TED2015
BJ Miller: What really matters at the end of life
BJ Miller: O que realmente importa ao final da vida
Filmed:
Readability: 3.9
10,470,704 views
Ao final das nosas vidas, que é o que máis desexamos? Moitos, sinxelamente: comodidade, respecto, amor. BJ Miller é un doutor dun hospital de enfermos terminais que reflexiona en profundidade sobre como crear unha fin digna e agradable para os seus pacientes. Tómense o tempo de saborear esta emotiva charla, que fai grandes preguntas sobre o que pensamos sobre a vida e unha vida digna.
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.
0
1999
3009
Todos precisamos dunha razón
para erguernos.
para erguernos.
00:18
For me, it just took 11,000 volts.
1
6898
2373
A min, costoume soamente 11.000 voltios.
00:23
I know you're too polite to ask,
2
11068
1674
Son educados demais
para preguntar,
para preguntar,
00:24
so I will tell you.
3
12766
1635
así que contareillelo.
00:27
One night, sophomore year of college,
4
15354
2223
Unha noite do segundo ano de universidade,
ao volver de acción de grazas,
00:29
just back from Thanksgiving holiday,
5
17601
3698
estaba cuns amigos armando
barullo
barullo
00:33
a few of my friends and I
were horsing around,
were horsing around,
6
21323
2652
e decidín subir ao teito
dun tren de cercanías aparcado.
dun tren de cercanías aparcado.
00:35
and we decided to climb atop
a parked commuter train.
a parked commuter train.
7
23999
3565
00:40
It was just sitting there,
with the wires that run overhead.
with the wires that run overhead.
8
28167
3114
Estaba alí,
cos cables enriba del.
cos cables enriba del.
Por algunha razón, pareceume
unha idea moi boa.
unha idea moi boa.
00:43
Somehow, that seemed
like a great idea at the time.
like a great idea at the time.
9
31305
3102
00:46
We'd certainly done stupider things.
10
34804
2482
Certo é que fixeramos cousas máis
estúpidas.
estúpidas.
00:50
I scurried up the ladder on the back,
11
38270
3021
Subín pola escaleira de atrás
00:53
and when I stood up,
12
41315
1722
e cando me puxen de pé,
00:55
the electrical current entered my arm,
13
43061
3582
a corrente eléctrica entroume polo brazo,
derriboume e saiume polos pés
e iso foi todo.
e iso foi todo.
00:58
blew down and out my feet,
and that was that.
and that was that.
14
46667
2540
01:03
Would you believe that watch still works?
15
51699
2589
Poden crer que ese reloxo aínda funciona?
01:08
Takes a licking!
16
56216
1207
Costoume unha malleira!
01:09
(Laughter)
17
57447
1031
(Risas)
O meu pai lévao agora en solidariedade.
01:10
My father wears it now in solidarity.
18
58502
2309
01:15
That night began my formal relationship
with death -- my death --
with death -- my death --
19
63295
6023
Esa noite comezou a miña relación
coa morte (a miña morte),
coa morte (a miña morte),
01:21
and it also began
my long run as a patient.
my long run as a patient.
20
69342
3808
e a miña carreira
como paciente.
como paciente.
É unha boa palabra.
01:25
It's a good word.
21
73174
1154
01:26
It means one who suffers.
22
74352
1727
Paciente significa o que sufre.
01:28
So I guess we're all patients.
23
76825
1441
Creo que todos o somos.
01:31
Now, the American health care system
24
79607
2366
Agora, o sistema sanitario americano
ten unha máis que xusta taxa
de disfunción,
de disfunción,
01:33
has more than its fair share
of dysfunction --
of dysfunction --
25
81997
3121
equiparable á súa brillantez.
01:37
to match its brilliance, to be sure.
26
85142
2060
01:39
I'm a physician now,
a hospice and palliative medicine doc,
a hospice and palliative medicine doc,
27
87750
4452
Agora son médico, un doutor
de coidados terminais e paliativos,
de coidados terminais e paliativos,
polo que coñezo as dúas partes.
01:44
so I've seen care from both sides.
28
92226
2246
01:47
And believe me: almost everyone
who goes into healthcare
who goes into healthcare
29
95076
3899
Créanme: case todos os que acuden
aos servizos sanitarios,
aos servizos sanitarios,
van realmente, quero dicir, de verdade.
01:50
really means well -- I mean, truly.
30
98999
3137
01:54
But we who work in it
are also unwitting agents
are also unwitting agents
31
102874
3933
Pero os que traballamos neles,
somos tamén axentes involuntarios
somos tamén axentes involuntarios
dun sistema que non funciona
demasiado a miúdo.
demasiado a miúdo.
01:58
for a system that too often
does not serve.
does not serve.
32
106831
4244
02:03
Why?
33
111999
1157
Por que?
02:05
Well, there's actually a pretty easy
answer to that question,
answer to that question,
34
113624
3381
Bueno, a resposta para esa pregunta
é sinxela
é sinxela
e explica moitas cousas:
02:09
and it explains a lot:
35
117029
2248
02:11
because healthcare was designed
with diseases, not people, at its center.
with diseases, not people, at its center.
36
119301
5958
os servizos sanitarios céntranse
nas enfermidades, non nas persoas.
nas enfermidades, non nas persoas.
02:18
Which is to say, of course,
it was badly designed.
it was badly designed.
37
126419
2906
Por iso, obviamente,
deseñáronse mal.
deseñáronse mal.
02:22
And nowhere are the effects
of bad design more heartbreaking
of bad design more heartbreaking
38
130158
6052
E non hai un intre no que o mal deseño
sexa máis descorazonador
sexa máis descorazonador
02:28
or the opportunity
for good design more compelling
for good design more compelling
39
136234
3335
ou máis atractiva a posibilidade
dun bo deseño
dun bo deseño
02:31
than at the end of life,
40
139593
2141
que ao final da vida,
02:33
where things are so distilled
and concentrated.
and concentrated.
41
141758
3356
momento no que as cousas son tan intensas.
02:38
There are no do-overs.
42
146234
1786
Non hai segundas oportunidades.
02:42
My purpose today is
to reach out across disciplines
to reach out across disciplines
43
150073
4491
O meu obxectivo hoxe é superar
as distintas disciplinas
as distintas disciplinas
e convidar ao pensamento creativo
a esta conversa.
a esta conversa.
02:46
and invite design thinking
into this big conversation.
into this big conversation.
44
154588
4367
02:51
That is, to bring intention and creativity
45
159495
5357
É dicir, atraer as boas intencións
e a creatividade
e a creatividade
á experiencia de morrer.
02:56
to the experience of dying.
46
164876
2769
03:01
We have a monumental
opportunity in front of us,
opportunity in front of us,
47
169235
4033
Temos unha oportunidade tremenda
diante de nós,
diante de nós,
ante un dos poucos temas universais
03:05
before one of the few universal issues
48
173292
4341
que nos afecta como individuos
e como sociedade:
e como sociedade:
03:09
as individuals as well as a civil society:
49
177657
3310
repensar e redeseñar como morremos.
03:12
to rethink and redesign how it is we die.
50
180991
3916
03:19
So let's begin at the end.
51
187489
2590
Así que comecemos polo final.
03:23
For most people, the scariest thing
about death isn't being dead,
about death isn't being dead,
52
191611
3935
Á maioría, o que máis medo lle dá
de morrer, non é a morte,
de morrer, non é a morte,
é estar morrendo, sufrindo.
03:27
it's dying, suffering.
53
195570
1819
03:29
It's a key distinction.
54
197809
1375
Esa é a principal diferenza.
03:32
To get underneath this,
it can be very helpful
it can be very helpful
55
200461
2168
Para chegar ao fondo disto,
pode axudar moito
pode axudar moito
03:34
to tease out suffering
which is necessary as it is,
which is necessary as it is,
56
202653
4354
coñecer o sufrimento,
que é preciso tal como é
que é preciso tal como é
porque grazas a el podése cambiar.
03:39
from suffering we can change.
57
207031
2665
03:42
The former is a natural,
essential part of life, part of the deal,
essential part of life, part of the deal,
58
210317
5236
O pasado é unha parte esencial da vida,
é unha parte da experiencia,
é unha parte da experiencia,
á que lle hai que facer sitio,
adaptarse e crecer grazas a ela.
adaptarse e crecer grazas a ela.
03:47
and to this we are called
to make space, adjust, grow.
to make space, adjust, grow.
59
215577
5114
03:55
It can be really good
to realize forces larger than ourselves.
to realize forces larger than ourselves.
60
223013
5346
É moi bo comprender forzas
que son superiores a nós.
que son superiores a nós.
04:01
They bring proportionality,
61
229098
3124
Achega proporcionalidade,
como un redimensionamento cósmico.
04:04
like a cosmic right-sizing.
62
232246
2319
04:08
After my limbs were gone,
63
236779
2434
Despois de perder as miñas extremidades,
esa perda, por exemplo,
converteuse nun feito, permanente
converteuse nun feito, permanente
04:11
that loss, for example,
became fact, fixed --
became fact, fixed --
64
239237
4586
e que é necesariamente parte da miña vida
04:15
necessarily part of my life,
65
243847
3313
e aprendín que non podía rexeitar
este feito máis que a min mesmo.
este feito máis que a min mesmo.
04:19
and I learned that I could no more
reject this fact than reject myself.
reject this fact than reject myself.
66
247184
6116
04:27
It took me a while,
but I learned it eventually.
but I learned it eventually.
67
255173
2621
Levoume un pouco,
pero co tempo entendino.
pero co tempo entendino.
04:30
Now, another great thing
about necessary suffering
about necessary suffering
68
258572
2444
Agora, outra gran cousa sobre
o sufrimento necesario
o sufrimento necesario
é que é o único
04:33
is that it is the very thing
69
261040
3508
que une ao coidador e ao coidado,
04:36
that unites caregiver and care receiver --
70
264572
5403
ambos seres humanos.
04:41
human beings.
71
269999
1253
04:45
This, we are finally realizing,
is where healing happens.
is where healing happens.
72
273089
3814
Neste punto é cando se
produce a curación.
produce a curación.
04:49
Yes, compassion -- literally,
as we learned yesterday --
as we learned yesterday --
73
277673
3520
Si, a compaixón, literalmente,
sufrir xuntos.
04:53
suffering together.
74
281217
1428
04:56
Now, on the systems side,
on the other hand,
on the other hand,
75
284672
3338
Agora, con respecto aos sistemas,
tanto sufrimento é innecesario,
inventado
inventado
05:00
so much of the suffering
is unnecessary, invented.
is unnecessary, invented.
76
288034
3858
05:04
It serves no good purpose.
77
292376
2274
e non serve para nada.
Pero a boa noticia é que, desde que
se inventou a marca do sufrimento,
se inventou a marca do sufrimento,
05:06
But the good news is,
since this brand of suffering is made up,
since this brand of suffering is made up,
78
294674
4301
podemos cambialo.
05:10
well, we can change it.
79
298999
1484
05:13
How we die is indeed
something we can affect.
something we can affect.
80
301681
2654
Podemos influír no xeito
de morrer.
de morrer.
05:18
Making the system sensitive
to this fundamental distinction
to this fundamental distinction
81
306446
4053
Facer que o sistema sexa sensible
en canto á diferenza
en canto á diferenza
entre o sufrimento necesario
e o innecesario
e o innecesario
05:22
between necessary
and unnecessary suffering
and unnecessary suffering
82
310523
3452
danos a primeira das tres cuestións
sobre o deseño que abordaremos hoxe.
sobre o deseño que abordaremos hoxe.
05:25
gives us our first of three
design cues for the day.
design cues for the day.
83
313999
3690
05:30
After all, our role as caregivers,
as people who care,
as people who care,
84
318299
4529
A fin de contas, a nosa función como
coidadores, persoas que coidan
coidadores, persoas que coidan
é aliviar a dor, non acrecentala.
05:34
is to relieve suffering --
not add to the pile.
not add to the pile.
85
322852
4662
05:42
True to the tenets of palliative care,
86
330292
1871
Segundo as bases do
coidado paliativo,
coidado paliativo,
eu son como un defensor reflexivo
05:44
I function as something
of a reflective advocate,
of a reflective advocate,
87
332187
3673
e á vez un médico prescriptor.
05:47
as much as prescribing physician.
88
335884
2119
05:51
Quick aside: palliative care -- a very
important field but poorly understood --
important field but poorly understood --
89
339177
6021
Un inciso: os coidados paliativos son un
eido moi importante e incomprendido
eido moi importante e incomprendido
xa que non se limitan aos coidados
durante a fin da vida,
durante a fin da vida,
05:57
while it includes, it is not
limited to end of life care.
limited to end of life care.
90
345222
2954
non se limitan a fases terminais.
06:00
It is not limited to hospice.
91
348200
1841
06:02
It's simply about comfort
and living well at any stage.
and living well at any stage.
92
350811
3457
Tratáse, sinxelamente, de vivir
cómodamente e ben en calquera momento.
cómodamente e ben en calquera momento.
06:06
So please know that you don't
have to be dying anytime soon
have to be dying anytime soon
93
354999
3039
Así que saiban que non teñen que
estar a morrer
estar a morrer
para beneficiarse dos paliativos.
06:10
to benefit from palliative care.
94
358062
1687
06:13
Now, let me introduce you to Frank.
95
361450
2280
Agora, permítanme presentarlles a Frank.
06:17
Sort of makes this point.
96
365768
1215
Serve como exemplo.
Frank é o meu paciente desde hai anos.
06:19
I've been seeing Frank now for years.
97
367007
2030
Vive cun cancro de próstata en fase
avanzada e con VIH desde hai tempo.
avanzada e con VIH desde hai tempo.
06:21
He's living with advancing prostate cancer
on top of long-standing HIV.
on top of long-standing HIV.
98
369061
4194
06:26
We work on his bone pain and his fatigue,
99
374197
1986
Traballamos na dor de ósos e na fatiga,
mais sobre todo conversamos
sobre a súa vida
sobre a súa vida
06:28
but most of the time we spend thinking
out loud together about his life --
out loud together about his life --
100
376207
4714
en serio, sobre a vida.
06:32
really, about our lives.
101
380945
1365
06:35
In this way, Frank grieves.
102
383071
1660
Isto alivia a Frank.
06:37
In this way, he keeps up with
his losses as they roll in,
his losses as they roll in,
103
385207
3779
Deste xeito, acepta as súas perdas
a medida que se suceden
a medida que se suceden
e así está preparado para asimilar
o que está por vir.
o que está por vir.
06:41
so that he's ready to take in
the next moment.
the next moment.
104
389010
3149
06:45
Loss is one thing,
but regret, quite another.
but regret, quite another.
105
393524
4171
A perda é unha cousa,
o pesar é outra ben distinta.
o pesar é outra ben distinta.
06:51
Frank has always been an adventurer --
106
399243
1957
Frank foi sempre un aventureiro.
Parece saído dun cadro de
Norman Rockwell
Norman Rockwell
06:53
he looks like something
out of a Norman Rockwell painting --
out of a Norman Rockwell painting --
107
401224
2841
e non un afeccionado ao pesar.
06:56
and no fan of regret.
108
404089
1564
06:58
So it wasn't surprising
when he came into clinic one day,
when he came into clinic one day,
109
406566
2681
Por iso non me sorprendeu cando un día
chegou á clínica
chegou á clínica
e dixo que quería facer o descenso
do río Colorado.
do río Colorado.
07:01
saying he wanted to raft
down the Colorado River.
down the Colorado River.
