TED2015
BJ Miller: What really matters at the end of life
BJ·米勒: 人生尽头有何求
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在人生的尽头，我们希望得到什么？对大多数人来说，是慰藉，尊重，爱。BJ·米勒是一名安宁病房医生，他深深思索如何给予他的病人一个端庄的，优雅的生命的结尾。花一片刻去品味这一个感人的演讲，其中有一些引人深思的问题，关于如何看待死亡，以及如何尊敬生命。
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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我们都需要一个醒来的理由。
00:18
For me, it just took 11,000 volts.
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对我来说是11,000伏特。
00:23
I know you're too polite to ask,
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我知道你们太礼貌了不会过问，
00:24
so I will tell you.
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那就让我告诉你们。
00:27
One night, sophomore year of college,
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在大学二年级，
00:29
just back from Thanksgiving holiday,
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感恩节假期后的一天晚上，
00:33
a few of my friends and I
were horsing around,
were horsing around,
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我和几个朋友闹着玩儿，
00:35
and we decided to climb atop
a parked commuter train.
a parked commuter train.
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决定爬到一列停在一旁的通勤列车顶上。
00:40
It was just sitting there,
with the wires that run overhead.
with the wires that run overhead.
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它就停在那儿，缆线就在车顶上方。
不知为什么，
这似乎在那个时候是一个好主意。
这似乎在那个时候是一个好主意。
00:43
Somehow, that seemed
like a great idea at the time.
like a great idea at the time.
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00:46
We'd certainly done stupider things.
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我们的确干过比这个还傻的事。
00:50
I scurried up the ladder on the back,
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我从后面的梯子窜了上去，
当我站起来的时候，
00:53
and when I stood up,
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一股电流进入了我的手臂，
00:55
the electrical current entered my arm,
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00:58
blew down and out my feet,
and that was that.
and that was that.
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一直到我的脚下然后就这样了。
01:03
Would you believe that watch still works?
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你能相信那块手表还没坏吗？
01:08
Takes a licking!
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真是金刚不坏！
（笑声）
01:09
(Laughter)
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01:10
My father wears it now in solidarity.
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我的父亲现在还一直戴着那块手表。
01:15
That night began my formal relationship
with death -- my death --
with death -- my death --
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那天晚上开启了我和死亡
正式的关系——我的死亡——
正式的关系——我的死亡——
01:21
and it also began
my long run as a patient.
my long run as a patient.
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也开始了我作为病人的漫长的旅程。
01:25
It's a good word.
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这是一个很合适的词。
01:26
It means one who suffers.
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它的意思是一个受苦的人。
01:28
So I guess we're all patients.
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我想我们应该都是病人吧。
01:31
Now, the American health care system
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美国的医疗保健系统
01:33
has more than its fair share
of dysfunction --
of dysfunction --
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有不少的功能障碍——
01:37
to match its brilliance, to be sure.
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当然，它也有杰出的方面。
01:39
I'm a physician now,
a hospice and palliative medicine doc,
a hospice and palliative medicine doc,
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我现在是一名医生，
安宁病房和临终关怀医生，
安宁病房和临终关怀医生，
01:44
so I've seen care from both sides.
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所以我从两个角度看医疗系统。
01:47
And believe me: almost everyone
who goes into healthcare
who goes into healthcare
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相信我：几乎每一个从事医疗的人
01:50
really means well -- I mean, truly.
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都是十分好心的——是真的。
01:54
But we who work in it
are also unwitting agents
are also unwitting agents
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但是我们这些从事医疗的人也是
01:58
for a system that too often
does not serve.
does not serve.
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在一个有许多缺陷的系统中工作。
02:03
Why?
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为什么呢？
02:05
Well, there's actually a pretty easy
answer to that question,
answer to that question,
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其实有一个很简单的答案，
02:09
and it explains a lot:
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而且也能反映很多事情：
02:11
because healthcare was designed
with diseases, not people, at its center.
with diseases, not people, at its center.
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因为医疗系统的设计是针对疾病的，
而病人不是焦点，
而病人不是焦点，
02:18
Which is to say, of course,
it was badly designed.
it was badly designed.
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也就是说这个设计是有问题的。
02:22
And nowhere are the effects
of bad design more heartbreaking
of bad design more heartbreaking
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而在生命的尽头，不良的设计的影响
02:28
or the opportunity
for good design more compelling
for good design more compelling
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更加让人心痛，完善的设计的机会
02:31
than at the end of life,
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也显得更有必要，
02:33
where things are so distilled
and concentrated.
and concentrated.
