ABOUT THE SPEAKER
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.

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.

More profile about the speaker
BJ Miller | Speaker | TED.com
TED2015

BJ Miller: What really matters at the end of life

BJ Miller: O que realmente importa ao final da vida

Filmed:
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.
- 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

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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Todos precisamos dunha razón
para erguernos.
00:18
For me, it just took 11,000 volts.
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A min, costoume soamente 11.000 voltios.
00:23
I know you're too polite to ask,
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Son educados demais
para preguntar,
00:24
so I will tell you.
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así que contareillelo.
00:27
One night, sophomore year of college,
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Unha noite do segundo ano de universidade,
ao volver de acción de grazas,
00:29
just back from Thanksgiving holiday,
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estaba cuns amigos armando
barullo
00:33
a few of my friends and I
were horsing around,
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e decidín subir ao teito
dun tren de cercanías aparcado.
00:35
and we decided to climb atop
a parked commuter train.
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00:40
It was just sitting there,
with the wires that run overhead.
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Estaba alí,
cos cables enriba del.
Por algunha razón, pareceume
unha idea moi boa.
00:43
Somehow, that seemed
like a great idea at the time.
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00:46
We'd certainly done stupider things.
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Certo é que fixeramos cousas máis
estúpidas.
00:50
I scurried up the ladder on the back,
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Subín pola escaleira de atrás
00:53
and when I stood up,
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e cando me puxen de pé,
00:55
the electrical current entered my arm,
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a corrente eléctrica entroume polo brazo,
derriboume e saiume polos pés
e iso foi todo.
00:58
blew down and out my feet,
and that was that.
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01:03
Would you believe that watch still works?
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Poden crer que ese reloxo aínda funciona?
01:08
Takes a licking!
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Costoume unha malleira!
01:09
(Laughter)
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(Risas)
O meu pai lévao agora en solidariedade.
01:10
My father wears it now in solidarity.
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01:15
That night began my formal relationship
with death -- my death --
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Esa noite comezou a miña relación
coa morte (a miña morte),
01:21
and it also began
my long run as a patient.
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e a miña carreira
como paciente.
É unha boa palabra.
01:25
It's a good word.
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01:26
It means one who suffers.
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Paciente significa o que sufre.
01:28
So I guess we're all patients.
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Creo que todos o somos.
01:31
Now, the American health care system
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Agora, o sistema sanitario americano
ten unha máis que xusta taxa
de disfunción,
01:33
has more than its fair share
of dysfunction --
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equiparable á súa brillantez.
01:37
to match its brilliance, to be sure.
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01:39
I'm a physician now,
a hospice and palliative medicine doc,
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Agora son médico, un doutor
de coidados terminais e paliativos,
polo que coñezo as dúas partes.
01:44
so I've seen care from both sides.
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01:47
And believe me: almost everyone
who goes into healthcare
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Créanme: case todos os que acuden
aos servizos sanitarios,
van realmente, quero dicir, de verdade.
01:50
really means well -- I mean, truly.
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01:54
But we who work in it
are also unwitting agents
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Pero os que traballamos neles,
somos tamén axentes involuntarios
dun sistema que non funciona
demasiado a miúdo.
01:58
for a system that too often
does not serve.
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02:03
Why?
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Por que?
02:05
Well, there's actually a pretty easy
answer to that question,
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Bueno, a resposta para esa pregunta
é sinxela
e explica moitas cousas:
02:09
and it explains a lot:
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02:11
because healthcare was designed
with diseases, not people, at its center.
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os servizos sanitarios céntranse
nas enfermidades, non nas persoas.
02:18
Which is to say, of course,
it was badly designed.
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Por iso, obviamente,
deseñáronse mal.
02:22
And nowhere are the effects
of bad design more heartbreaking
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E non hai un intre no que o mal deseño
sexa máis descorazonador
02:28
or the opportunity
for good design more compelling
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ou máis atractiva a posibilidade
dun bo deseño
02:31
than at the end of life,
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que ao final da vida,
02:33
where things are so distilled
and concentrated.
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momento no que as cousas son tan intensas.
02:38
There are no do-overs.
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Non hai segundas oportunidades.
02:42
My purpose today is
to reach out across disciplines
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O meu obxectivo hoxe é superar
as distintas disciplinas
e convidar ao pensamento creativo
a esta conversa.
02:46
and invite design thinking
into this big conversation.
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02:51
That is, to bring intention and creativity
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É dicir, atraer as boas intencións
e a creatividade
á experiencia de morrer.
02:56
to the experience of dying.
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03:01
We have a monumental
opportunity in front of us,
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Temos unha oportunidade tremenda
diante de nós,
ante un dos poucos temas universais
03:05
before one of the few universal issues
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que nos afecta como individuos
e como sociedade:
03:09
as individuals as well as a civil society:
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repensar e redeseñar como morremos.
03:12
to rethink and redesign how it is we die.
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03:19
So let's begin at the end.
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Así que comecemos polo final.
03:23
For most people, the scariest thing
about death isn't being dead,
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Á maioría, o que máis medo lle dá
de morrer, non é a morte,
é estar morrendo, sufrindo.
03:27
it's dying, suffering.
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03:29
It's a key distinction.
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Esa é a principal diferenza.
03:32
To get underneath this,
it can be very helpful
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Para chegar ao fondo disto,
pode axudar moito
03:34
to tease out suffering
which is necessary as it is,
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coñecer o sufrimento,
que é preciso tal como é
porque grazas a el podése cambiar.
03:39
from suffering we can change.
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03:42
The former is a natural,
essential part of life, part of the deal,
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O pasado é unha parte esencial da vida,
é unha parte da experiencia,
á que lle hai que facer sitio,
adaptarse e crecer grazas a ela.
03:47
and to this we are called
to make space, adjust, grow.
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03:55
It can be really good
to realize forces larger than ourselves.
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É moi bo comprender forzas
que son superiores a nós.
04:01
They bring proportionality,
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Achega proporcionalidade,
como un redimensionamento cósmico.
04:04
like a cosmic right-sizing.
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04:08
After my limbs were gone,
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Despois de perder as miñas extremidades,
esa perda, por exemplo,
converteuse nun feito, permanente
04:11
that loss, for example,
became fact, fixed --
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e que é necesariamente parte da miña vida
04:15
necessarily part of my life,
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e aprendín que non podía rexeitar
este feito máis que a min mesmo.
04:19
and I learned that I could no more
reject this fact than reject myself.
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04:27
It took me a while,
but I learned it eventually.
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Levoume un pouco,
pero co tempo entendino.
04:30
Now, another great thing
about necessary suffering
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Agora, outra gran cousa sobre
o sufrimento necesario
é que é o único
04:33
is that it is the very thing
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que une ao coidador e ao coidado,
04:36
that unites caregiver and care receiver --
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ambos seres humanos.
04:41
human beings.
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04:45
This, we are finally realizing,
is where healing happens.
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Neste punto é cando se
produce a curación.
04:49
Yes, compassion -- literally,
as we learned yesterday --
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Si, a compaixón, literalmente,
sufrir xuntos.
04:53
suffering together.
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04:56
Now, on the systems side,
on the other hand,
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Agora, con respecto aos sistemas,
tanto sufrimento é innecesario,
inventado
05:00
so much of the suffering
is unnecessary, invented.
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05:04
It serves no good purpose.
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e non serve para nada.
Pero a boa noticia é que, desde que
se inventou a marca do sufrimento,
05:06
But the good news is,
since this brand of suffering is made up,
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podemos cambialo.
05:10
well, we can change it.
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05:13
How we die is indeed
something we can affect.
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Podemos influír no xeito
de morrer.
05:18
Making the system sensitive
to this fundamental distinction
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Facer que o sistema sexa sensible
en canto á diferenza
entre o sufrimento necesario
e o innecesario
05:22
between necessary
and unnecessary suffering
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danos a primeira das tres cuestións
sobre o deseño que abordaremos hoxe.
