TED2015
BJ Miller: What really matters at the end of life
BJ Miller: Što je na koncu života zaista najbitnije?
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Što najviše želimo na koncu naših života? Mnogi žele tek ugodu, poštovanje, ljubav. BJ Miller liječnik je u klinici za palijativnu njegu koji duboko promišlja o tome kako svojim pacijentima priuštiti dostojanstven, skladan kraj života. Dajte si vremena da uživate u ovom dirljivom govoru u kojem BJ Miller postavlja velika pitanja o tome kako gledamo na smrt i kako cijenimo život.
BJ Miller - Palliative care physician
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
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.
00:13
Well, we all need a reason to wake up.
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Svima nama potreban je razlog
da se ujutro ustanemo iz kreveta.
da se ujutro ustanemo iz kreveta.
00:18
For me, it just took 11,000 volts.
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Meni je za to trebalo samo 11 000 volti.
00:23
I know you're too polite to ask,
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Znam da ste prepristojni da pitate,
00:24
so I will tell you.
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pa ću vam reći.
00:27
One night, sophomore year of college,
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Jedne večeri na 2. godini faksa,
00:29
just back from Thanksgiving holiday,
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baš nakon praznika za Dan zahvalnosti,
00:33
a few of my friends and I
were horsing around,
were horsing around,
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nekolicina mojih prijatelja
i ja smo se budalesali
i ja smo se budalesali
00:35
and we decided to climb atop
a parked commuter train.
a parked commuter train.
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i odlučili se popeti
na parkirani putnički vlak.
na parkirani putnički vlak.
00:40
It was just sitting there,
with the wires that run overhead.
with the wires that run overhead.
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Samo je stajao tamo,
žice su bile na krovu.
žice su bile na krovu.
00:43
Somehow, that seemed
like a great idea at the time.
like a great idea at the time.
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Tada se to nekako činilo
kao izvrsna ideja.
kao izvrsna ideja.
00:46
We'd certainly done stupider things.
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Radili smo i glupljih stvari.
00:50
I scurried up the ladder on the back,
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Popeo sam se na stražnje ljestve
00:53
and when I stood up,
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i kad sam ustao,
00:55
the electrical current entered my arm,
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struja mi je ušla kroz ruku,
00:58
blew down and out my feet,
and that was that.
and that was that.
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pošla prema dolje i prema
stopalima i to je bilo to.
stopalima i to je bilo to.
01:03
Would you believe that watch still works?
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Možete li vjerovati
da taj sat još uvijek radi?
da taj sat još uvijek radi?
01:08
Takes a licking!
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Svašta je prošao.
01:09
(Laughter)
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(Smijeh)
01:10
My father wears it now in solidarity.
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Sad ga moj otac nosi iz solidarnosti.
01:15
That night began my formal relationship
with death -- my death --
with death -- my death --
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Ta je večer započela moju formalnu vezu
sa smrti - s mojom smrti -
sa smrti - s mojom smrti -
01:21
and it also began
my long run as a patient.
my long run as a patient.
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a započela je i moju
dugoročnu karijeru pacijenta.
dugoročnu karijeru pacijenta.
01:25
It's a good word.
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Dobra je to riječ.
01:26
It means one who suffers.
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Znači "onaj koji pati".
01:28
So I guess we're all patients.
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Svi smo mi pacijenti.
01:31
Now, the American health care system
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Američki zdravstveni sustav
01:33
has more than its fair share
of dysfunction --
of dysfunction --
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nefunkcionalan je
01:37
to match its brilliance, to be sure.
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koliko i briljantan.
01:39
I'm a physician now,
a hospice and palliative medicine doc,
a hospice and palliative medicine doc,
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Sad sam liječnik za palijativnu njegu
u staračkom domu,
u staračkom domu,
01:44
so I've seen care from both sides.
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pa sam vidio kako je
njegovati i biti njegovan.
njegovati i biti njegovan.
01:47
And believe me: almost everyone
who goes into healthcare
who goes into healthcare
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Vjerujte mi - gotovo svatko tko se odluči
na karijeru u zdravstvu
na karijeru u zdravstvu
01:50
really means well -- I mean, truly.
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ima najbolje namjere. Zaista ima,
01:54
But we who work in it
are also unwitting agents
are also unwitting agents
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ali svi mi koji u njemu
radimo smo i nesvjesni agenti
radimo smo i nesvjesni agenti
01:58
for a system that too often
does not serve.
does not serve.
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sustava koji nerijetko ne služi svrsi.
02:03
Why?
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Zašto?
02:05
Well, there's actually a pretty easy
answer to that question,
answer to that question,
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Odgovor na to pitanje
prilično je jednostavan
prilično je jednostavan
02:09
and it explains a lot:
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i puno toga objašnjava:
02:11
because healthcare was designed
with diseases, not people, at its center.
with diseases, not people, at its center.