110
409271
2736
07:05
Was this a good idea?
111
413142
1675
Era unha boa idea?
07:07
With all the risks to his safety
and his health, some would say no.
and his health, some would say no.
112
415268
4204
Tendo en conta os riscos para a súa saúde
e a súa seguridade, moitos dirían que non.
e a súa seguridade, moitos dirían que non.
Moitos dixérono, pero fixémolo,
mentres el aínda era capaz.
mentres el aínda era capaz.
07:11
Many did, but he went for it,
while he still could.
while he still could.
113
419496
3566
07:15
It was a glorious, marvelous trip:
114
423999
3611
Foi unha excursión marabillosa, gloriosa:
07:20
freezing water, blistering dry heat,
scorpions, snakes,
scorpions, snakes,
115
428928
5322
auga xeada, calor abrasadora,
escorpións, serpes,
escorpións, serpes,
bramidos da fauna que
saían do Gran Canón...
saían do Gran Canón...
07:26
wildlife howling off the flaming walls
of the Grand Canyon --
of the Grand Canyon --
116
434274
5431
Todas as caras do mundo,
fóra do noso control.
fóra do noso control.
07:31
all the glorious side of the world
beyond our control.
beyond our control.
117
439729
3544
07:36
Frank's decision, while maybe dramatic,
118
444492
1890
A decisión de Frank, foi dramática
pero é exactamente a mesma
que moitos tomariamos,
que moitos tomariamos,
07:38
is exactly the kind
so many of us would make,
so many of us would make,
119
446406
2287
se tivésemos a oportunidade de saber
que é o mellor para nós.
que é o mellor para nós.
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.
120
448717
6197
07:49
So much of what we're talking about today
is a shift in perspective.
is a shift in perspective.
121
457291
3369
Moitas das cousas das que estamos a falar
son cuestión de perspectiva.
son cuestión de perspectiva.
07:54
After my accident,
when I went back to college,
when I went back to college,
122
462723
2252
Despois do accidente,
ao volver á universidade,
ao volver á universidade,
cambiei de carreira para
estudar historia da arte.
estudar historia da arte.
07:56
I changed my major to art history.
123
464999
2366
08:00
Studying visual art, I figured
I'd learn something about how to see --
I'd learn something about how to see --
124
468095
4300
Mentres estudaba arte visual,
aprendín como mirar
aprendín como mirar
08:05
a really potent lesson
for a kid who couldn't change
for a kid who couldn't change
125
473705
3374
unha lección enorme para un rapaz
que non era quen de cambiar,
que non era quen de cambiar,
e que o cambia o que estaba vendo.
08:09
so much of what he was seeing.
126
477103
2041
08:12
Perspective, that kind of alchemy
we humans get to play with,
we humans get to play with,
127
480602
3738
A perspectiva é a clase de alquimia coa
que os humanos podemos xogar
que os humanos podemos xogar
e converter a angustia nunha flor.
08:16
turning anguish into a flower.
128
484364
2510
08:21
Flash forward: now I work
at an amazing place in San Francisco
at an amazing place in San Francisco
129
489999
3792
Avancemos: actualmente traballo nun lugar
incrible en San Francisco
incrible en San Francisco
que é o Proxecto Zen de Hospital
para terminais,
para terminais,
08:25
called the Zen Hospice Project,
130
493815
2239
onde temos un pequeno ritual
que axuda a cambiar a perspectiva.
que axuda a cambiar a perspectiva.
08:28
where we have a little ritual
that helps with this shift in perspective.
that helps with this shift in perspective.
131
496078
3620
08:32
When one of our residents dies,
132
500405
3061
Cando un dos residentes morre,
os homes da funeraria veñen e, cando
cando se está a sacar o corpo polo xardín,
cando se está a sacar o corpo polo xardín,
08:35
the mortuary men come, and as we're
wheeling the body out through the garden,
wheeling the body out through the garden,
133
503490
4470
dirixíndose á porta, paramos.
08:39
heading for the gate, we pause.
134
507984
2030
Calquera que o desexa
08:42
Anyone who wants --
135
510038
2185
(outros residentes, familia,
enfermeiros, voluntarios,
enfermeiros, voluntarios,
08:44
fellow residents, family,
nurses, volunteers,
nurses, volunteers,
136
512247
2724
os condutores dos coches fúnebres...)
08:46
the hearse drivers too, now --
137
514995
2444
comparte unha historia, unha canción
ou un silencio
ou un silencio
08:49
shares a story or a song or silence,
138
517463
4427
mentres cubrimos o corpo con pétalos
de flores.
de flores.
08:53
as we sprinkle the body
with flower petals.
with flower petals.
139
521914
2788
08:57
It takes a few minutes;
140
525282
2304
Leva uns minutos
e é unha imaxe sinxela e delicada
para pasar acompañar a dor co cariño,
para pasar acompañar a dor co cariño,
08:59
it's a sweet, simple parting image
to usher in grief with warmth,
to usher in grief with warmth,
141
527610
5365
no canto de con desprezo.
09:04
rather than repugnance.