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因为在生命的尽头，
所有的东西都是浓缩下来的精华。
所有的东西都是浓缩下来的精华。
02:38
There are no do-overs.
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没有重新来过的机会。
02:42
My purpose today is
to reach out across disciplines
to reach out across disciplines
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我今天的目的就是号召各个领域的人们，
02:46
and invite design thinking
into this big conversation.
into this big conversation.
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邀请大家把设计思维带入这个大话题中。
02:51
That is, to bring intention and creativity
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也就是将好意和创意
02:56
to the experience of dying.
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带入濒死的经历。
03:01
We have a monumental
opportunity in front of us,
opportunity in front of us,
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这是一个十分难得的机会，
03:05
before one of the few universal issues
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这是一个会影响到个人，
以及整个社会的
以及整个社会的
03:09
as individuals as well as a civil society:
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普遍问题之一：
03:12
to rethink and redesign how it is we die.
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重新思考并设计我们如何面对死亡。
03:19
So let's begin at the end.
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我们从终点开始谈起。
03:23
For most people, the scariest thing
about death isn't being dead,
about death isn't being dead,
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对大多数人来说，
变成死人并不是死亡最可怕的部分，
变成死人并不是死亡最可怕的部分，
03:27
it's dying, suffering.
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最可怕的是垂死，病痛。
03:29
It's a key distinction.
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这是一个关键的区别。
03:32
To get underneath this,
it can be very helpful
it can be very helpful
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为了更好地领会这一切，
那就非常有必要
那就非常有必要
03:34
to tease out suffering
which is necessary as it is,
which is necessary as it is,
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区分一下死亡无法避免的痛苦
03:39
from suffering we can change.
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和我们可以改变的痛苦。
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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前者是一个自然的，
生命中必不可少的一部分，
生命中必不可少的一部分，
03:47
and to this we are called
to make space, adjust, grow.
to make space, adjust, grow.
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于是我们为自己预留空间，调整，成长。
03:55
It can be really good
to realize forces larger than ourselves.
to realize forces larger than ourselves.
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能够认识到有比自己更强大的力量是件好事。
04:01
They bring proportionality,
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这能够带给我们均衡性，
04:04
like a cosmic right-sizing.
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一个全新的自我认识。
04:08
After my limbs were gone,
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在我失去肢体之后，
04:11
that loss, for example,
became fact, fixed --
became fact, fixed --
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这个损失变成了一个事实，无法改变——
04:15
necessarily part of my life,
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这变成了我生活中的一部分，
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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我认识到抵触这个事实就是在抵触自己。
04:27
It took me a while,
but I learned it eventually.
but I learned it eventually.
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过了一段时间，我才最终认识到这一点。
04:30
Now, another great thing
about necessary suffering
about necessary suffering
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这种不可避免的痛苦的另一个好处
04:33
is that it is the very thing
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是它最能够
04:36
that unites caregiver and care receiver --
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团结照顾者和被看护者——
04:41
human beings.
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增进人与人之间的关系。
04:45
This, we are finally realizing,
is where healing happens.
is where healing happens.
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我们意识到这就是痊愈的开始。
04:49
Yes, compassion -- literally,
as we learned yesterday --
as we learned yesterday --
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是的，同情——就像我们昨天所学的——
04:53
suffering together.
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一起承担。
04:56
Now, on the systems side,
on the other hand,
on the other hand,
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从另一方面，从医疗系统的角度来看，
05:00
so much of the suffering
is unnecessary, invented.
is unnecessary, invented.
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有许多痛苦都是没有必要的，制造出来的。
05:04
It serves no good purpose.
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没有任何意义。
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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但是好消息是：既然这种痛苦是人为造成的，
05:10
well, we can change it.
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那我们就可以改变它。
05:13
How we die is indeed
something we can affect.
something we can affect.
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如何死亡确实是我们可以改变的。
05:18
Making the system sensitive
to this fundamental distinction
to this fundamental distinction
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让整个系统辨别不可避免的痛苦
05:22
between necessary
and unnecessary suffering
and unnecessary suffering
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和没有必要的痛苦之间的最基本的区别
05:25
gives us our first of three
design cues for the day.
design cues for the day.