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zdravstvo je dizajnirano imajući
u vidu bolesti, a ne ljude,
u vidu bolesti, a ne ljude,
02:18
Which is to say, of course,
it was badly designed.
it was badly designed.
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što, naravno, znači
da je loše dizajnirano.
da je loše dizajnirano.
02:22
And nowhere are the effects
of bad design more heartbreaking
of bad design more heartbreaking
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Posljedice lošeg dizajna
nigdje nisu toliko žalosne,
nigdje nisu toliko žalosne,
02:28
or the opportunity
for good design more compelling
for good design more compelling
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ili prilike za dobru zamišljenost
toliko stvarne,
toliko stvarne,
02:31
than at the end of life,
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kao na koncu života
02:33
where things are so distilled
and concentrated.
and concentrated.
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kad je sve toliko sažeto i koncentrirano.
02:38
There are no do-overs.
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Tu nema popravaka.
02:42
My purpose today is
to reach out across disciplines
to reach out across disciplines
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Moj današnji cilj je doprijeti
do različitih disciplina
do različitih disciplina
02:46
and invite design thinking
into this big conversation.
into this big conversation.
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i pozvati na razmišljanje o planiranju,
02:51
That is, to bring intention and creativity
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odnosno uvesti namjeru i kreativnost
02:56
to the experience of dying.
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u doživljaj umiranja.
03:01
We have a monumental
opportunity in front of us,
opportunity in front of us,
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Pred nama je monumentalna prilika,
03:05
before one of the few universal issues
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pred jednim od rijetkih
univerzalnih pitanja
univerzalnih pitanja
03:09
as individuals as well as a civil society:
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koja se tiču i pojedinaca,
a i civilnog društva:
a i civilnog društva:
03:12
to rethink and redesign how it is we die.
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ponovno razmisliti i redizajnirati
način na koji umiremo.
način na koji umiremo.
03:19
So let's begin at the end.
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Krenimo od kraja.
03:23
For most people, the scariest thing
about death isn't being dead,
about death isn't being dead,
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Kad govorimo o smrti, većini ljudi
najveći strah nije to što će biti mrtvi,
najveći strah nije to što će biti mrtvi,
03:27
it's dying, suffering.
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već samo umiranje, patnja.
03:29
It's a key distinction.
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To je glavna razlika.
03:32
To get underneath this,
it can be very helpful
it can be very helpful
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Kako bismo to razumjeli, nekad zna pomoći
03:34
to tease out suffering
which is necessary as it is,
which is necessary as it is,
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odvojiti patnju koja je ionako nužna
03:39
from suffering we can change.
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od patnje na koju možemo utjecati.
03:42
The former is a natural,
essential part of life, part of the deal,
essential part of life, part of the deal,
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Nužna patnja je prirodna,
prirodan dio života, dolazi u paketu,
prirodan dio života, dolazi u paketu,
03:47
and to this we are called
to make space, adjust, grow.
to make space, adjust, grow.
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na to se moramo priviknuti.
03:55
It can be really good
to realize forces larger than ourselves.
to realize forces larger than ourselves.
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Dobro je uvidjeti sile veće od nas samih
04:01
They bring proportionality,
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koje nam donose proporcionalnost,
04:04
like a cosmic right-sizing.
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poput kozmičkog smanjivanja ljudske snage.
04:08
After my limbs were gone,
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Kad su mi uklonili udove,
04:11
that loss, for example,
became fact, fixed --
became fact, fixed --
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taj je gubitak postao
činjeničan, fiksiran -
činjeničan, fiksiran -
04:15
necessarily part of my life,
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nužan dio mog života
04:19
and I learned that I could no more
reject this fact than reject myself.
reject this fact than reject myself.
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i shvatio sam da ne mogu odbacivati
tu činjenicu, kao ni sebe.
tu činjenicu, kao ni sebe.
04:27
It took me a while,
but I learned it eventually.
but I learned it eventually.
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Trebalo mi je vremena,
ali pomirio sam se s tim.
ali pomirio sam se s tim.
04:30
Now, another great thing
about necessary suffering
about necessary suffering
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Još jedna sjajna stvar
po pitanju nužne patnje
po pitanju nužne patnje
04:33
is that it is the very thing
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jest upravo ono
04:36
that unites caregiver and care receiver --
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što ujedinjuje pružatelja
i primatelja njege -
i primatelja njege -
04:41
human beings.
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ljudska bića.
04:45
This, we are finally realizing,
is where healing happens.
is where healing happens.
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Konačno uviđamo
da se tu odvija ozdravljenje.
da se tu odvija ozdravljenje.
04:49
Yes, compassion -- literally,
as we learned yesterday --
as we learned yesterday --
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Da, suosjećanje - kao što smo
doslovno jučer naučili -
doslovno jučer naučili -
04:53
suffering together.
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zajednička patnja.
04:56
Now, on the systems side,
on the other hand,
on the other hand,
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S druge strane, što se sustava tiče,
05:00
so much of the suffering
is unnecessary, invented.
is unnecessary, invented.