05:25
gives us our first of three
design cues for the day.
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05:30
After all, our role as caregivers,
as people who care,
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A fin de contas, a nosa función como
coidadores, persoas que coidan
é aliviar a dor, non acrecentala.
05:34
is to relieve suffering --
not add to the pile.
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05:42
True to the tenets of palliative care,
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Segundo as bases do
coidado paliativo,
eu son como un defensor reflexivo
05:44
I function as something
of a reflective advocate,
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e á vez un médico prescriptor.
05:47
as much as prescribing physician.
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05:51
Quick aside: palliative care -- a very
important field but poorly understood --
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Un inciso: os coidados paliativos son un
eido moi importante e incomprendido
xa que non se limitan aos coidados
durante a fin da vida,
05:57
while it includes, it is not
limited to end of life care.
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non se limitan a fases terminais.
06:00
It is not limited to hospice.
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06:02
It's simply about comfort
and living well at any stage.
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Tratáse, sinxelamente, de vivir
cómodamente e ben en calquera momento.
06:06
So please know that you don't
have to be dying anytime soon
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Así que saiban que non teñen que
estar a morrer
para beneficiarse dos paliativos.
06:10
to benefit from palliative care.
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06:13
Now, let me introduce you to Frank.
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Agora, permítanme presentarlles a Frank.
06:17
Sort of makes this point.
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Serve como exemplo.
Frank é o meu paciente desde hai anos.
06:19
I've been seeing Frank now for years.
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Vive cun cancro de próstata en fase
avanzada e con VIH desde hai tempo.
06:21
He's living with advancing prostate cancer
on top of long-standing HIV.
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06:26
We work on his bone pain and his fatigue,
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Traballamos na dor de ósos e na fatiga,
mais sobre todo conversamos
sobre a súa vida
06:28
but most of the time we spend thinking
out loud together about his life --
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en serio, sobre a vida.
06:32
really, about our lives.
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06:35
In this way, Frank grieves.
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Isto alivia a Frank.
06:37
In this way, he keeps up with
his losses as they roll in,
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Deste xeito, acepta as súas perdas
a medida que se suceden
e así está preparado para asimilar
o que está por vir.
06:41
so that he's ready to take in
the next moment.
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06:45
Loss is one thing,
but regret, quite another.
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A perda é unha cousa,
o pesar é outra ben distinta.
06:51
Frank has always been an adventurer --
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Frank foi sempre un aventureiro.
Parece saído dun cadro de
Norman Rockwell
06:53
he looks like something
out of a Norman Rockwell painting --
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e non un afeccionado ao pesar.
06:56
and no fan of regret.
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06:58
So it wasn't surprising
when he came into clinic one day,
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Por iso non me sorprendeu cando un día
chegou á clínica
e dixo que quería facer o descenso
do río Colorado.
07:01
saying he wanted to raft
down the Colorado River.
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07:05
Was this a good idea?
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Era unha boa idea?
07:07
With all the risks to his safety
and his health, some would say no.
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Tendo en conta os riscos para a súa saúde
e a súa seguridade, moitos dirían que non.
Moitos dixérono, pero fixémolo,
mentres el aínda era capaz.
07:11
Many did, but he went for it,
while he still could.
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07:15
It was a glorious, marvelous trip:
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Foi unha excursión marabillosa, gloriosa:
07:20
freezing water, blistering dry heat,
scorpions, snakes,
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auga xeada, calor abrasadora,
escorpións, serpes,
bramidos da fauna que
saían do Gran Canón...
07:26
wildlife howling off the flaming walls
of the Grand Canyon --
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Todas as caras do mundo,
fóra do noso control.
07:31
all the glorious side of the world
beyond our control.
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07:36
Frank's decision, while maybe dramatic,
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A decisión de Frank, foi dramática
pero é exactamente a mesma
que moitos tomariamos,
07:38
is exactly the kind
so many of us would make,
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se tivésemos a oportunidade de saber
que é o mellor para nós.