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给予了我们三个中第一个的设计暗示。
05:30
After all, our role as caregivers,
as people who care,
as people who care,
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毕竟我们作为照顾者的角色，
05:34
is to relieve suffering --
not add to the pile.
not add to the pile.
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照顾病人是去减轻他的痛苦，
而不是雪上加霜。
而不是雪上加霜。
05:42
True to the tenets of palliative care,
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这是缓和医疗的原则，
05:44
I function as something
of a reflective advocate,
of a reflective advocate,
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我的职责就是当一个支持者，
05:47
as much as prescribing physician.
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就像一个处方医生一样。
05:51
Quick aside: palliative care -- a very
important field but poorly understood --
important field but poorly understood --
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顺便提一下：缓和医疗——是一个非常重要的
工作领域，但是经常被误解——
工作领域，但是经常被误解——
05:57
while it includes, it is not
limited to end of life care.
limited to end of life care.
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它涵盖，但不仅限于病人临终前。
06:00
It is not limited to hospice.
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不仅限于安宁病房。
06:02
It's simply about comfort
and living well at any stage.
and living well at any stage.
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而是在任何一个阶段
都有舒适的生活品质。
都有舒适的生活品质。
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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所以不一定是在病人临终前
06:10
to benefit from palliative care.
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才能得到安宁缓和医疗。
06:13
Now, let me introduce you to Frank.
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现在，让我给你们介绍一下弗兰克。
06:17
Sort of makes this point.
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他可以证明这一点。
06:19
I've been seeing Frank now for years.
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我照顾弗兰克好多年了。
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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他患有前列腺癌，外加艾滋病。
06:26
We work on his bone pain and his fatigue,
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我们针对治疗他的骨痛和疲倦问题，
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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但是我们大多时间都在一起思考他的人生——
06:32
really, about our lives.
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其实，就是我们的人生。
06:35
In this way, Frank grieves.
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弗兰克用这种方法表达他的悲痛。
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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他用这种方法面对他所失去的一切，
06:41
so that he's ready to take in
the next moment.
the next moment.
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这样他才能去面对下一个难题。
06:45
Loss is one thing,
but regret, quite another.
but regret, quite another.
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失去是一回事儿，而后悔是另一回事儿。
06:51
Frank has always been an adventurer --
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弗兰克一直是一个探险家——
06:53
he looks like something
out of a Norman Rockwell painting --
out of a Norman Rockwell painting --
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他看上去像诺曼·洛克威尔的画里的人物——
06:56
and no fan of regret.
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他从不后悔。
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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所以我一点都不惊讶有一天他来到诊所，
07:01
saying he wanted to raft
down the Colorado River.
down the Colorado River.
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跟我说他想泛竹筏从科罗拉多河顺流而下。
07:05
Was this a good idea?
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这是一个好主意吗？
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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考虑到他的人身安全和健康情况，
有些人会说这不行。
有些人会说这不行。
07:11
Many did, but he went for it,
while he still could.
while he still could.
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很多人都这么说，但是他依旧去了，
趁他还有能力去的时候。
趁他还有能力去的时候。
07:15
It was a glorious, marvelous trip:
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那是一个美好，奇妙的旅程：
07:20
freezing water, blistering dry heat,
scorpions, snakes,
scorpions, snakes,
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冰凉的水，干热的酷暑，蝎子，蛇，
07:26
wildlife howling off the flaming walls
of the Grand Canyon --
of the Grand Canyon --
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大峡谷似火的岩壁上各种野生动物的嚎叫——
07:31
all the glorious side of the world
beyond our control.
beyond our control.
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都是我们无法控制的世界的壮丽的一面。
07:36
Frank's decision, while maybe dramatic,
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弗兰克的决定，或许有些戏剧性，
07:38
is exactly the kind
so many of us would make,
so many of us would make,
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但是如果我们有我们所需要的支持，
去寻找做最有利于自己的选择，
去寻找做最有利于自己的选择，
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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那我们大多数人可能都会做出这样的选择。
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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今天聊到的许多都是从不同角度看问题。
07:54
After my accident,
when I went back to college,
when I went back to college,
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在我的事故发生之后，我回到了大学，
07:56
I changed my major to art history.
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我把我的主修改成了艺术史。
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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在学习视觉艺术的过程中，
我发现我学会了如何去观察——
我发现我学会了如何去观察——
08:05
a really potent lesson
for a kid who couldn't change
for a kid who couldn't change
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对于一个无法改变过去所见的孩子来说，
08:09
so much of what he was seeing.