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puno je patnje bespotrebno, izmišljeno.
05:04
It serves no good purpose.
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Nema neku svrhu.
05:06
But the good news is,
since this brand of suffering is made up,
since this brand of suffering is made up,
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Dobra vijest glasi:
budući da je ova vrsta patnje izmišljena,
budući da je ova vrsta patnje izmišljena,
05:10
well, we can change it.
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možemo je promijeniti.
05:13
How we die is indeed
something we can affect.
something we can affect.
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Na to kako umiremo zaista možemo utjecati.
05:18
Making the system sensitive
to this fundamental distinction
to this fundamental distinction
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Osvješćivanje sustava
o ovoj ključnoj razlici
o ovoj ključnoj razlici
05:22
between necessary
and unnecessary suffering
and unnecessary suffering
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između nužne i bespotrebne patnje
05:25
gives us our first of three
design cues for the day.
design cues for the day.
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dobivamo prvi od triju dizajnerskih
tragova za danas.
tragova za danas.
05:30
After all, our role as caregivers,
as people who care,
as people who care,
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Ipak je naša uloga kao pružatelja skrbi,
kao ljudi koji brinu,
kao ljudi koji brinu,
05:34
is to relieve suffering --
not add to the pile.
not add to the pile.
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ublažiti patnju, a ne je
dodatno pogoršati.
dodatno pogoršati.
05:42
True to the tenets of palliative care,
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Prema stanarima staračkog doma,
05:44
I function as something
of a reflective advocate,
of a reflective advocate,
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ja sam nešto kao zagovornik refleksije,
05:47
as much as prescribing physician.
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kao i liječnik koji propisuje terapiju.
05:51
Quick aside: palliative care -- a very
important field but poorly understood --
important field but poorly understood --
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Kratka digresija - palijativna njega -
važno polje koje je slabo shvaćeno -
važno polje koje je slabo shvaćeno -
05:57
while it includes, it is not
limited to end of life care.
limited to end of life care.
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uključuje njegu na kraju života,
ali nije ograničeno na njega.
ali nije ograničeno na njega.
06:00
It is not limited to hospice.
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Nije ograničeno na hospicij,
06:02
It's simply about comfort
and living well at any stage.
and living well at any stage.
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već se tiče ugode i kvalitetnog
življenja u bilo kojoj fazi života.
življenja u bilo kojoj fazi života.
06:06
So please know that you don't
have to be dying anytime soon
have to be dying anytime soon
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Imajte na umu da se ne morate
opasno bližiti smrti
opasno bližiti smrti
06:10
to benefit from palliative care.
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da biste imali koristi
od palijativne njege.
od palijativne njege.
06:13
Now, let me introduce you to Frank.
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Upoznajte Franka.
06:17
Sort of makes this point.
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On to nekako i dokazuje.
06:19
I've been seeing Frank now for years.
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Viđam se s njim godinama.
06:21
He's living with advancing prostate cancer
on top of long-standing HIV.
on top of long-standing HIV.
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Živi s uznapredovanim rakom prostate,
kao i s dugogodišnjim virusom HIV.
kao i s dugogodišnjim virusom HIV.
06:26
We work on his bone pain and his fatigue,
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Radimo na njegovoj kostobolji i umoru,
06:28
but most of the time we spend thinking
out loud together about his life --
out loud together about his life --
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ali najviše vremena provodimo
razmišljajući naglas o njegovu životu -
razmišljajući naglas o njegovu životu -
06:32
really, about our lives.
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zapravo, o našim životima.
06:35
In this way, Frank grieves.
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Frank tako tuguje.
06:37
In this way, he keeps up with
his losses as they roll in,
his losses as they roll in,
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Tako prati svoje gubitke kako nadolaze,
06:41
so that he's ready to take in
the next moment.
the next moment.
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pa je spreman proživjeti
sljedeći trenutak.
sljedeći trenutak.
06:45
Loss is one thing,
but regret, quite another.
but regret, quite another.
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Gubitak je jedna stvar,
ali žaljenje je nešto sasvim drugo.
ali žaljenje je nešto sasvim drugo.
06:51
Frank has always been an adventurer --
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Frank je uvijek bio avanturist -
06:53
he looks like something
out of a Norman Rockwell painting --
out of a Norman Rockwell painting --
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izgleda kao da je iskočio sa slike
Normana Rockwella -
Normana Rockwella -
06:56
and no fan of regret.
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i nije ljubitelj žaljenja.
06:58
So it wasn't surprising
when he came into clinic one day,
when he came into clinic one day,
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Nije me iznenadilo kad mi je
jednog dana došao u kliniku
jednog dana došao u kliniku
07:01
saying he wanted to raft
down the Colorado River.
down the Colorado River.
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i rekao da želi ići na rafting
rijekom Colorado.
rijekom Colorado.
07:05
Was this a good idea?
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Je li to bila dobra ideja?
