WEBVTT 00:00:00.578 --> 00:00:02.601 Look, I had second thoughts, really, 00:00:02.601 --> 00:00:04.636 about whether I could talk about this 00:00:04.636 --> 00:00:07.676 to such a vital and alive audience as you guys. 00:00:07.676 --> 00:00:10.266 Then I remembered the quote from Gloria Steinem, 00:00:10.266 --> 00:00:11.905 which goes, 00:00:11.905 --> 00:00:13.836 "The truth will set you free, 00:00:13.836 --> 00:00:17.795 but first it will piss you off." (Laughter) 00:00:17.795 --> 00:00:20.063 So -- (Laughter) NOTE Paragraph 00:00:20.063 --> 00:00:22.187 So with that in mind, I'm going to set about 00:00:22.187 --> 00:00:23.778 trying to do those things here, 00:00:23.778 --> 00:00:25.640 and talk about dying in the 21st century. 00:00:25.640 --> 00:00:28.040 Now the first thing that will piss you off, undoubtedly, 00:00:28.040 --> 00:00:30.659 is that all of us are, in fact, going to die 00:00:30.659 --> 00:00:31.733 in the 21st century. 00:00:31.733 --> 00:00:34.123 There will be no exceptions to that. 00:00:34.123 --> 00:00:36.780 There are, apparently, about one in eight of you 00:00:36.780 --> 00:00:39.304 who think you're immortal, on surveys, but -- 00:00:39.304 --> 00:00:41.482 (Laughter) 00:00:41.482 --> 00:00:46.095 Unfortunately, that isn't going to happen. NOTE Paragraph 00:00:46.095 --> 00:00:47.748 While I give this talk, in the next 10 minutes, 00:00:47.748 --> 00:00:51.244 a hundred million of my cells will die, 00:00:51.244 --> 00:00:53.838 and over the course of today, 2,000 of my brain cells 00:00:53.838 --> 00:00:55.979 will die and never come back, 00:00:55.979 --> 00:00:58.060 so you could argue that the dying process 00:00:58.060 --> 00:01:00.138 starts pretty early in the piece. NOTE Paragraph 00:01:00.138 --> 00:01:02.252 Anyway, the second thing I want to say about dying in the 00:01:02.252 --> 00:01:04.617 21st century, apart from it's going to happen to everybody, 00:01:04.617 --> 00:01:07.233 is it's shaping up to be a bit of a train wreck 00:01:07.233 --> 00:01:09.578 for most of us, 00:01:09.578 --> 00:01:12.547 unless we do something to try and reclaim this process 00:01:12.547 --> 00:01:16.264 from the rather inexorable trajectory that it's currently on. NOTE Paragraph 00:01:16.264 --> 00:01:18.072 So there you go. That's the truth. 00:01:18.072 --> 00:01:19.503 No doubt that will piss you off, and now let's see 00:01:19.503 --> 00:01:22.479 whether we can set you free. I don't promise anything. 00:01:22.479 --> 00:01:25.062 Now, as you heard in the intro, I work in intensive care, 00:01:25.062 --> 00:01:28.166 and I think I've kind of lived through the heyday 00:01:28.166 --> 00:01:30.173 of intensive care. It's been a ride, man. 00:01:30.173 --> 00:01:31.373 This has been fantastic. 00:01:31.373 --> 00:01:32.528 We have machines that go ping. 00:01:32.528 --> 00:01:34.838 There's many of them up there. 00:01:34.838 --> 00:01:37.582 And we have some wizard technology which I think 00:01:37.582 --> 00:01:40.094 has worked really well, and over the course of the time 00:01:40.094 --> 00:01:42.166 I've worked in intensive care, the death rate 00:01:42.166 --> 00:01:44.536 for males in Australia has halved, 00:01:44.536 --> 00:01:46.155 and intensive care has had something to do with that. 00:01:46.155 --> 00:01:48.163 Certainly, a lot of the technologies that we use 00:01:48.163 --> 00:01:50.383 have got something to do with that. NOTE Paragraph 00:01:50.383 --> 00:01:52.887 So we have had tremendous success, and we kind of 00:01:52.887 --> 00:01:55.241 got caught up in our own success quite a bit, 00:01:55.241 --> 00:01:58.865 and we started using expressions like "lifesaving." 