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那是强有力有的一课。
08:12
Perspective, that kind of alchemy
we humans get to play with,
we humans get to play with,
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观点是一种人们可以改变的炼金术，
08:16
turning anguish into a flower.
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可以把煎熬变成花朵。
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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往前快进：
现在我在旧金山一个很棒的地方工作，
现在我在旧金山一个很棒的地方工作，
08:25
called the Zen Hospice Project,
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叫做禅宗安宁病房项目。
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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在那里我们会举行一个小仪式
帮助我们换一个角度看问题。
帮助我们换一个角度看问题。
08:32
When one of our residents dies,
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当我们的一个病人去世后，
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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太平间的人会来，
当我们推他的遗体车穿过花园时，
当我们推他的遗体车穿过花园时，
08:39
heading for the gate, we pause.
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在大门前，我们会停留片刻。
08:42
Anyone who wants --
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任何人——
08:44
fellow residents, family,
nurses, volunteers,
nurses, volunteers,
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其他的住客，家人，护士，志愿者，
08:46
the hearse drivers too, now --
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还有灵车司机——
08:49
shares a story or a song or silence,
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如果他们愿意，他们会分享一段故事，
一首歌，或者简单的沉默，
一首歌，或者简单的沉默，
08:53
as we sprinkle the body
with flower petals.
with flower petals.
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同时，我们在遗体上撒花瓣；
08:57
It takes a few minutes;
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只有几分钟的时间；
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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这是个很美好，简单的告别场景，
用温暖迎接悲痛，
用温暖迎接悲痛，
09:04
rather than repugnance.
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而不是厌恶。
09:08
Contrast that with the typical experience
in the hospital setting,
in the hospital setting,
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把这个和普通的医院中的环境对比，
09:13
much like this -- floodlit room
lined with tubes and beeping machines
lined with tubes and beeping machines
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差不多跟这个一样——灯光照明的房间中
排满各种管子和嘟嘟叫的机器，
排满各种管子和嘟嘟叫的机器，
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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还有不停闪烁的灯光，
尽管病人的生命已经停止了。
尽管病人的生命已经停止了。
09:23
Cleaning crew swoops in,
the body's whisked away,
the body's whisked away,
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清理人员立即进来，遗体被快速地接走，
09:26
and it all feels as though that person
had never really existed.
had never really existed.
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然后就好像那个人从来没有存在过似的。
09:33
Well-intended, of course,
in the name of sterility,
in the name of sterility,
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从卫生角度考虑，他们的做法当然有道理，
09:35
but hospitals tend to assault our senses,
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但是医院很容易侵犯我们的感官，
09:39
and the most we might hope for
within those walls is numbness --
within those walls is numbness --
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在那四面墙内，我们最多也只能期盼麻木——
09:44
anesthetic, literally
the opposite of aesthetic.
the opposite of aesthetic.
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麻木不仁，字面意思上和美感完全相反。
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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我敬仰医院所做的一切，
因为有它们我现在还活着。
因为有它们我现在还活着。
09:56
But we ask too much of our hospitals.
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但是我们对医院的要求太高了。
09:59
They are places for acute trauma
and treatable illness.
and treatable illness.
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它们是处理急性创伤和可治疗疾病的地方。
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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它们不是应对生死的地方；
它们不是为这个而设计的。
它们不是为这个而设计的。
10:10
Now mind you -- I am not
giving up on the notion
giving up on the notion
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提醒一下——我并没有放弃把
10:12
that our institutions
can become more humane.
can become more humane.
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我们的医疗机构变得更加人性化的想法。
10:16
Beauty can be found anywhere.
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任何地方都有美好的事物。
10:21
I spent a few months in a burn unit
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我在在新泽西州利文斯顿的圣巴纳巴斯医院
10:23
at St. Barnabas Hospital
in Livingston, New Jersey,
in Livingston, New Jersey,
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烧伤科呆了几个月。
10:26
where I got really
great care at every turn,
great care at every turn,
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我在那里得到无微不至的照顾，
10:30
including good
palliative care for my pain.
palliative care for my pain.
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包括针对我的病痛的缓和治疗。、
10:33
And one night, it began to snow outside.
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有一天晚上，外面开始下雪。
10:37
I remember my nurses
complaining about driving through it.
complaining about driving through it.
