At Thanksgiving this year, let’s talk about what matters

By Erik Fromme

For many, a conversation about what would matter most if they became seriously ill seems like an uncomfortable topic. And yet, now that Americans are more polarized than at any time since the Civil War era, now that serious illness is a daily news headline, and now that our need to feel close to each other has never been greater, that conversation might actually be the safest and most important way we can connect despite all our differences.

Perhaps more than any other day of the year, Thanksgiving is notorious for bringing these differences to light. There’s always someone whose political views raise eyebrows or who’s cheering for the wrong football team. For all of us, the last year and a half has forced us to reflect on what’s most important to us — to think about the big questions. Many have lost loved ones due to the COVID-19 pandemic and have had to make difficult decisions about their care that they weren’t prepared to make.

So, for those of us lucky enough to have people to share Thanksgiving Dinner with, let’s set our differences aside. Instead of fighting about politics, let’s ask the big questions about what matters to every person at your table. Let’s really listen to each other, so that if someone at the table this year became sick we would know what’s most important to them. We know now more than ever that our time together is more finite than we like to pretend.

Instead of small talk, try Big Talk. Ask each other, if you became seriously ill:

• What would your most important goals be?
• What would you worry about the most?
• What would you want to make sure the people around this table know?

That’s Big Talk, and for many, it’s not hypothetical. Over 12 million Americans are living with a serious, chronic illness. The reality is that those of us who do not die suddenly will personally face serious illness during our lifetimes. Increasingly, we can be seriously ill and still live for years. This is not a curse — it’s the price we pay for living longer than our ancestors did. Acknowledging it can feel heavy, but the benefit we get is that it is much harder to take each other (and ourselves) for granted.

For those currently living with a serious illness, The Conversation Project has teamed up with Ariadne Labs to create the What Matters to Me Workbook. It is filled with Big Talk Questions that take 30–60 minutes to fill out and serves as a powerful resource for living your best life, come what may. If you or one of your important people is living with a serious illness, print one out and go through it together.

Feeling motivated to try? Here are two important tips:

Number 1: Let people know ahead of time that you’d like Thanksgiving to include a conversation about What Matters Most to them.

One of my colleagues tried springing a conversation about end-of-life care on family, and it went over like a lead balloon. She thought she’d failed. But it turns out they went home and thought about it and next Thanksgiving, the conversation happened spontaneously. This is an opportunity, not an obligation.

Number 2: When people share what matters most to them, listen generously.

That means you just listen — you don’t need to add your 2 cents, and you definitely don’t need to set them straight. You are listening to know what is true for them at this time.

What a gift we can give each other if we just listen, and what a wonderful way to spend Thanksgiving together.

Erik Fromme, MD, MCR was born and raised in Stillwater, Oklahoma. Dr. Fromme is a Palliative Care Physician at Dana-Farber Cancer Institute and a Senior Scientist at Ariadne Labs, a joint center of health systems innovation at Brigham & Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts.