BJ Miller: What really matters at the end of life
بي جاي ميلر: مايهم حقاً في نهاية الحياة
Using empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death. Full bio
Double-click the English transcript below to play the video.
were horsing around,
a parked commuter train.
with the wires that run overhead.
like a great idea at the time.
في تلك اللحظة
and that was that.
with death -- my death --
-- موتي--
my long run as a patient.
of dysfunction --
a hospice and palliative medicine doc,
who goes into healthcare
are also unwitting agents
وكلاء من غير قصد
does not serve.
answer to that question,
with diseases, not people, at its center.
لا للأشخاص, في أساسه
it was badly designed.
of bad design more heartbreaking
تكون أكثر مأساوية
for good design more compelling
أكثر إلزاماً
and concentrated.
to reach out across disciplines
into this big conversation.
الحوار الكبير
opportunity in front of us,
about death isn't being dead,
في الموت ليس أن يكونوا ميتين
it can be very helpful
سيكون مفيد جداً
which is necessary as it is,
essential part of life, part of the deal,
, جزء من الصفقة
to make space, adjust, grow.
تكيف, نضج
to realize forces larger than ourselves.
became fact, fixed --
ثابتة
reject this fact than reject myself.
أن أرفض نفسي
but I learned it eventually.
لكن تعلمته بالنهاية
about necessary suffering
is where healing happens.
as we learned yesterday --
on the other hand,
is unnecessary, invented.
since this brand of suffering is made up,
هذا النوع من المعاناة مُختلق
something we can affect.
نستطيع التأثير فيه
to this fundamental distinction
الإختلال الأساسي
and unnecessary suffering
design cues for the day.
لهذا اليوم
as people who care,
يكترثون
not add to the pile.
of a reflective advocate,
important field but poorly understood --
مجال مهم لكن يُساء فهمه
limited to end of life care.
نهاية الحياة
and living well at any stage.
في أي مرحلة
have to be dying anytime soon
on top of long-standing HIV.
إضافة إلى فيروس العوز المناعي البشري
out loud together about his life --
سوية حول حياته
his losses as they roll in,
عندما تصل إليه
the next moment.
but regret, quite another.
out of a Norman Rockwell painting --
when he came into clinic one day,
العيادة في يوم
down the Colorado River.
كولورادو
and his health, some would say no.
البعض سيقول لا
while he still could.
لايزال بإمكانه
scorpions, snakes,
عقارب , أفاعي
of the Grand Canyon --
غراند كانيون
beyond our control.
خارج سيطرتنا
so many of us would make,
معظمنا
what is best for ourselves over time.
مع مرور الوقت
is a shift in perspective.
في المنظور
when I went back to college,
I'd learn something about how to see --
كيف أرى
for a kid who couldn't change
التغيير
we humans get to play with,
نستطيع أن نلعب فيها
at an amazing place in San Francisco
في مكان رائع في سان فرانسيسكو
that helps with this shift in perspective.
تساعد في تغيير المنظور
wheeling the body out through the garden,
الجثة مروراً بالحديقة
nurses, volunteers,
المتطوعين
with flower petals.
to usher in grief with warmth,
in the hospital setting,
في المستشفيات
lined with tubes and beeping machines
والآت تصدر صفيراً
even when the patient's life has.
حياة المريض توقفت
the body's whisked away,
had never really existed.
in the name of sterility,
within those walls is numbness --
التخدر
the opposite of aesthetic.
I am alive because of them.
حي بسببهم
and treatable illness.
القابلة للعلاج
that's not what they were designed for.
ليس لهذا الأمر صممت
giving up on the notion
can become more humane.
in Livingston, New Jersey,
, نيوجرسي
great care at every turn,
palliative care for my pain.
بالخارج
complaining about driving through it.
coming down all sticky.
smuggled in a snowball for me.
كرة ثلج لي
holding that in my hand,
حاملاً إياها في يدي
onto my burning skin;
and turn into water.
إلى ماء
in this universe mattered more to me
كان أهم لدي
all the inspiration I needed
كل الألهام الذي أحتجته
and be OK if I did not.
أن لم أكن
I've known many people
الكثيرين
مستعدين للموت
some final peace or transcendence,
by what their lives had become --
living with chronic and terminal illness,
مزمنة وعضال
or prepared for this silver tsunami.
لهذا التسونامي الفضي
dynamic enough to handle
تكفي للتعامل مع
something new, something vital.
شيء حيوي
for designers of all stripes to work with.
الشرائح للعمل معها
who are closer to death:
and unburdening to those they love;
على من يحبون
of wonderment and spirituality.
from our residents in subtle detail.
one day to the next due to ALS.
التصلب الجانبي الضموري
while she has them.
في حين أنها لازالت تملكهم
at the foot of her bed,
على السرير
coursing through her veins --
أوردتها
where in a moment, in an instant,
في لحظة
loving our time by way of the senses,
الحواس
doing the living and the dying.
أننا نعيش ونموت
is our kitchen,
أنها المطبخ
can eat very little, if anything at all.
لاشيء على الأطلاق
sustenance on several levels:
على عدة مستويات:
happening under our roof,
الثقيلة تحت سقفنا
interventions we know of,
التي عرفنا بها,
the possibility of accessing
living and dying with dementia.
بالخرف
the things we don't have words for,
التي لانجد الكلمات لها
of the system was our first design cue,
من النظام كان بسبب أول إشارة للتصميم
by way of the senses,
the aesthetic realm --
and final bit for today;
لهذا اليوم
to set our sights on well-being,
نصب أعيننا الرخاء
more wonderful,
or human-centered model of care,
محوره البشر
becomes a creative, generative,
وتوليدي
highest forms of adaptation.
التكيف
it takes to be human.
حتى نكون بشر
has given rise to architecture.
is a necessary part of life,
we take a light approach to dying
تأخذ الطريقة الألطف للموت
any particular way of dying.
that cannot move,
we will all kneel there.
to play itself all the way out --
أن تمضي
getting out of the way,
أن تبتعد عن الطريق
a process of crescendo through to the end.
حتى النهاية
one way or another.
around this fact,
a shock of beauty or meaning
أو المعنى
for a perfect moment,
ABOUT THE SPEAKER
BJ Miller - Palliative care physicianUsing empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death.
Why you should listen
Palliative care specialist BJ Miller helps patients face their own deaths realistically, comfortably, and on their own terms. Miller is cultivating a model for palliative care organizations around the world, and emphasizing healthcare’s quixotic relationship to the inevitability of death. He is a hospice and palliative medicine physician and sees patients and families at the UCSF Helen Diller Family Comprehensive Cancer Center.
Miller’s passion for palliative care stems from personal experience -- a shock sustained while a Princeton undergraduate cost him three limbs and nearly killed him. But his experiences form the foundation of a hard-won empathy for patients who are running out of time.
BJ Miller | Speaker | TED.com