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我记得我的护士抱怨在雪天开车。
10:42
And there was no window in my room,
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我的房间没有窗户，
10:44
but it was great to just imagine it
coming down all sticky.
coming down all sticky.
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但是能想象迷漫的雪花也很好。
10:49
Next day, one of my nurses
smuggled in a snowball for me.
smuggled in a snowball for me.
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第二天，有一个护士为我偷偷地带进来一个雪球。
10:53
She brought it in to the unit.
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她把雪球带到烧伤中心里面。
10:56
I cannot tell you the rapture I felt
holding that in my hand,
holding that in my hand,
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我无法描述我用手捧着雪球
那种欣喜若狂的感觉，
那种欣喜若狂的感觉，
11:02
and the coldness dripping
onto my burning skin;
onto my burning skin;
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一股股寒意滴在我滚烫的皮肤上；
11:05
the miracle of it all,
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这一切有多么神奇，
11:07
the fascination as I watched it melt
and turn into water.
and turn into water.
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我入迷地看着它融化成水。
11:15
In that moment,
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在那一刻，
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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能够属于这个星球上，
这个宇宙中任何一个部分对我来说
这个宇宙中任何一个部分对我来说
11:21
than whether I lived or died.
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比我的生与死还要重要。
11:24
That little snowball packed
all the inspiration I needed
all the inspiration I needed
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那个小小的雪球包含了一切我所需要的鼓舞，
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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无论我试着活下去，
还是接受死亡都可以接受。
还是接受死亡都可以接受。
11:31
In a hospital, that's a stolen moment.
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在医院里，那是我珍藏的一段回忆。
11:36
In my work over the years,
I've known many people
I've known many people
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在我多年的工作中，我结交了许多
11:39
who were ready to go, ready to die.
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愿意离开，准备好接受死亡的人。
11:43
Not because they had found
some final peace or transcendence,
some final peace or transcendence,
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并不是因为他们找到了
最终的安乐或者超越，
最终的安乐或者超越，
11:47
but because they were so repulsed
by what their lives had become --
by what their lives had become --
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而是因为他们被他们
生命中的转折击退了——
生命中的转折击退了——
11:54
in a word, cut off, or ugly.
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有一个词，也就是隔绝，丑陋。
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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生活在长期病痛中和患有绝症的人
已经是历史新高了，
已经是历史新高了，
12:09
and into ever older age.
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年龄也不断攀升。
12:11
And we are nowhere near ready
or prepared for this silver tsunami.
or prepared for this silver tsunami.
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而我们丝毫没有准备好迎接这个银色海啸。
12:19
We need an infrastructure
dynamic enough to handle
dynamic enough to handle
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我们需要一个有足够动力的
基础设施去应对
基础设施去应对
12:22
these seismic shifts in our population.
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这些人口比例的重大变化。
12:27
Now is the time to create
something new, something vital.
something new, something vital.
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现在正是时候去创造一个
全新的，重要的系统。
全新的，重要的系统。
12:30
I know we can because we have to.
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我知道我们可以成功，
因为我们必须要这么做。
因为我们必须要这么做。
12:33
The alternative is just unacceptable.
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我们没有选择的余地。
12:35
And the key ingredients are known:
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而且，我们已经把握住关键的因素了：
12:37
policy, education and training,
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政策，教育和训练，
12:41
systems, bricks and mortar.
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系统，砖块和砂浆。
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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我们有无数的信息可以供设计师参考搭建。
12:49
We know, for example, from research
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比如说，从调查研究中，我们可以得知
12:51
what's most important to people
who are closer to death:
who are closer to death:
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对于临终的人而言，什么更加重要：
12:54
comfort; feeling unburdened
and unburdening to those they love;
and unburdening to those they love;
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舒适；没有任何负担，也不牵累他们爱的人；
13:01
existential peace; and a sense
of wonderment and spirituality.
of wonderment and spirituality.
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心境平静；充满感叹和灵性的感觉。
13:08
Over Zen Hospice's nearly 30 years,
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在禅宗安宁病房将近30年的历史中，
13:12
we've learned much more
from our residents in subtle detail.
from our residents in subtle detail.
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我们从我们的住客的
微妙的细节中学到了很多。
微妙的细节中学到了很多。
13:17
Little things aren't so little.
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有些东西没有它看上去那么小。
13:21
Take Janette.
