagnosis to do it.

Talking about your end-of-life wishes openly with family and those you trust is the focus of Horizon Planning, WellSpan’s way of initiating and documenting advance care planning.  It gives you a voice in your healthcare decision making, and relieves the stress for your family when difficult decisions need to be made at unfortunate times.

Horizon Planning seeks to promote a culture for open conversations about death, making your wishes known, respected and honored so you may live and die with dignity. I urge you to have the conversation, through a Horizon Planning session with your loved ones, to make your wishes known.

We can help you start the process. Go online to WellSpan.org/HorizonPlanning to find a conversation starter kit, a Five Wishes Booklet, a living will and other resources.
Follow Papa’s example.

Give your family the gift of the conversation. You won’t regret it.


Kelly Smith is senior director of nursing services for WellSpan Health.