07:40
if we only had the support to figure out
what is best for ourselves over time.
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07:49
So much of what we're talking about today
is a shift in perspective.
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Moitas das cousas das que estamos a falar
son cuestión de perspectiva.
07:54
After my accident,
when I went back to college,
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Despois do accidente,
ao volver á universidade,
cambiei de carreira para
estudar historia da arte.
07:56
I changed my major to art history.
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08:00
Studying visual art, I figured
I'd learn something about how to see --
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Mentres estudaba arte visual,
aprendín como mirar
08:05
a really potent lesson
for a kid who couldn't change
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unha lección enorme para un rapaz
que non era quen de cambiar,
e que o cambia o que estaba vendo.
08:09
so much of what he was seeing.
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08:12
Perspective, that kind of alchemy
we humans get to play with,
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A perspectiva é a clase de alquimia coa
que os humanos podemos xogar
e converter a angustia nunha flor.
08:16
turning anguish into a flower.
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08:21
Flash forward: now I work
at an amazing place in San Francisco
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Avancemos: actualmente traballo nun lugar
incrible en San Francisco
que é o Proxecto Zen de Hospital
para terminais,
08:25
called the Zen Hospice Project,
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onde temos un pequeno ritual
que axuda a cambiar a perspectiva.
08:28
where we have a little ritual
that helps with this shift in perspective.
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08:32
When one of our residents dies,
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Cando un dos residentes morre,
os homes da funeraria veñen e, cando
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,
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dirixíndose á porta, paramos.
08:39
heading for the gate, we pause.
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Calquera que o desexa
08:42
Anyone who wants --
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(outros residentes, familia,
enfermeiros, voluntarios,
08:44
fellow residents, family,
nurses, volunteers,
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os condutores dos coches fúnebres...)
08:46
the hearse drivers too, now --
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comparte unha historia, unha canción
ou un silencio
08:49
shares a story or a song or silence,
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mentres cubrimos o corpo con pétalos
de flores.
08:53
as we sprinkle the body
with flower petals.
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08:57
It takes a few minutes;
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Leva uns minutos
e é unha imaxe sinxela e delicada
para pasar acompañar a dor co cariño,
08:59
it's a sweet, simple parting image
to usher in grief with warmth,
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no canto de con desprezo.
09:04
rather than repugnance.
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09:08
Contrast that with the typical experience
in the hospital setting,
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Comparen iso co que adoita acontecer
nun hospital:
unha habitación iluminada, chea de tubos
e alarmas
09:13
much like this -- floodlit room
lined with tubes and beeping machines
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e luces que non deixan de capelexar,
mesmo cando a vida dos pacientes cesou.
09:18
and blinking lights that don't stop
even when the patient's life has.
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09:23
Cleaning crew swoops in,
the body's whisked away,
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Os limpadores entran,
o corpo desaperece
e semella que esa persoa
nunca existiu realmente.
09:26
and it all feels as though that person
had never really existed.
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09:33
Well-intended, of course,
in the name of sterility,
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A intención é boa, claro está, pero,
en nome da esterilidade,
os hospitais tenden a agredir
os nosos sentidos
09:35
but hospitals tend to assault our senses,
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e o máximo que podemos esperar dentro
desas paredes é adormecemento
09:39
and the most we might hope for
within those walls is numbness --
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(anestesia, que é o contrario á estética)
09:44
anesthetic, literally
the opposite of aesthetic.
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09:50
I revere hospitals for what they can do;
I am alive because of them.
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Venero aos hospitais polo que fan,
estou vivo grazas a eles.
09:56
But we ask too much of our hospitals.
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Pero pedímoslles demasiado.
09:59
They are places for acute trauma
and treatable illness.
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Son lugares para traumatismos agudos
e enfermidades curables.
Non son un lugar para vivir e morrer.
Non están deseñados para iso.
10:03
They are no place to live and die;
that's not what they were designed for.
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10:10
Now mind you -- I am not
giving up on the notion
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Iso si, non deixo de crer
que as nosas institucións
poden ser máis humanas.
10:12
that our institutions
can become more humane.
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10:16
Beauty can be found anywhere.
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Hai fermosura en calquera parte.
10:21
I spent a few months in a burn unit
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Pasei uns meses nunha unidade
de queimados
no hospital S. Barnabas de
Livingston, Nova Jersei.
10:23
at St. Barnabas Hospital
in Livingston, New Jersey,
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Alí recibín un coidado fantástico
en todos os turnos,
10:26
where I got really
great care at every turn,
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incluídos coidados paliativos
para a dor.
10:30
including good
palliative care for my pain.
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10:33
And one night, it began to snow outside.
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E unha noite, comezou a nevar fóra.
10:37
I remember my nurses
complaining about driving through it.
164
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3915
Lémbrome de que as miñas enfermeiras
queixábanse de ter que conducir así,
10:42
And there was no window in my room,
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2184
Non había fiestra na miña habitación,
mais era estupendo imaxinala caendo,
toda apegañenta.
10:44
but it was great to just imagine it
coming down all sticky.
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632311
3306
10:49
Next day, one of my nurses
smuggled in a snowball for me.
167
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3934
Ao día seguinte, unha das enfermeiras
tróuxome unha bóla de neve.
Meteuna na unidade.
10:53
She brought it in to the unit.
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641257
1633
10:56
I cannot tell you the rapture I felt
holding that in my hand,
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5408
Non podo explicar a éxtase que sentín
ao sostela na man
e ao sentir como o frío
entraba na miña pel queimada.
11:02
and the coldness dripping
onto my burning skin;
170
650163
3049
O milagre disto
11:05
the miracle of it all,
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2310
foi a miña fascinación ao vela
derreterse e converterse en auga.
11:07
the fascination as I watched it melt
and turn into water.
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3759
11:15
In that moment,
173
663293
2131
Daquela,
para min era máis importante formar
parte deste universo
11:17
just being any part of this planet
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
11:24
That little snowball packed
all the inspiration I needed
176
672083
3123
para intentar vivir e aceptar
se non o facía.
11:27
to both try to live
and be OK if I did not.
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3205
11:31
In a hospital, that's a stolen moment.
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2884
Nun hospital, ese é un intre roubado.
11:36
In my work over the years,
I've known many people
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684356
3389
Polo meu traballo, ao longo dos anos,
coñecín moita xente
lista para marchar,
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,
181
691192
4783
Non porque atoparan unha paz
final ou unha transcendencia,
mais polo rechazo que sentían
pola vida que tiñan.
11:47
but because they were so repulsed
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,
184
711394
6086
Hai cifras de cantos de nós convivimos
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.
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719947
4800
Non estamos preparados, nin nada que se
lle pareza, para o tsunami prateado.
12:19
We need an infrastructure
dynamic enough to handle
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727335
3261
Precisamos infraestructuras
suficientemente dinámicas para manexar
estes movementos sísmicos
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.
189
735637
3020
Agora é o momento de crear
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.
195
752642
3806
Temos moreas de datos cos que deseñadores
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:
12:51
what's most important to people
who are closer to death:
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759028
3486
a comodidade, sentirse aliviado
e aliviar aos seres queridos,
12:54
comfort; feeling unburdened
and unburdening to those they love;
198
762538
6965
13:01
existential peace; and a sense
of wonderment and spirituality.
199
769527
5242
a paz existencial e un sentimento
de asombro e espiritualidade.
13:08
Over Zen Hospice's nearly 30 years,
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776896
3758
Ao longo dos case 30 anos do Hospicio Zen
aprendemos moito máis
dos nosos residentes cos detalles sutiles.
13:12
we've learned much more
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.
13:22
She finds it harder to breathe
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.
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.
Trátase de sentir encherse os seus pulmóns
mentres os fuma.
13:39
but to feel her lungs filled
while she has them.