07:07
With all the risks to his safety
and his health, some would say no.
and his health, some would say no.
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Imajući na umu sve rizike po njegovu
sigurnost i zdravlje, neki bi rekli - ne.
sigurnost i zdravlje, neki bi rekli - ne.
07:11
Many did, but he went for it,
while he still could.
while he still could.
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Mnogi i jesu, ali odvažio se na to
dok je još mogao.
dok je još mogao.
07:15
It was a glorious, marvelous trip:
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Bio je to veličanstven, sjajan put:
07:20
freezing water, blistering dry heat,
scorpions, snakes,
scorpions, snakes,
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ledena voda, strašna vrućina,
škorpioni, zmije,
škorpioni, zmije,
07:26
wildlife howling off the flaming walls
of the Grand Canyon --
of the Grand Canyon --
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zavijanje divljih životinja širilo se
uzavrelim zidinama Grand Canyona -
uzavrelim zidinama Grand Canyona -
07:31
all the glorious side of the world
beyond our control.
beyond our control.
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sva veličanstvena strana svijeta
koja je izvan naše kontrole.
koja je izvan naše kontrole.
07:36
Frank's decision, while maybe dramatic,
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Iako je Frankova odluka
bila dramatična,
bila dramatična,
07:38
is exactly the kind
so many of us would make,
so many of us would make,
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to je i odluka na kakvu bi se
mnogi od nas odvažili
mnogi od nas odvažili
07:40
if we only had the support to figure out
what is best for ourselves over time.
what is best for ourselves over time.
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kad bi imali podršku osmisliti što je
za nas najbolje, dugoročno gledano.
za nas najbolje, dugoročno gledano.
07:49
So much of what we're talking about today
is a shift in perspective.
is a shift in perspective.
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Puno toga o čemu danas govorimo
tiče se promjene u perspektivi.
tiče se promjene u perspektivi.
07:54
After my accident,
when I went back to college,
when I went back to college,
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Nakon nesreće, vratio sam se na faks
07:56
I changed my major to art history.
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i promijenio glavni studij
u povijest umjetnosti.
u povijest umjetnosti.
08:00
Studying visual art, I figured
I'd learn something about how to see --
I'd learn something about how to see --
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Mislio sam da ću proučavajući
likovnu umjetnost naučiti kako vidjeti -
likovnu umjetnost naučiti kako vidjeti -
08:05
a really potent lesson
for a kid who couldn't change
for a kid who couldn't change
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bila je to moćna lekcija za mladića
koji nije mogao promijeniti
koji nije mogao promijeniti
08:09
so much of what he was seeing.
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puno opažanoga.
08:12
Perspective, that kind of alchemy
we humans get to play with,
we humans get to play with,
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Perspektiva, svojevrsna alkemija
kojom se mi ljudi igramo -
kojom se mi ljudi igramo -
08:16
turning anguish into a flower.
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pretvaramo muku u cvijet.
08:21
Flash forward: now I work
at an amazing place in San Francisco
at an amazing place in San Francisco
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Sad radim na krasnom mjestu
u San Francisku
u San Francisku
08:25
called the Zen Hospice Project,
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koji se zove Hospicijski projekt Zen
08:28
where we have a little ritual
that helps with this shift in perspective.
that helps with this shift in perspective.
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gdje imamo mali ritual koji pomaže
s ovim promjenama perspektive.
s ovim promjenama perspektive.
08:32
When one of our residents dies,
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Kad jedan od naših stanara umre,
08:35
the mortuary men come, and as we're
wheeling the body out through the garden,
wheeling the body out through the garden,
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dolaze mrtvozornici i vozimo
tijelo kroz vrt,
tijelo kroz vrt,
08:39
heading for the gate, we pause.
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idemo prema vratima i zastanemo.
08:42
Anyone who wants --
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Svatko tko želi -
08:44
fellow residents, family,
nurses, volunteers,
nurses, volunteers,
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drugi stanari, obitelj, sestre, volonteri,
08:46
the hearse drivers too, now --
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pa i vozači mrtvačkih kola -
08:49
shares a story or a song or silence,
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s ostalima podijeli priču,
pjesmu ili tišinu
pjesmu ili tišinu
08:53
as we sprinkle the body
with flower petals.
with flower petals.
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dok tijelo posipamo laticama cvijeća.
08:57
It takes a few minutes;
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Traje nekoliko minuta;
08:59
it's a sweet, simple parting image
to usher in grief with warmth,
to usher in grief with warmth,
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to je dražesna, jednostavna slika
kojom tugu pratimo toplinom,
kojom tugu pratimo toplinom,
09:04
rather than repugnance.
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a ne gađenjem.
09:08
Contrast that with the typical experience
in the hospital setting,
in the hospital setting,
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Usporedite to s uobičajenim
iskustvom u bolnici
iskustvom u bolnici
09:13
much like this -- floodlit room
lined with tubes and beeping machines
lined with tubes and beeping machines
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koje izgleda ovako nekako -
osvijetljena soba puna cijevi i aparata
osvijetljena soba puna cijevi i aparata
09:18
and blinking lights that don't stop
even when the patient's life has.
even when the patient's life has.
