BJ Miller: What really matters at the end of life
BJ‧米勒: 在生命終點,真正重要的是什麼?
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.
and that was that.
結果就是現在你們看到的情況
with death -- my death --
-- 自己的死亡 --
my long run as a patient.
of dysfunction --
a hospice and palliative medicine doc,
負責安寧療護和緩和藥物治療
who goes into healthcare
are also unwitting agents
does not serve.
answer to that question,
with diseases, not people, at its center.
而不是病人
it was badly designed.
of bad design more heartbreaking
for good design more compelling
and concentrated.
to reach out across disciplines
into this big conversation.
opportunity in front of us,
about death isn't being dead,
不是變成死人
it can be very helpful
which is necessary as it is,
如同一個談好的條件
essential part of life, part of the deal,
to make space, adjust, grow.
to realize forces larger than ourselves.
became fact, fixed --
reject this fact than reject myself.
因為那等同拒絕自己
but I learned it eventually.
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,
something we can affect.
to this fundamental distinction
and unnecessary suffering
design cues for the day.
as people who care,
我們醫護照顧者的角色
not add to the pile.
of a reflective advocate,
important field but poorly understood --
但其實沒有正確地被理解
limited to end of life care.
and living well at any stage.
都能舒適地好好活著
have to be dying anytime soon
on top of long-standing HIV.
和愛滋病毒為吾
out loud together about his life --
一起思考他的人生
his losses as they roll in,
讓他一直處於喪去之中
the next moment.
but regret, quite another.
out of a Norman Rockwell painting --
when he came into clinic one day,
down the Colorado River.
一點也不令人意外
and his health, some would say no.
一些人或許會說不是
while he still could.
趁他還能辦到的時候
scorpions, snakes,
of the Grand Canyon --
不斷傳來野生動物的咆哮
beyond our control.
so many of us would make,
what is best for ourselves over time.
對我們都是最好的決定
is a shift in perspective.
when I went back to college,
I'd learn something about how to see --
我發現我學到一些如何「看」--
所見的孩子而言
for a kid who couldn't change
we humans get to play with,
at an amazing place in San Francisco
一個很棒的地方工作
that helps with this shift in perspective.
觀點移轉的小小儀式
wheeling the body out through the garden,
nurses, volunteers,
或者單純的靜默
with flower petals.
to usher in grief with warmth,
用溫暖迎接悲痛
in the hospital setting,
lined with tubes and beeping machines
排滿管線和嗶嗶叫的機器
even when the patient's life has.
the body's whisked away,
had never really existed.
in the name of sterility,
within those walls is numbness --
我們最多能渴望的大概就是麻木
the opposite of aesthetic.
I am alive because of them.
他們是我還活著的原因
and treatable illness.
that's not what they were designed for.
他們不是為此設計的
giving up on the notion
can become more humane.
in Livingston, New Jersey,
great care at every turn,
palliative care for my pain.
complaining about driving through it.
coming down all sticky.
smuggled in a snowball for me.
為我偷偷帶進了一個雪球
holding that in my hand,
就當我感受到它就在我手中
onto my burning skin;
and turn into water.
in this universe mattered more to me
all the inspiration I needed
and be OK if I did not.
I've known many people
some final peace or transcendence,
by what their lives had become --
living with chronic and terminal illness,
已經達到歷史新高
or prepared for this silver tsunami.
dynamic enough to handle
人口結構轉移的震盪
something new, something vital.
不可或缺的東西
for designers of all stripes to work with.
可讓各種不同的設計師進行作業
who are closer to death:
and unburdening to those they love;
並不再牽累他們所愛的人
of wonderment and spirituality.
from our residents in subtle detail.
one day to the next due to ALS.
她發現一天比一天難以呼吸
while she has them.
感覺裡面被充滿
at the foot of her bed,
coursing through her veins --
where in a moment, in an instant,
loving our time by way of the senses,
最終大多只剩下感官
doing the living and the dying.
千真萬確經歷活著和死亡的東西
is our kitchen,
can eat very little, if anything at all.
sustenance on several levels:
我們都在提供維持生計的東西
happening under our roof,
interventions we know of,
the possibility of accessing
living and dying with dementia.
the things we don't have words for,
說明了我們無法形容的事
of the system was our first design cue,
從醫療體系中抽離是第一個設計提示
by way of the senses,
the aesthetic realm --
and final bit for today;
也是今天最後一個段落
to set our sights on well-being,
將其放在人們的福祉上
more wonderful,
or human-centered model of care,
becomes a creative, generative,
highest forms of adaptation.
it takes to be human.
has given rise to architecture.
is a necessary part of life,
we take a light approach to dying
選個輕快有趣的方式死亡
any particular way of dying.
that cannot move,
we will all kneel there.
to play itself all the way out --
讓生命可以自己一路享受到最後
getting out of the way,
a process of crescendo through to the end.
漸強直至高潮的旋律
one way or another.
around this fact,
重新設計我的生命
a shock of beauty or meaning
你永遠能在留下的生命裡
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