00:01:58.865 --> 00:02:00.999 I really apologize to everybody for doing that, 00:02:00.999 --> 00:02:02.229 because obviously, we don't. 00:02:02.229 --> 00:02:04.757 What we do is prolong people's lives, 00:02:04.757 --> 00:02:06.858 and delay death, 00:02:06.858 --> 00:02:09.703 and redirect death, but we can't, strictly speaking, 00:02:09.703 --> 00:02:12.558 save lives on any sort of permanent basis. NOTE Paragraph 00:02:12.558 --> 00:02:14.543 And what's really happened over the period of time 00:02:14.543 --> 00:02:17.182 that I've been working in intensive care is that 00:02:17.182 --> 00:02:20.752 the people whose lives we started saving back in the '70s, 00:02:20.752 --> 00:02:25.230 '80s, and '90s, are now coming to die in the 21st century 00:02:25.230 --> 00:02:28.830 of diseases that we no longer have the answers to 00:02:28.830 --> 00:02:31.340 in quite the way we did then. NOTE Paragraph 00:02:31.340 --> 00:02:33.215 So what's happening now is there's been a big shift 00:02:33.215 --> 00:02:35.022 in the way that people die, 00:02:35.022 --> 00:02:37.293 and most of what they're dying of now isn't as amenable 00:02:37.293 --> 00:02:40.119 to what we can do as what it used to be like 00:02:40.119 --> 00:02:44.030 when I was doing this in the '80s and '90s. NOTE Paragraph 00:02:44.030 --> 00:02:46.894 So we kind of got a bit caught up with this, 00:02:46.894 --> 00:02:49.927 and we haven't really squared with you guys about 00:02:49.927 --> 00:02:53.982 what's really happening now, and it's about time we did. 00:02:53.982 --> 00:02:57.373 I kind of woke up to this bit in the late '90s 00:02:57.373 --> 00:02:59.467 when I met this guy. 00:02:59.467 --> 00:03:03.824 This guy is called Jim, Jim Smith, and he looked like this. 00:03:03.824 --> 00:03:06.127 I was called down to the ward to see him. 00:03:06.127 --> 00:03:08.372 His is the little hand. 00:03:08.372 --> 00:03:09.758 I was called down to the ward to see him 00:03:09.758 --> 00:03:10.852 by a respiratory physician. 00:03:10.852 --> 00:03:13.028 He said, "Look, there's a guy down here. 00:03:13.028 --> 00:03:14.628 He's got pneumonia, 00:03:14.628 --> 00:03:17.133 and he looks like he needs intensive care. 00:03:17.133 --> 00:03:19.207 His daughter's here and she wants everything possible 00:03:19.207 --> 00:03:21.738 to be done." 00:03:21.738 --> 00:03:24.357 Which is a familiar phrase to us. 00:03:24.357 --> 00:03:26.188 So I go down to the ward and see Jim, 00:03:26.188 --> 00:03:27.873 and his skin his translucent like this. 00:03:27.873 --> 00:03:30.123 You can see his bones through the skin. 00:03:30.123 --> 00:03:31.661 He's very, very thin, 00:03:31.661 --> 00:03:35.043 and he is, indeed, very sick with pneumonia, 00:03:35.043 --> 00:03:36.524 and he's too sick to talk to me, 00:03:36.524 --> 00:03:41.674 so I talk to his daughter Kathleen, and I say to her, 00:03:41.674 --> 00:03:44.638 "Did you and Jim ever talk about 00:03:44.638 --> 00:03:46.321 what you would want done 00:03:46.321 --> 00:03:48.335 if he ended up in this kind of situation?" 00:03:48.335 --> 00:03:52.064 And she looked at me and said, "No, of course not!" 00:03:52.064 --> 00:03:57.124 I thought, "Okay. Take this steady." 00:03:57.124 --> 00:03:59.968 And I got talking to her, and after a while, she said to me, 00:03:59.968 --> 00:04:02.971 "You know, we always thought there'd be time." NOTE Paragraph 00:04:02.971 --> 00:04:06.737 Jim was 94. (Laughter) 00:04:06.737 --> 00:04:09.271 And I realized that something wasn't happening here. 00:04:09.271 --> 00:04:10.595 There wasn't this dialogue going on 00:04:10.595 --> 00:04:13.248 that I imagined was happening. 00:04:13.248 --> 00:04:16.255 So a group of us started doing survey work, 00:04:16.255 --> 00:04:18.475 and we looked at four and a half thousand nursing home 00:04:18.475 --> 00:04:21.815 residents in Newcastle, in the Newcastle area, 00:04:21.815 --> 00:04:24.762 and discovered that only one in a hundred of them 00:04:24.762 --> 00:04:27.827 had a plan about what to do when their hearts stopped beating. 00:04:27.827 --> 00:04:28.966 One in a hundred. 