142
532999
1711
09:08
Contrast that with the typical experience
in the hospital setting,
in the hospital setting,
143
536060
5046
Comparen iso co que adoita acontecer
nun hospital:
nun hospital:
unha habitación iluminada, chea de tubos
e alarmas
e alarmas
09:13
much like this -- floodlit room
lined with tubes and beeping machines
lined with tubes and beeping machines
144
541130
4864
e luces que non deixan de capelexar,
mesmo cando a vida dos pacientes cesou.
mesmo cando a vida dos pacientes cesou.
09:18
and blinking lights that don't stop
even when the patient's life has.
even when the patient's life has.
145
546018
4168
09:23
Cleaning crew swoops in,
the body's whisked away,
the body's whisked away,
146
551419
3026
Os limpadores entran,
o corpo desaperece
o corpo desaperece
e semella que esa persoa
nunca existiu realmente.
nunca existiu realmente.
09:26
and it all feels as though that person
had never really existed.
had never really existed.
147
554469
5028
09:33
Well-intended, of course,
in the name of sterility,
in the name of sterility,
148
561070
2623
A intención é boa, claro está, pero,
en nome da esterilidade,
en nome da esterilidade,
os hospitais tenden a agredir
os nosos sentidos
os nosos sentidos
09:35
but hospitals tend to assault our senses,
149
563717
3496
e o máximo que podemos esperar dentro
desas paredes é adormecemento
desas paredes é adormecemento
09:39
and the most we might hope for
within those walls is numbness --
within those walls is numbness --
150
567237
5504
(anestesia, que é o contrario á estética)
09:44
anesthetic, literally
the opposite of aesthetic.
the opposite of aesthetic.
151
572765
4242
09:50
I revere hospitals for what they can do;
I am alive because of them.
I am alive because of them.
152
578499
4305
Venero aos hospitais polo que fan,
estou vivo grazas a eles.
estou vivo grazas a eles.
09:56
But we ask too much of our hospitals.
153
584096
2117
Pero pedímoslles demasiado.
09:59
They are places for acute trauma
and treatable illness.
and treatable illness.
154
587436
3593
Son lugares para traumatismos agudos
e enfermidades curables.
e enfermidades curables.
Non son un lugar para vivir e morrer.
Non están deseñados para iso.
Non están deseñados para iso.
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.
155
591053
4025
10:10
Now mind you -- I am not
giving up on the notion
giving up on the notion
156
598078
2300
Iso si, non deixo de crer
que as nosas institucións
poden ser máis humanas.
poden ser máis humanas.
10:12
that our institutions
can become more humane.
can become more humane.
157
600402
3210
10:16
Beauty can be found anywhere.
158
604057
2381
Hai fermosura en calquera parte.
10:21
I spent a few months in a burn unit
159
609092
2272
Pasei uns meses nunha unidade
de queimados
de queimados
no hospital S. Barnabas de
Livingston, Nova Jersei.
Livingston, Nova Jersei.
10:23
at St. Barnabas Hospital
in Livingston, New Jersey,
in Livingston, New Jersey,
160
611388
2748
Alí recibín un coidado fantástico
en todos os turnos,
en todos os turnos,
10:26
where I got really
great care at every turn,
great care at every turn,
161
614160
4157
incluídos coidados paliativos
para a dor.
para a dor.
10:30
including good
palliative care for my pain.
palliative care for my pain.
162
618341
2197
10:33
And one night, it began to snow outside.
163
621415
2845
E unha noite, comezou a nevar fóra.
10:37
I remember my nurses
complaining about driving through it.
complaining about driving through it.
164
625426
3915
Lémbrome de que as miñas enfermeiras
queixábanse de ter que conducir así,
queixábanse de ter que conducir así,
10:42
And there was no window in my room,
165
630103
2184
Non había fiestra na miña habitación,
mais era estupendo imaxinala caendo,
toda apegañenta.
toda apegañenta.
10:44
but it was great to just imagine it
coming down all sticky.
coming down all sticky.
166
632311
3306
10:49
Next day, one of my nurses
smuggled in a snowball for me.
smuggled in a snowball for me.
167
637299
3934
Ao día seguinte, unha das enfermeiras
tróuxome unha bóla de neve.
tróuxome unha bóla de neve.
Meteuna na unidade.
10:53
She brought it in to the unit.
168
641257
1633
10:56
I cannot tell you the rapture I felt
holding that in my hand,
holding that in my hand,
169
644731
5408
Non podo explicar a éxtase que sentín
ao sostela na man
ao sostela na man
e ao sentir como o frío
entraba na miña pel queimada.
entraba na miña pel queimada.
11:02
and the coldness dripping
onto my burning skin;
onto my burning skin;
170
650163
3049
O milagre disto
11:05
the miracle of it all,
171
653236
2310
foi a miña fascinación ao vela
derreterse e converterse en auga.
derreterse e converterse en auga.
11:07
the fascination as I watched it melt
and turn into water.
and turn into water.
172
655570
3759
11:15
In that moment,
173
663293
2131
Daquela,
para min era máis importante formar
parte deste universo
parte deste universo
11:17
just being any part of this planet
in this universe mattered more to me
in this universe mattered more to me
174
665448
4488
que se vivía ou morría.
11:21
than whether I lived or died.
175
669960
2099
A pequena bóla de neve
deume canta inspiración precisaba
deume canta inspiración precisaba
11:24
That little snowball packed
all the inspiration I needed
all the inspiration I needed
176
672083
3123
para intentar vivir e aceptar
se non o facía.
se non o facía.