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i svjetla koja neprestano trepere,
pa čak i nakon smrti pacijenta.
pa čak i nakon smrti pacijenta.
09:23
Cleaning crew swoops in,
the body's whisked away,
the body's whisked away,
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Dolaze čistačice, tijelo
jurno odvoze iz prostorije
jurno odvoze iz prostorije
09:26
and it all feels as though that person
had never really existed.
had never really existed.
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i čini se kao da ta osoba
nikad nije ni postojala.
nikad nije ni postojala.
09:33
Well-intended, of course,
in the name of sterility,
in the name of sterility,
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Naravno, sve u najboljoj namjeri,
u ime sterilnosti,
u ime sterilnosti,
09:35
but hospitals tend to assault our senses,
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ali bolnice vrše udar na naša osjetila,
09:39
and the most we might hope for
within those walls is numbness --
within those walls is numbness --
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a najviše čemu se možemo nadati
unutar tih zidova jest otupjelost -
unutar tih zidova jest otupjelost -
09:44
anesthetic, literally
the opposite of aesthetic.
the opposite of aesthetic.
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anestetik - doslovno suprotnost estetici.
09:50
I revere hospitals for what they can do;
I am alive because of them.
I am alive because of them.
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Cijenim bolnice zbog svega što rade,
zbog njih sam danas živ,
zbog njih sam danas živ,
09:56
But we ask too much of our hospitals.
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ali previše tražimo od naših bolnica.
09:59
They are places for acute trauma
and treatable illness.
and treatable illness.
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To su mjesta za akutne traume
i izlječive bolesti.
i izlječive bolesti.
10:03
They are no place to live and die;
that's not what they were designed for.
that's not what they were designed for.
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To nisu mjesta za život i smrt;
nisu za to zamišljene.
nisu za to zamišljene.
10:10
Now mind you -- I am not
giving up on the notion
giving up on the notion
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Pazite, ne odričem se ideje
10:12
that our institutions
can become more humane.
can become more humane.
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da naše institucije mogu postati humanije.
10:16
Beauty can be found anywhere.
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Ljepotu možemo pronaći svugdje.
10:21
I spent a few months in a burn unit
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Nekoliko mjeseci proveo sam
na odjelu za opekotine
na odjelu za opekotine
10:23
at St. Barnabas Hospital
in Livingston, New Jersey,
in Livingston, New Jersey,
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u bolnici sv. Barnabe u Livingstonu,
New Jersey
New Jersey
10:26
where I got really
great care at every turn,
great care at every turn,
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gdje mi je pružana sjajna njega
na svakom koraku
na svakom koraku
10:30
including good
palliative care for my pain.
palliative care for my pain.
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uključujući i izvrsnu palijativnu njegu
za moje bolove.
za moje bolove.
10:33
And one night, it began to snow outside.
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Jedne je večeri počelo sniježiti.
10:37
I remember my nurses
complaining about driving through it.
complaining about driving through it.
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Sjećam se da su se sestre žalile
što moraju voziti kroz taj snijeg.
što moraju voziti kroz taj snijeg.
10:42
And there was no window in my room,
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U sobi nije bilo prozora,
10:44
but it was great to just imagine it
coming down all sticky.
coming down all sticky.
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ali bilo je zabavno zamišljati ga
kako pada.
kako pada.
10:49
Next day, one of my nurses
smuggled in a snowball for me.
smuggled in a snowball for me.
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Sljedećeg dana jedna od mojih sestara
prokrijumčarila mi je grudu snijega.
prokrijumčarila mi je grudu snijega.
10:53
She brought it in to the unit.
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Donijela ju je na odjel.
10:56
I cannot tell you the rapture I felt
holding that in my hand,
holding that in my hand,
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Ne mogu vam opisati koliko sam se sjajno
osjećao držeći je u ruci
osjećao držeći je u ruci
11:02
and the coldness dripping
onto my burning skin;
onto my burning skin;
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dok je hladnoća kapala
po mojoj uzavreloj koži;
po mojoj uzavreloj koži;
11:05
the miracle of it all,
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koliko je to čudesno bilo,
11:07
the fascination as I watched it melt
and turn into water.
and turn into water.
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fascinacija s kojom sam promatrao
kako se pretvara u vodu.
kako se pretvara u vodu.
11:15
In that moment,
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U tom trenutku
11:17
just being any part of this planet
in this universe mattered more to me
in this universe mattered more to me
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sama činjenica da sam bilo koji dio ovog
planeta u svemiru značilo mi je više
planeta u svemiru značilo mi je više
11:21
than whether I lived or died.
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od činjenice hoću li živjeti ili umrijeti.