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拿珍妮特举例。
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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因为她患有渐冻人症，
每一天她的呼吸都会变得更加困难。
每一天她的呼吸都会变得更加困难。
13:26
Well, guess what?
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你们猜怎么样？
13:28
She wants to start smoking again --
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她又开始想抽烟了——
13:31
and French cigarettes, if you please.
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还是法国香烟，如果可以的话。
13:36
Not out of some self-destructive bent,
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并不是因为自我摧残的倾向，
13:39
but to feel her lungs filled
while she has them.
while she has them.
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而是想在她还有肺的时候，
去感受她的肺被充满的感觉。
去感受她的肺被充满的感觉。
13:44
Priorities change.
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优先顺序不同了。
13:47
Or Kate -- she just wants to know
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还有凯特——她只想感受着
13:50
her dog Austin is lying
at the foot of her bed,
at the foot of her bed,
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她的狗狗奥斯丁躺在她的床脚，
13:54
his cold muzzle against her dry skin,
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他冷冷的鼻子贴着她干燥的皮肤，
13:57
instead of more chemotherapy
coursing through her veins --
coursing through her veins --
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而不是让更多的化疗流淌在她的血液中——
14:00
she's done that.
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她已经经历过了。
14:02
Sensuous, aesthetic gratification,
where in a moment, in an instant,
where in a moment, in an instant,
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在一刹那间，能够感受到美感的满足
14:07
we are rewarded for just being.
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立刻成为我们活着的奖励。
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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这种感觉在我们珍爱的时间中
通过感官和我们的身体——
通过感官和我们的身体——
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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也就是正在经历生命和死亡的东西。
14:26
Probably the most poignant room
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也许在禅宗安宁病房中
14:27
in the Zen Hospice guest house
is our kitchen,
is our kitchen,
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最凄凉的地方是我们的厨房，
14:30
which is a little strange when you realize
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你肯定觉得这有点奇怪，
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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因为有许多住在病房中的人
就算能进食，也只能很少量。
就算能进食，也只能很少量。
14:36
But we realize we are providing
sustenance on several levels:
sustenance on several levels:
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但是我们意识到这样可以在
许多层面上给他们提供支持：
许多层面上给他们提供支持：
14:41
smell, a symbolic plane.
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比如嗅觉，一个象征性的平面。
14:46
Seriously, with all the heavy-duty stuff
happening under our roof,
happening under our roof,
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真的，在我们的病房中所有的重大责任中，
14:51
one of the most tried and true
interventions we know of,
interventions we know of,
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其中我们所知的尝试过多次，
也是最真切的治疗方法，
也是最真切的治疗方法，
14:55
is to bake cookies.
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是烘焙饼干。
15:10
As long as we have our senses --
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只要我们还有感官——
15:11
even just one --
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哪怕只有一个——
15:13
we have at least
the possibility of accessing
the possibility of accessing
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我们至少还有可以接触
15:17
what makes us feel human, connected.
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人性的感觉，和世界连接。
15:22
Imagine the ripples of this notion
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对于全世界数百万的与痴呆症
15:25
for the millions of people
living and dying with dementia.
living and dying with dementia.
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生死搏斗的人来说，
我们可以想象一下这个观点的效应。
我们可以想象一下这个观点的效应。
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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最原始的感官上的愉悦是我们无法用语言描述的，
15:33
impulses that make us stay present --
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是使我们珍惜当下的冲动——
15:36
no need for a past or a future.
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2805
不需要回到过去或者展望未来。
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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如果把不必要的痛苦从系统中剔除
是我们的第一个设计提示的话，
是我们的第一个设计提示的话，
15:50
then tending to dignity
by way of the senses,
by way of the senses,
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2704
那么给予人们感官上的，
15:53
by way of the body --
the aesthetic realm --
the aesthetic realm --
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身体上的尊严——
美感的境界——
美感的境界——
15:57
is design cue number two.
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则是我们的第二个设计提示。
15:59
Now this gets us quickly to the third
and final bit for today;
and final bit for today;
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这也把我们带到今天
第三个和最后一个部分；
第三个和最后一个部分；
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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6864
也就是，我们需要提高眼界，
把重点放在人们的福祉上，
把重点放在人们的福祉上，
16:10
so that life and health and healthcare
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为的是生命，健康和医疗
16:13
can become about making life
more wonderful,
more wonderful,
245
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可以使生活变得更加美好，
16:16
rather than just less horrible.