11:27
to both try to live
and be OK if I did not.
and be OK if I did not.
177
675230
3205
11:31
In a hospital, that's a stolen moment.
178
679176
2884
Nun hospital, ese é un intre roubado.
11:36
In my work over the years,
I've known many people
I've known many people
179
684356
3389
Polo meu traballo, ao longo dos anos,
coñecín moita xente
coñecín moita xente
lista para marchar,
para morrer.
para morrer.
11:39
who were ready to go, ready to die.
180
687769
1827
11:43
Not because they had found
some final peace or transcendence,
some final peace or transcendence,
181
691192
4783
Non porque atoparan unha paz
final ou unha transcendencia,
final ou unha transcendencia,
mais polo rechazo que sentían
pola vida que tiñan.
pola vida que tiñan.
11:47
but because they were so repulsed
by what their lives had become --
by what their lives had become --
182
695999
4309
11:54
in a word, cut off, or ugly.
183
702553
4549
En poucas palabras, unha vida horrible.
12:03
There are already record numbers of us
living with chronic and terminal illness,
living with chronic and terminal illness,
184
711394
6086
Hai cifras de cantos de nós convivimos
con enfermidades crónicas ou terminais
con enfermidades crónicas ou terminais
e ata idades avanzadas.
12:09
and into ever older age.
185
717504
1452
12:11
And we are nowhere near ready
or prepared for this silver tsunami.
or prepared for this silver tsunami.
186
719947
4800
Non estamos preparados, nin nada que se
lle pareza, para o tsunami prateado.
lle pareza, para o tsunami prateado.
12:19
We need an infrastructure
dynamic enough to handle
dynamic enough to handle
187
727335
3261
Precisamos infraestructuras
suficientemente dinámicas para manexar
suficientemente dinámicas para manexar
estes movementos sísmicos
da nosa poboación.
da nosa poboación.
12:22
these seismic shifts in our population.
188
730620
4064
12:27
Now is the time to create
something new, something vital.
something new, something vital.
189
735637
3020
Agora é o momento de crear
algo novo, algo vital.
algo novo, algo vital.
Sei que podemos porque temos que facelo.
12:30
I know we can because we have to.
190
738681
2360
A alternativa é inaceptable.
12:33
The alternative is just unacceptable.
191
741065
2022
12:35
And the key ingredients are known:
192
743651
1882
E os elementos fundamentais son:
política, educación e adestramento,
12:37
policy, education and training,
193
745557
3674
sistemas, ladrillos e morteiro.
12:41
systems, bricks and mortar.
194
749255
2062
12:44
We have tons of input
for designers of all stripes to work with.
for designers of all stripes to work with.
195
752642
3806
Temos moreas de datos cos que deseñadores
de toda clase poden traballar.
de toda clase poden traballar.
12:49
We know, for example, from research
196
757123
1881
Por exemplo, sabemos por investigacións
que é o máis importante para a xente
que está ao bordo da morte:
que está ao bordo da morte:
12:51
what's most important to people
who are closer to death:
who are closer to death:
197
759028
3486
a comodidade, sentirse aliviado
e aliviar aos seres queridos,
e aliviar aos seres queridos,
12:54
comfort; feeling unburdened
and unburdening to those they love;
and unburdening to those they love;
198
762538
6965
13:01
existential peace; and a sense
of wonderment and spirituality.
of wonderment and spirituality.
199
769527
5242
a paz existencial e un sentimento
de asombro e espiritualidade.
de asombro e espiritualidade.
13:08
Over Zen Hospice's nearly 30 years,
200
776896
3758
Ao longo dos case 30 anos do Hospicio Zen
aprendemos moito máis
dos nosos residentes cos detalles sutiles.
dos nosos residentes cos detalles sutiles.
13:12
we've learned much more
from our residents in subtle detail.
from our residents in subtle detail.
201
780678
3643
13:17
Little things aren't so little.
202
785662
2465
Os pequenos detalles non son tan pequenos.
13:21
Take Janette.
203
789499
1174
Por exemplo, Janette.
Para ela, cada día é máis difícil respirar,
debido á ELA.
debido á ELA.
13:22
She finds it harder to breathe
one day to the next due to ALS.
one day to the next due to ALS.
204
790697
3487
Saben que?
13:26
Well, guess what?
205
794208
1150
13:28
She wants to start smoking again --
206
796121
3378
Ela quere volver a fumar
e que ademais sexan cigarros franceses,
se fan o favor.
se fan o favor.
13:31
and French cigarettes, if you please.
207
799523
2928
13:36
Not out of some self-destructive bent,
208
804786
2223
Non é ningún tipo de tendencia
autodestructiva.
autodestructiva.
Trátase de sentir encherse os seus pulmóns
mentres os fuma.
mentres os fuma.
13:39
but to feel her lungs filled
while she has them.
while she has them.
209
807033
3959
13:44
Priorities change.
210
812786
1197
As prioridades cambian.
13:47
Or Kate -- she just wants to know
211
815556
2471
Ou Kate. Quere saber
que o seu can Austin está
aos pés da súa cama,
aos pés da súa cama,
13:50
her dog Austin is lying
at the foot of her bed,
at the foot of her bed,
212
818051
4035
13:54
his cold muzzle against her dry skin,
213
822110
3717
co seu frío fociño contra a súa pel seca,
en lugar de máis quimioterapia
correndo polas súas venas.
correndo polas súas venas.