11:24
That little snowball packed
all the inspiration I needed
all the inspiration I needed
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Da gruda snijega nosila je inspiraciju
koja mi je bila potrebna
koja mi je bila potrebna
11:27
to both try to live
and be OK if I did not.
and be OK if I did not.
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da pokušam živjeti i da mi ne smeta
ako i ne poživim.
ako i ne poživim.
11:31
In a hospital, that's a stolen moment.
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U bolnici je to ukraden trenutak.
11:36
In my work over the years,
I've known many people
I've known many people
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Tijekom godina karijere
upoznao sam mnoge ljude
upoznao sam mnoge ljude
11:39
who were ready to go, ready to die.
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koji su bili spremni na smrt -
11:43
Not because they had found
some final peace or transcendence,
some final peace or transcendence,
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ne zato što su pronašli
konačan spokoj ili transcedenciju,
konačan spokoj ili transcedenciju,
11:47
but because they were so repulsed
by what their lives had become --
by what their lives had become --
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nego zato što im se zgadilo to
na što su im se životi sveli -
na što su im se životi sveli -
11:54
in a word, cut off, or ugly.
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Jednom riječju - odvojeni ili ružni.
12:03
There are already record numbers of us
living with chronic and terminal illness,
living with chronic and terminal illness,
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Već postoji rekordni broj nas koji živimo
s kroničnim i terminalnim bolestima,
s kroničnim i terminalnim bolestima,
12:09
and into ever older age.
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pa čak i u starijoj dobi.
12:11
And we are nowhere near ready
or prepared for this silver tsunami.
or prepared for this silver tsunami.
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Nismo ni blizu spremni
ili pripravni za ovaj srebrni tsunami.
ili pripravni za ovaj srebrni tsunami.
12:19
We need an infrastructure
dynamic enough to handle
dynamic enough to handle
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Treba nam dovoljno dinamična
infrastruktura koja će se nositi
infrastruktura koja će se nositi
12:22
these seismic shifts in our population.
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s ovim seizmičkim promjenama
u našoj populaciji.
u našoj populaciji.
12:27
Now is the time to create
something new, something vital.
something new, something vital.
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Sad je vrijeme da stvorimo
nešto novo, nešto ključno.
nešto novo, nešto ključno.
12:30
I know we can because we have to.
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Znam da to možemo jer to moramo.
12:33
The alternative is just unacceptable.
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2022
Alternativa je jednostavno neprihvatljiva,
12:35
And the key ingredients are known:
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a ključni sastojci su poznati:
12:37
policy, education and training,
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politika, odgoj i obrazovanje i obuka,
12:41
systems, bricks and mortar.
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sustavi, cigle i žbuka.
12:44
We have tons of input
for designers of all stripes to work with.
for designers of all stripes to work with.
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Imamo hrpu materijala s kojima
mogu raditi dizajneri svih orijentacija.
mogu raditi dizajneri svih orijentacija.
12:49
We know, for example, from research
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Npr. iz istraživanja znamo
12:51
what's most important to people
who are closer to death:
who are closer to death:
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što je najvažnije ljudima
koji se bliže smrti:
koji se bliže smrti:
12:54
comfort; feeling unburdened
and unburdening to those they love;
and unburdening to those they love;
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ugoda; osjećaj neopterećenosti
i nestvaranja tereta onima koje vole;
i nestvaranja tereta onima koje vole;
13:01
existential peace; and a sense
of wonderment and spirituality.
of wonderment and spirituality.
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egzistencijalni mir;
osjećaj čuđenja i duhovnosti.
osjećaj čuđenja i duhovnosti.
13:08
Over Zen Hospice's nearly 30 years,
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U gotovo trideset godina hospicija Zen
13:12
we've learned much more
from our residents in subtle detail.
from our residents in subtle detail.
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puno smo više detalja naučili
od naših stanara.
od naših stanara.
13:17
Little things aren't so little.
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Male stvari i nisu toliko male.
13:21
Take Janette.
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Npr. Janette je
13:22
She finds it harder to breathe
one day to the next due to ALS.
one day to the next due to ALS.
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svakim danom sve teže disati zbog ALS-a.
13:26
Well, guess what?
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Znate što?
13:28
She wants to start smoking again --
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Želi ponovno početi pušiti,
13:31
and French cigarettes, if you please.
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2928
i to francuske cigarete.
13:36
Not out of some self-destructive bent,
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Ne iz nekog auto-destruktivnog hira,
13:39
but to feel her lungs filled
while she has them.
while she has them.
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već kako bi osjetila kako joj se
pluća pune dok ih još uvijek ima.
pluća pune dok ih još uvijek ima.
13:44
Priorities change.
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Prioriteti se mijenjaju.
