Jess demonstrated expertise and advocated for optimal patient care by speaking up to stop a plan that was in motion. An outpatient was referred to the Seattle ALS team as a specialty consultant by another ALS care team who had recommended several procedures and surgical interventions that would have led to permanent trach/vent status. Jess’s expertise, advocacy, and determination prevented this complex ALS patient from undergoing unnecessary surgery and subsequent impacts on his optimal participation and independence in daily life. Jess recommended specific non-surgical interventions, which were successful in addressing the concerns. He continues to participate in his daily activities with his family in his home, as he did before. I am so proud to work with Jess and others on this highly recognized ALS Center of Excellence at VAPSHCS.