13:57
instead of more chemotherapy
coursing through her veins --
coursing through her veins --
214
825851
2723
E fíxoo.
14:00
she's done that.
215
828598
1181
14:02
Sensuous, aesthetic gratification,
where in a moment, in an instant,
where in a moment, in an instant,
216
830849
5016
Un detalle gratificante, sensual, estético
nun nomento, nun intre
nun nomento, nun intre
no que nos sentimos recompensados por vivir.
14:07
we are rewarded for just being.
217
835889
3352
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,
218
843373
4282
Tan só se trata de gozar do tempo
que se ten, aproveitando os sentidos,
que se ten, aproveitando os sentidos,
o corpo (precisamente, o que vive
e morre).
e morre).
14:19
by way of the body -- the very thing
doing the living and the dying.
doing the living and the dying.
219
847679
5292
14:26
Probably the most poignant room
220
854258
1559
Quizais, a sala máis conmovedora
do hospicio Zen é a nosa cociña.
14:27
in the Zen Hospice guest house
is our kitchen,
is our kitchen,
221
855841
2253
Isto é chamativo se temos en
conta
conta
14:30
which is a little strange when you realize
222
858118
2037
que a maior parte dos residentes
non poden comer case nada.
non poden comer case nada.
14:32
that so many of our residents
can eat very little, if anything at all.
can eat very little, if anything at all.
223
860179
3813
O que pasa é que, nela,
damos sustento a diferentes niveis:
damos sustento a diferentes niveis:
14:36
But we realize we are providing
sustenance on several levels:
sustenance on several levels:
224
864016
5870
olfacto, un plano simbólico.
14:41
smell, a symbolic plane.
225
869910
3066
14:46
Seriously, with all the heavy-duty stuff
happening under our roof,
happening under our roof,
226
874356
4917
De veras, con todas as tarefas duras que
levamos a cabo,
levamos a cabo,
unha das accións máis efectivas e
auténticas que coñecemos
auténticas que coñecemos
14:51
one of the most tried and true
interventions we know of,
interventions we know of,
227
879297
3734
é facer galletas.
14:55
is to bake cookies.
228
883055
3493
15:10
As long as we have our senses --
229
898144
1604
Mentres temos os sentidos...
aínda que só sexa un...
15:11
even just one --
230
899772
2012
temos a posibilidade de acceder
15:13
we have at least
the possibility of accessing
the possibility of accessing
231
901808
3409
ao que nos fai sentir humanos,
conectados.
conectados.
15:17
what makes us feel human, connected.
232
905241
3168
15:22
Imagine the ripples of this notion
233
910999
2786
Imaxinen as implicacións deste concepto
para os millóns que viven
e morren con demencia.
e morren con demencia.
15:25
for the millions of people
living and dying with dementia.
living and dying with dementia.
234
913809
2785
15:29
Primal sensorial delights that say
the things we don't have words for,
the things we don't have words for,
235
917554
4265
Praceres sensoriais primarios que din
cousas para as que non temos palabras,
cousas para as que non temos palabras,
impulsos que nos fan seguir presentes
15:33
impulses that make us stay present --
236
921843
2874
sen necesidade de pasado ou futuro.
15:36
no need for a past or a future.
237
924741
2805
15:42
So, if teasing unnecessary suffering out
of the system was our first design cue,
of the system was our first design cue,
238
930280
6194
Se aliviar o sufrimento innecesario
é o desafío número un do sistema,
é o desafío número un do sistema,
15:50
then tending to dignity
by way of the senses,
by way of the senses,
239
938559
2704
intentar acadar a dignidade
por medio dos sentidos,
por medio dos sentidos,
por medio do corpo
(a esfera estética)
(a esfera estética)
15:53
by way of the body --
the aesthetic realm --
the aesthetic realm --
240
941287
3792
é o desafío número dous.
15:57
is design cue number two.
241
945103
1857
15:59
Now this gets us quickly to the third
and final bit for today;
and final bit for today;
242
947944
3806
Isto lévanos ao terceiro
e último punto do día.
e último punto do día.
Precisamos elevar a nosa visión
sobre que é o benestar
sobre que é o benestar
16:03
namely, we need to lift our sights,
to set our sights on well-being,
to set our sights on well-being,
243
951774
6864
de xeito que a vida, a saúde
e a sanidade
e a sanidade
16:10
so that life and health and healthcare
244
958662
3313
traten de facer a vida
máis marabillosa
máis marabillosa
16:13
can become about making life
more wonderful,
more wonderful,
245
961999
2385
en lugar de menos horrible.
16:16
rather than just less horrible.
246
964408
2444
16:20
Beneficence.
247
968196
1156
A beneficencia.
16:22
Here, this gets right at the distinction
248
970999
2135
Neste punto, atopámonos coa diferenza
entre un sistema centrado na enfermidade ou
no coidado do paciente, da persoa.
no coidado do paciente, da persoa.
16:25
between a disease-centered and a patient-
or human-centered model of care,
or human-centered model of care,
249
973158
5134
Aí é cando coidar se converte nun acto
creativo, creador
creativo, creador
16:30
and here is where caring
becomes a creative, generative,
becomes a creative, generative,
250
978316
3461
e mesmo xoguetón.