13:47
Or Kate -- she just wants to know
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Ili npr. Kate koja samo želi znati
13:50
her dog Austin is lying
at the foot of her bed,
at the foot of her bed,
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da njezin pas Austin leži
ispred njezinog kreveta,
ispred njezinog kreveta,
13:54
his cold muzzle against her dry skin,
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3717
njegova hladna njuška
na njezinoj suhoj koži
na njezinoj suhoj koži
13:57
instead of more chemotherapy
coursing through her veins --
coursing through her veins --
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umjesto dodatne kemoterapije
koja joj teče venama -
koja joj teče venama -
14:00
she's done that.
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1181
učinila je to.
14:02
Sensuous, aesthetic gratification,
where in a moment, in an instant,
where in a moment, in an instant,
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Senzualna, estetička zadovoljština
u kojoj u trenutku, u sekundi
u kojoj u trenutku, u sekundi
14:07
we are rewarded for just being.
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dobijemo nagradu samo zato što postojimo.
14:15
So much of it comes down to
loving our time by way of the senses,
loving our time by way of the senses,
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Toliko se toga svodi na uživanje
u preostalom vremenu putem osjetila,
u preostalom vremenu putem osjetila,
14:19
by way of the body -- the very thing
doing the living and the dying.
doing the living and the dying.
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putem tijela - onoga što je zaslužno
za život i smrt.
za život i smrt.
14:26
Probably the most poignant room
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Vjerojatno najbolnija soba
14:27
in the Zen Hospice guest house
is our kitchen,
is our kitchen,
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u gostinjskoj kući hospicija Zen
naša je kuhinja,
naša je kuhinja,
14:30
which is a little strange when you realize
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što je malo neobično kad shvatite
14:32
that so many of our residents
can eat very little, if anything at all.
can eat very little, if anything at all.
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da toliko naših stanara
jede vrlo malo ili nimalo.
jede vrlo malo ili nimalo.
14:36
But we realize we are providing
sustenance on several levels:
sustenance on several levels:
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Svjesni smo da im pružamo podršku
na nekoliko različitih razina:
na nekoliko različitih razina:
14:41
smell, a symbolic plane.
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miris, simboličke osnove.
14:46
Seriously, with all the heavy-duty stuff
happening under our roof,
happening under our roof,
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Ozbiljno, sa svim obvezama koje su se
odvijale pod našim krovom,
odvijale pod našim krovom,
14:51
one of the most tried and true
interventions we know of,
interventions we know of,
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jedna od najboljih intervencija
koje smo otkrili
koje smo otkrili
14:55
is to bake cookies.
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3493
jest pečenje kolača.
15:10
As long as we have our senses --
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1604
Sve dok imamo osjetila -
15:11
even just one --
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2012
makar samo jedno -
15:13
we have at least
the possibility of accessing
the possibility of accessing
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3409
imamo barem mogućnost pristupa
15:17
what makes us feel human, connected.
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onome zbog čega se osjećamo
kao ljudi, povezano.
kao ljudi, povezano.
15:22
Imagine the ripples of this notion
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Zamislite posljedice ovoga
15:25
for the millions of people
living and dying with dementia.
living and dying with dementia.
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za milijune ljudi koji žive
i umiru s demencijom.
i umiru s demencijom.
15:29
Primal sensorial delights that say
the things we don't have words for,
the things we don't have words for,
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Osnovni senzorni užici koji govore
stvari za koje mi nemamo riječi,
stvari za koje mi nemamo riječi,
15:33
impulses that make us stay present --
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impulsi koji nam pomažu
da ostanemo u sadašnjosti -
da ostanemo u sadašnjosti -
15:36
no need for a past or a future.
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2805
bez potrebe za prošlosti ili budućnosti.
15:42
So, if teasing unnecessary suffering out
of the system was our first design cue,
of the system was our first design cue,
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Ako nam je prvi dizajnerski trag bio
uklanjanje nepotrebne patnje iz sustava,
uklanjanje nepotrebne patnje iz sustava,
15:50
then tending to dignity
by way of the senses,
by way of the senses,
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2704
onda je težnja dostojanstvu
putem osjetila,
putem osjetila,
15:53
by way of the body --
the aesthetic realm --
the aesthetic realm --
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putem tijela - estetski realm -
15:57
is design cue number two.
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drugi dizajnerski trag.
15:59
Now this gets us quickly to the third
and final bit for today;
and final bit for today;
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To nas je brzo dovelo do trećeg
i posljednjeg dijela;
i posljednjeg dijela;
16:03
namely, we need to lift our sights,
to set our sights on well-being,
to set our sights on well-being,
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moramo podići pogled
i pažnju usmjeriti na našu dobrobit
i pažnju usmjeriti na našu dobrobit
16:10
so that life and health and healthcare
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kako bi se život i zdravlje i zdravstvo
16:13
can become about making life
more wonderful,
more wonderful,
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više usredotočio na uljepšavanje života,
16:16
rather than just less horrible.
246
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2444
umjesto na uklanjanje užasnosti.
16:20
Beneficence.
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1156
Dobrotvornost.