00:04:28.966 --> 00:04:32.307 And only one in 500 of them had plan about what to do 00:04:32.307 --> 00:04:35.404 if they became seriously ill. 00:04:35.404 --> 00:04:38.164 And I realized, of course, this dialogue 00:04:38.164 --> 00:04:42.800 is definitely not occurring in the public at large. NOTE Paragraph 00:04:42.800 --> 00:04:44.278 Now, I work in acute care. 00:04:44.278 --> 00:04:46.383 This is John Hunter Hospital. 00:04:46.383 --> 00:04:50.384 And I thought, surely, we do better than that. 00:04:50.384 --> 00:04:53.380 So a colleague of mine from nursing called Lisa Shaw and I 00:04:53.380 --> 00:04:55.896 went through hundreds and hundreds of sets of notes 00:04:55.896 --> 00:04:57.169 in the medical records department 00:04:57.169 --> 00:04:59.790 looking at whether there was any sign at all 00:04:59.790 --> 00:05:02.218 that anybody had had any conversation about 00:05:02.218 --> 00:05:04.071 what might happen to them if the treatment they were 00:05:04.071 --> 00:05:07.415 receiving was unsuccessful to the point that they would die. 00:05:07.415 --> 00:05:10.356 And we didn't find a single record of any preference 00:05:10.356 --> 00:05:14.200 about goals, treatments or outcomes from any 00:05:14.200 --> 00:05:18.770 of the sets of notes initiated by a doctor or by a patient. NOTE Paragraph 00:05:18.770 --> 00:05:21.487 So we started to realize 00:05:21.487 --> 00:05:23.688 that we had a problem, 00:05:23.688 --> 00:05:28.711 and the problem is more serious because of this. NOTE Paragraph 00:05:28.711 --> 00:05:32.013 What we know is that obviously we are all going to die, 00:05:32.013 --> 00:05:34.678 but how we die is actually really important, 00:05:34.678 --> 00:05:38.233 obviously not just to us, but also to how that 00:05:38.233 --> 00:05:41.367 features in the lives of all the people who live on afterwards. 00:05:41.367 --> 00:05:43.688 How we die lives on in the minds of everybody 00:05:43.688 --> 00:05:46.805 who survives us, and 00:05:46.805 --> 00:05:50.537 the stress created in families by dying is enormous, 00:05:50.537 --> 00:05:53.223 and in fact you get seven times as much stress by dying 00:05:53.223 --> 00:05:55.960 in intensive care as by dying just about anywhere else, 00:05:55.960 --> 00:05:59.038 so dying in intensive care is not your top option 00:05:59.038 --> 00:06:01.496 if you've got a choice. NOTE Paragraph 00:06:01.496 --> 00:06:03.665 And, if that wasn't bad enough, of course, 00:06:03.665 --> 00:06:06.313 all of this is rapidly progressing towards the fact that 00:06:06.313 --> 00:06:08.665 many of you, in fact, about one in 10 of you at this point, 00:06:08.665 --> 00:06:10.115 will die in intensive care. 00:06:10.115 --> 00:06:11.449 In the U.S., it's one in five. 00:06:11.449 --> 00:06:15.199 In Miami, it's three out of five people die in intensive care. 00:06:15.199 --> 00:06:17.264 So this is the sort of momentum 00:06:17.264 --> 00:06:19.552 that we've got at the moment. NOTE Paragraph 00:06:19.552 --> 00:06:22.097 The reason why this is all happening is due to this, 00:06:22.097 --> 00:06:23.399 and I do have to take you through what this is about. 00:06:23.399 --> 00:06:25.364 These are the four ways to go. 00:06:25.364 --> 00:06:28.229 So one of these will happen to all of us. 00:06:28.229 --> 00:06:30.759 The ones you may know most about are the ones 00:06:30.759 --> 00:06:33.605 that are becoming increasingly of historical interest: 00:06:33.605 --> 00:06:35.022 sudden death. 00:06:35.022 --> 00:06:36.467 It's quite likely in an audience this size 00:06:36.467 --> 00:06:39.018 this won't happen to anybody here. 00:06:39.018 --> 00:06:40.748 Sudden death has become very rare. 00:06:40.748 --> 00:06:43.203 The death of Little Nell and Cordelia and all that sort of stuff 00:06:43.203 --> 00:06:44.876 just doesn't happen anymore. 00:06:44.876 --> 00:06:47.293 The dying process of those with terminal illness 00:06:47.293 --> 00:06:48.325 that we've just seen 00:06:48.325 --> 00:06:49.940 occurs to younger people. 