16:33
even playful act.
251
981801
1842
16:36
"Play" may sound like a funny word here.
252
984657
2000
O termo "xogar" pode semellar raro neste
contexto,
contexto,
16:39
But it is also one of our
highest forms of adaptation.
highest forms of adaptation.
253
987687
2904
mais é unha das ferramentas de
adaptación máis importantes.
adaptación máis importantes.
Pensen en todos os esforzos
que esixe ser humano.
que esixe ser humano.
16:42
Consider every major compulsory effort
it takes to be human.
it takes to be human.
254
990615
4659
16:47
The need for food has birthed cuisine.
255
995298
2503
A necesidade de alimento,
impulsou a cociña.
impulsou a cociña.
A necesidade dun fogar,
deu lugar á arquitectura.
deu lugar á arquitectura.
16:49
The need for shelter
has given rise to architecture.
has given rise to architecture.
256
997825
2588
A necesidade de abrigo,
á moda.
á moda.
16:52
The need for cover, fashion.
257
1000437
2206
E ao estar sometidos ao tempo,
16:54
And for being subjected to the clock,
258
1002667
2731
inventamos a música.
16:57
well, we invented music.
259
1005422
3527
17:03
So, since dying
is a necessary part of life,
is a necessary part of life,
260
1011766
3209
Dado que morrer é unha parte
necesaria da vida,
necesaria da vida,
que podemos facer con isto?
17:06
what might we create with this fact?
261
1014999
2631
17:12
By "play" I am in no way suggesting
we take a light approach to dying
we take a light approach to dying
262
1020054
3376
Con "xogar" non intento que tomemos
á lixeira o tema da morte
á lixeira o tema da morte
ou que impoñamos ningunha
maneira de morrer.
maneira de morrer.
17:15
or that we mandate
any particular way of dying.
any particular way of dying.
263
1023454
2639
Hai montes de tristeza
que non podemos combater
que non podemos combater
17:18
There are mountains of sorrow
that cannot move,
that cannot move,
264
1026117
2858
e dun xeito ou doutro,
todos temos que afrontalos.
todos temos que afrontalos.
17:20
and one way or another,
we will all kneel there.
we will all kneel there.
265
1028999
3067
17:24
Rather, I am asking that we make space --
266
1032999
3501
Para iso, pido que creemos un espazo
(físico e psíquico) que permita á vida
marchar,
marchar,
17:28
physical, psychic room, to allow life
to play itself all the way out --
to play itself all the way out --
267
1036524
5743
en lugar de desaparecer sen máis.
17:34
so that rather than just
getting out of the way,
getting out of the way,
268
1042291
3357
Envellecer e morrer podería ser
un proceso de ascenso cara a fin.
un proceso de ascenso cara a fin.
17:37
aging and dying can become
a process of crescendo through to the end.
a process of crescendo through to the end.
269
1045672
4817
17:44
We can't solve for death.
270
1052931
3841
Non podemos evitar a morte.
17:50
I know some of you are working on this.
271
1058283
2307
Sei que algúns de vostedes traballan niso.
(Risas)
17:52
(Laughter)
272
1060614
3675
17:57
Meanwhile, we can --
273
1065003
1812
Mentres tanto, podemos...
17:58
(Laughter)
274
1066839
2016
(Risas)
deseñar o camiño ata chegar a ela.
18:00
We can design towards it.
275
1068879
2306
18:04
Parts of me died early on,
276
1072042
1375
Partes de min xa morreron.
18:05
and that's something we can all say
one way or another.
one way or another.
277
1073441
2764
Isto é algo que, por unha ou
outra razón, pásanos a todos.
outra razón, pásanos a todos.
18:08
I got to redesign my life
around this fact,
around this fact,
278
1076583
2641
Tiven que redeseñar a miña vida
en función a este feito,
en función a este feito,
e para min foi unha liberación
18:11
and I tell you it has been a liberation
279
1079248
3340
decatarme de que sempre hai
beleza ou un significado
beleza ou un significado
18:14
to realize you can always find
a shock of beauty or meaning
a shock of beauty or meaning
280
1082612
3155
no que a un lle depara a vida,
18:17
in what life you have left,
281
1085791
2267
como a bóla de neve, que fixo daquel
un momento perfecto
un momento perfecto
18:20
like that snowball lasting
for a perfect moment,
for a perfect moment,
282
1088082
2764
ata que se derreteu.
18:22
all the while melting away.
283
1090870
2298
18:26
If we love such moments ferociously,
284
1094700
6019
Se apreciamos eses instantes
con intensidade,
con intensidade,
podemos aprender a vivir ben,
18:32
then maybe we can learn to live well --
285
1100743
2272
non a pesar da morte,
18:35
not in spite of death,
286
1103039
2087
mais grazas a ela.
18:37
but because of it.
287
1105150
1586
18:42
Let death be what takes us,
288
1110520
2176
Deixemos que a morte nos guíe,
non perdamos a imaxinación.
18:44
not lack of imagination.
289
1112720
2862
18:48
Thank you.
290
1116868
1152
Grazas.
(Aplausos)
18:50
(Applause)
291
1118044
7920
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