16:22
Here, this gets right at the distinction
248
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2135
Ovo pokazuje razliku
16:25
between a disease-centered and a patient-
or human-centered model of care,
or human-centered model of care,
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5134
između modela brige usmjerenog na bolest
i onog usmjerenog na pacijenta, čovjeka.
i onog usmjerenog na pacijenta, čovjeka.
16:30
and here is where caring
becomes a creative, generative,
becomes a creative, generative,
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Tu briga postaje kreativni, proizvodni,
16:33
even playful act.
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pa čak i zaigran čin.
16:36
"Play" may sound like a funny word here.
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Riječ "igra" ovdje se može učiniti čudnom,
16:39
But it is also one of our
highest forms of adaptation.
highest forms of adaptation.
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2904
ali to je ujedno jedan
od najviših oblika prilagođavanja.
od najviših oblika prilagođavanja.
16:42
Consider every major compulsory effort
it takes to be human.
it takes to be human.
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Razmislite o svakom većem obveznom naporu
koji moramo napraviti da bismo bili ljudi.
koji moramo napraviti da bismo bili ljudi.
16:47
The need for food has birthed cuisine.
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Potreba za hranom izrodila je kuharstvo.
16:49
The need for shelter
has given rise to architecture.
has given rise to architecture.
256
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2588
Potreba za skloništem
izrodila je arhitekturu.
izrodila je arhitekturu.
16:52
The need for cover, fashion.
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Potreba za pokrivanjem - modu.
16:54
And for being subjected to the clock,
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2731
A kako bismo se podredili satu,
16:57
well, we invented music.
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3527
izumili smo glazbu.
17:03
So, since dying
is a necessary part of life,
is a necessary part of life,
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Budući da je umiranje nužan dio življenja,
17:06
what might we create with this fact?
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što možemo učiniti s tom činjenicom?
17:12
By "play" I am in no way suggesting
we take a light approach to dying
we take a light approach to dying
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"Igrom" nikako ne predlažem
da olako pristupimo smrti
da olako pristupimo smrti
17:15
or that we mandate
any particular way of dying.
any particular way of dying.
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ili da naredimo kako umirati.
17:18
There are mountains of sorrow
that cannot move,
that cannot move,
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Brda tuge ne možemo pomaknuti
17:20
and one way or another,
we will all kneel there.
we will all kneel there.
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i bilo kako bilo, svi ćemo
pred njima pokleknuti.
pred njima pokleknuti.
17:24
Rather, I am asking that we make space --
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Zapravo tražim da napravimo mjesta -
17:28
physical, psychic room, to allow life
to play itself all the way out --
to play itself all the way out --
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fizičkog, psihičkog mjesta
da pustimo život da se sam odigra do kraja
da pustimo život da se sam odigra do kraja
17:34
so that rather than just
getting out of the way,
getting out of the way,
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i da umjesto da mu se samo izmičemo,
17:37
aging and dying can become
a process of crescendo through to the end.
a process of crescendo through to the end.
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starenje i umiranje može postati proces
koji se razvija sve do kraja.
koji se razvija sve do kraja.
17:44
We can't solve for death.
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Ne možemo izliječiti smrt.
17:50
I know some of you are working on this.
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Znam da neki od vas rade na tome.
17:52
(Laughter)
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(Smijeh)
17:57
Meanwhile, we can --
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U međuvremenu možemo -
17:58
(Laughter)
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(Smijeh)
18:00
We can design towards it.
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- možemo dizajnirati prema njoj.
18:04
Parts of me died early on,
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Dijelovi mene rano su umrli,
18:05
and that's something we can all say
one way or another.
one way or another.
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a to svi mi možemo reći
za sebe ovako ili onako.
za sebe ovako ili onako.
18:08
I got to redesign my life
around this fact,
around this fact,
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Dobio sam priliku redizajnirati
svoj život oko te činjenice
svoj život oko te činjenice
18:11
and I tell you it has been a liberation
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i mogu vam reći da je bilo oslobađajuće
18:14
to realize you can always find
a shock of beauty or meaning
a shock of beauty or meaning
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shvatiti da uvijek možete pronaći
iznenađujuću ljepotu ili smisao
iznenađujuću ljepotu ili smisao
18:17
in what life you have left,
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u životu koji vam je preostao,
18:20
like that snowball lasting
for a perfect moment,
for a perfect moment,
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poput one grude snijega koja je
stvorila savršen trenutak
stvorila savršen trenutak
18:22
all the while melting away.
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topeći se.
18:26
If we love such moments ferociously,
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Ako divljački volimo te trenutke,
18:32
then maybe we can learn to live well --
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onda možda možemo naučiti dobro živjeti -
18:35
not in spite of death,
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ne u inat smrti,
18:37
but because of it.
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već zbog nje.
18:42
Let death be what takes us,
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Neka smrt bude ono što će nas izbrisati,
18:44
not lack of imagination.
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a ne manjak mašte.
18:48
Thank you.
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Hvala vam.
18:50
(Applause)
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(Pljesak)
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