00:06:49.940 --> 00:06:52.790 By the time you've reached 80, this is unlikely to happen to you. 00:06:52.790 --> 00:06:56.205 Only one in 10 people who are over 80 will die of cancer. NOTE Paragraph 00:06:56.205 --> 00:07:01.040 The big growth industry are these. 00:07:01.040 --> 00:07:04.291 What you die of is increasing organ failure, 00:07:04.291 --> 00:07:06.526 with your respiratory, cardiac, renal, 00:07:06.526 --> 00:07:08.306 whatever organs packing up. Each of these 00:07:08.306 --> 00:07:10.909 would be an admission to an acute care hospital, 00:07:10.909 --> 00:07:12.878 at the end of which, or at some point during which, 00:07:12.878 --> 00:07:15.054 somebody says, enough is enough, and we stop. NOTE Paragraph 00:07:15.054 --> 00:07:17.622 And this one's the biggest growth industry of all, 00:07:17.622 --> 00:07:20.197 and at least six out of 10 of the people in this room 00:07:20.197 --> 00:07:22.759 will die in this form, which is 00:07:22.759 --> 00:07:26.653 the dwindling of capacity 00:07:26.653 --> 00:07:28.972 with increasing frailty, 00:07:28.972 --> 00:07:31.222 and frailty's an inevitable part of aging, 00:07:31.222 --> 00:07:33.775 and increasing frailty is in fact the main thing 00:07:33.775 --> 00:07:34.824 that people die of now, 00:07:34.824 --> 00:07:36.952 and the last few years, or the last year of your life 00:07:36.952 --> 00:07:40.967 is spent with a great deal of disability, unfortunately. NOTE Paragraph 00:07:40.967 --> 00:07:44.351 Enjoying it so far? (Laughs) 00:07:44.351 --> 00:07:47.504 (Laughter) 00:07:47.504 --> 00:07:50.932 Sorry, I just feel such a, I feel such a Cassandra here. 00:07:50.932 --> 00:07:56.090 (Laughter) NOTE Paragraph 00:07:56.090 --> 00:07:57.149 What can I say that's positive? What's positive is 00:07:57.149 --> 00:07:59.564 that this is happening at very great age, now. 00:07:59.564 --> 00:08:02.309 We are all, most of us, living to reach this point. 00:08:02.309 --> 00:08:04.197 You know, historically, we didn't do that. 00:08:04.197 --> 00:08:05.666 This is what happens to you 00:08:05.666 --> 00:08:08.189 when you live to be a great age, 00:08:08.189 --> 00:08:10.078 and unfortunately, increasing longevity does mean 00:08:10.078 --> 00:08:12.005 more old age, not more youth. 00:08:12.005 --> 00:08:18.098 I'm sorry to say that. (Laughter) 00:08:18.098 --> 00:08:19.895 What we did, anyway, look, what we did, 00:08:19.895 --> 00:08:21.422 we didn't just take this lying down 00:08:21.422 --> 00:08:22.924 at John Hunter Hospital and elsewhere. 00:08:22.924 --> 00:08:24.546 We've started a whole series of projects 00:08:24.546 --> 00:08:27.542 to try and look about whether we could, in fact, involve 00:08:27.542 --> 00:08:31.036 people much more in the way that things happen to them. 00:08:31.036 --> 00:08:32.268 But we realized, of course, that we are dealing 00:08:32.268 --> 00:08:34.612 with cultural issues, 00:08:34.612 --> 00:08:36.471 and this is, I love this Klimt painting, 00:08:36.471 --> 00:08:38.676 because the more you look at it, the more you kind of get 00:08:38.676 --> 00:08:40.695 the whole issue that's going on here, 00:08:40.695 --> 00:08:44.213 which is clearly the separation of death from the living, 00:08:44.213 --> 00:08:46.093 and the fear — Like, if you actually look, 00:08:46.093 --> 00:08:47.268 there's one woman there 00:08:47.268 --> 00:08:49.187 who has her eyes open. 00:08:49.187 --> 00:08:50.872 She's the one he's looking at, 00:08:50.872 --> 00:08:54.100 and [she's] the one he's coming for. Can you see that? 00:08:54.100 --> 00:08:55.626 She looks terrified. 00:08:55.626 --> 00:08:57.319 It's an amazing picture. NOTE Paragraph 00:08:57.319 --> 00:08:59.540 Anyway, we had a major cultural issue. 00:08:59.540 --> 00:09:01.524 Clearly, people didn't want us to talk about death, 00:09:01.524 --> 00:09:03.019 or, we thought that. 00:09:03.019 --> 00:09:04.966 So with loads of funding from the Federal Government 00:09:04.966 --> 00:09:06.386 and the local Health Service, we introduced a thing 00:09:06.386 --> 00:09:09.284 at John Hunter called Respecting Patient Choices. 