246
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2444
而不只是少几分可怕。
16:20
Beneficence.
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1156
慈善。
16:22
Here, this gets right at the distinction
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区别就在这儿，
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
在一个以疾病为核心
和一个以人为核心的医疗模式之间，
和一个以人为核心的医疗模式之间，
16:30
and here is where caring
becomes a creative, generative,
becomes a creative, generative,
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3461
在这儿，医疗变成了一种有创意、生产力，
16:33
even playful act.
251
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甚至好玩的举动。
16:36
"Play" may sound like a funny word here.
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“玩”在这里是一个很有趣的词。
16:39
But it is also one of our
highest forms of adaptation.
highest forms of adaptation.
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2904
但它也是我们适应的最高境界之一。
16:42
Consider every major compulsory effort
it takes to be human.
it takes to be human.
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想一想人类每一个不可缺少的需求。
16:47
The need for food has birthed cuisine.
255
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2503
我们对食物的需求带来了烹饪。
16:49
The need for shelter
has given rise to architecture.
has given rise to architecture.
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2588
我们对遮风避雨的需求构成了建筑。
16:52
The need for cover, fashion.
257
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2206
我们对遮蔽身体的需求促成了时尚。
16:54
And for being subjected to the clock,
258
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2731
而因为我们要服从于时间，
16:57
well, we invented music.
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3527
我们发明了音乐。
17:03
So, since dying
is a necessary part of life,
is a necessary part of life,
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那么，既然死亡也是生命中
必不可少的一部分，
必不可少的一部分，
17:06
what might we create with this fact?
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我们又能创造出什么呢？
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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3376
说到“玩”，我决不是
在提议我们轻视死亡
在提议我们轻视死亡
17:15
or that we mandate
any particular way of dying.
any particular way of dying.
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2639
或者指定某种特定的死亡方式。
17:18
There are mountains of sorrow
that cannot move,
that cannot move,
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2858
有许多悲伤是我们无法消除的，
17:20
and one way or another,
we will all kneel there.
we will all kneel there.
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3067
无论如何，我们都会屈服于它的。
17:24
Rather, I am asking that we make space --
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3501
我只是希望大家可以创造一点空间——
17:28
physical, psychic room, to allow life
to play itself all the way out --
to play itself all the way out --
267
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5743
生理和心理上的空间，
让生命自己走完它的路——
让生命自己走完它的路——
17:34
so that rather than just
getting out of the way,
getting out of the way,
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3357
而不是把它赶走，
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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4817
衰老和临终可以变成
一个渐强的过程一直到结尾。
一个渐强的过程一直到结尾。
17:44
We can't solve for death.
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3841
我们无法避免死亡。
17:50
I know some of you are working on this.
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我知道你们有些人在尝试。
17:52
(Laughter)
272
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3675
（笑声）
17:57
Meanwhile, we can --
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1812
在此同时，我们可以——
17:58
(Laughter)
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2016
（笑声）
18:00
We can design towards it.
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我们可以针对死亡做设计。
18:04
Parts of me died early on,
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我的一部分很早以前就已经死了，
18:05
and that's something we can all say
one way or another.
one way or another.
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不管怎么说，事实就是这样。
18:08
I got to redesign my life
around this fact,
around this fact,
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但是我针对这个事实重新设计了我的人生，
18:11
and I tell you it has been a liberation
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当你意识到你在生命中
18:14
to realize you can always find
a shock of beauty or meaning
a shock of beauty or meaning
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永远可以找到
美好的事物和有意义的事情时，
美好的事物和有意义的事情时，
18:17
in what life you have left,
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我可以告诉你们这是一种解放。
18:20
like that snowball lasting
for a perfect moment,
for a perfect moment,
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就像那个停留在完美的一瞬间的雪球，
18:22
all the while melting away.
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同时一直在融化。
18:26
If we love such moments ferociously,
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如果我们能够拼尽全力去爱那些片刻，
18:32
then maybe we can learn to live well --
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也许我们就能学会如何活得更加精彩——
18:35
not in spite of death,
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不是不顾死亡而活得精彩，
18:37
but because of it.
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而是因为死亡而活得精彩。
18:42
Let death be what takes us,
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可以让死亡夺走我们的生命，
18:44
not lack of imagination.
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但别让它带走我们的想象力。
18:48
Thank you.
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谢谢
18:50
(Applause)
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（掌声）
Reviewed by Huazhe Xie
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