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807033
3959
13:44
Priorities change.
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812786
1197
As prioridades cambian.
13:47
Or Kate -- she just wants to know
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815556
2471
Ou Kate. Quere saber
que o seu can Austin está
aos pés da súa cama,
13:50
her dog Austin is lying
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.
13:57
instead of more chemotherapy
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,
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830849
5016
Un detalle gratificante, sensual, estético
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,
218
843373
4282
Tan só se trata de gozar do tempo
que se ten, aproveitando os sentidos,
o corpo (precisamente, o que vive
e morre).
14:19
by way of the body -- the very thing
doing the living and the dying.
219
847679
5292
14:26
Probably the most poignant room
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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,
221
855841
2253
Isto é chamativo se temos en
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.
14:32
that so many of our residents
can eat very little, if anything at all.
223
860179
3813
O que pasa é que, nela,
damos sustento a diferentes niveis:
14:36
But we realize we are providing
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,
226
874356
4917
De veras, con todas as tarefas duras que
levamos a cabo,
unha das accións máis efectivas e
auténticas que coñecemos
14:51
one of the most tried and true
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
231
901808
3409
ao que nos fai sentir humanos,
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.
15:25
for the millions of people
living and dying with dementia.
234
913809
2785
15:29
Primal sensorial delights that say
the things we don't have words for,
235
917554
4265
Praceres sensoriais primarios que din
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,
238
930280
6194
Se aliviar o sufrimento innecesario
é o desafío número un do sistema,
15:50
then tending to dignity
by way of the senses,
239
938559
2704
intentar acadar a dignidade
por medio dos sentidos,
por medio do corpo
(a esfera estética)
15:53
by way of the body --
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;
242
947944
3806
Isto lévanos ao terceiro
e último punto do día.
Precisamos elevar a nosa visión
sobre que é o benestar
16:03
namely, we need to lift our sights,
to set our sights on well-being,
243
951774
6864
de xeito que a vida, a saúde
e a sanidade
16:10
so that life and health and healthcare
244
958662
3313
traten de facer a vida
máis marabillosa
16:13
can become about making life
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.
16:25
between a disease-centered and a patient-
or human-centered model of care,
249
973158
5134
Aí é cando coidar se converte nun acto
creativo, creador
16:30
and here is where caring
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,
16:39
But it is also one of our
highest forms of adaptation.
253
987687
2904
mais é unha das ferramentas de
adaptación máis importantes.
Pensen en todos os esforzos
que esixe ser humano.
16:42
Consider every major compulsory effort
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.
A necesidade dun fogar,
deu lugar á arquitectura.
16:49
The need for shelter
has given rise to architecture.
256
997825
2588
A necesidade de abrigo,
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,
260
1011766
3209
Dado que morrer é unha parte
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
262
1020054
3376
Con "xogar" non intento que tomemos
á lixeira o tema da morte
ou que impoñamos ningunha
maneira de morrer.
17:15
or that we mandate
any particular way of dying.
263
1023454
2639
Hai montes de tristeza
que non podemos combater
17:18
There are mountains of sorrow
that cannot move,
264
1026117
2858
e dun xeito ou doutro,
todos temos que afrontalos.
17:20
and one way or another,
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,
17:28
physical, psychic room, to allow life
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,
268
1042291
3357
Envellecer e morrer podería ser
un proceso de ascenso cara a fin.
17:37
aging and dying can become
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.
277
1073441
2764
Isto é algo que, por unha ou
outra razón, pásanos a todos.
18:08
I got to redesign my life
around this fact,
278
1076583
2641
Tiven que redeseñar a miña vida
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
18:14
to realize you can always find
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
18:20
like that snowball lasting
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,
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
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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
Translated by Sara Dosil Amor
Reviewed by Belén García Penerbosa

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ABOUT THE SPEAKER
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.

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.

More profile about the speaker
BJ Miller | Speaker | TED.com
THE ORIGINAL VIDEO ON TED.COM