The crucial conversation: simple paperwork prevents guesswork when the unthinkable happens.

• Author: Rogers, Melinda
• Position: TIMEOUT FOR HEALTH

David Entwistle was only 38 the day he unexpectedly traded his role in the boardroom as CEO of University of Utah Hospitals and Clinics for that of patient in the Neuro Intensive Care Unit, after a catastrophic bike accident in 2009 left him with a traumatic brain injury.

Entwistle, nearing the end of the course at the Stansbury Park triathlon, flew off his bike as he sped along at 23 MPH, crashing to the ground for reasons he still can't remember. What he does recall is waking up at University Hospital in Salt Lake City and the road to rehabilitation, which included having a neurosurgeon place a temporary stent in his skull to relieve the pressure of brain swelling. He initially spent a week in an intensive care unit.

Entwistle's story has a happy ending: He recovered without any permanent problems related to speech, physical ability, and memory. But he knows his journey could have just as easily taken a different direction, which is one reason why Entwistle today encourages others to fill out an advanced directive with loved ones who might be left guessing when stressful end-of-life choices come suddenly.

An advance directive is a way to tell both family and health care providers your wishes if you can't make decisions yourself. It's important to make these wishes known while you're healthy and before a crisis, said Entwistle. Advance directives don't limit the quality of care, just the types of treatments you choose. There are three types: living wills, POLST forms (doctors' orders that transfer between treatment facilities), and Do Not Resuscitate (DNR) or Do Not Intubate (DNI) orders.

The subject can be uncomfortable. But as Entwistle learned, it's much better to have a difficult conversation than to leave a loved one wondering...