00:09:09.284 --> 00:09:12.133 We trained hundreds of people to go to the wards 00:09:12.133 --> 00:09:15.276 and talk to people about the fact that they would die, 00:09:15.276 --> 00:09:17.562 and what would they prefer under those circumstances. 00:09:17.562 --> 00:09:21.081 They loved it. The families and the patients, they loved it. 00:09:21.081 --> 00:09:23.541 Ninety-eight percent of people really thought 00:09:23.541 --> 00:09:24.995 this just should have been normal practice, 00:09:24.995 --> 00:09:27.378 and that this is how things should work. 00:09:27.378 --> 00:09:29.316 And when they expressed wishes, 00:09:29.316 --> 00:09:31.289 all of those wishes came true, as it were. 00:09:31.289 --> 00:09:33.269 We were able to make that happen for them. 00:09:33.269 --> 00:09:35.519 But then, when the funding ran out, 00:09:35.519 --> 00:09:37.604 we went back to look six months later, 00:09:37.604 --> 00:09:39.871 and everybody had stopped again, 00:09:39.871 --> 00:09:43.064 and nobody was having these conversations anymore. 00:09:43.064 --> 00:09:45.117 So that was really kind of heartbreaking for us, 00:09:45.117 --> 00:09:47.834 because we thought this was going to really take off. 00:09:47.834 --> 00:09:51.805 The cultural issue had reasserted itself. NOTE Paragraph 00:09:51.805 --> 00:09:52.960 So here's the pitch: 00:09:52.960 --> 00:09:57.046 I think it's important that we don't just get on this freeway 00:09:57.046 --> 00:09:59.545 to ICU without thinking hard about whether or not 00:09:59.545 --> 00:10:01.338 that's where we all want to end up, 00:10:01.338 --> 00:10:03.474 particularly as we become older and increasingly frail 00:10:03.474 --> 00:10:07.128 and ICU has less and less and less to offer us. 00:10:07.128 --> 00:10:09.458 There has to be a little side road 00:10:09.458 --> 00:10:13.933 off there for people who don't want to go on that track. 00:10:13.933 --> 00:10:16.569 And I have one small idea, 00:10:16.569 --> 00:10:21.018 and one big idea about what could happen. NOTE Paragraph 00:10:21.018 --> 00:10:22.079 And this is the small idea. 00:10:22.079 --> 00:10:24.860 The small idea is, let's all of us 00:10:24.860 --> 00:10:28.796 engage more with this in the way that Jason has illustrated. 00:10:28.796 --> 00:10:30.849 Why can't we have these kinds of conversations 00:10:30.849 --> 00:10:32.170 with our own elders 00:10:32.170 --> 00:10:34.960 and people who might be approaching this? 00:10:34.960 --> 00:10:36.794 There are a couple of things you can do. 00:10:36.794 --> 00:10:38.925 One of them is, you can, 00:10:38.925 --> 00:10:41.839 just ask this simple question. This question never fails. 00:10:41.839 --> 00:10:45.594 "In the event that you became too sick to speak for yourself, 00:10:45.594 --> 00:10:48.527 who would you like to speak for you?" 00:10:48.527 --> 00:10:50.441 That's a really important question to ask people, 00:10:50.441 --> 00:10:52.464 because giving people the control over who that is 00:10:52.464 --> 00:10:55.772 produces an amazing outcome. 00:10:55.772 --> 00:10:56.918 The second thing you can say is, 00:10:56.918 --> 00:10:58.416 "Have you spoken to that person 00:10:58.416 --> 00:11:00.336 about the things that are important to you 00:11:00.336 --> 00:11:04.490 so that we've got a better idea of what it is we can do?" 00:11:04.490 --> 00:11:07.012 So that's the little idea. NOTE Paragraph 00:11:07.012 --> 00:11:08.506 The big idea, I think, is more political. 00:11:08.506 --> 00:11:10.457 I think we have to get onto this. 00:11:10.457 --> 00:11:13.519 I suggested we should have Occupy Death. 00:11:13.519 --> 00:11:16.304 (Laughter) 00:11:16.304 --> 00:11:18.874 My wife said, "Yeah, right, sit-ins in the mortuary. 00:11:18.874 --> 00:11:21.453 Yeah, yeah. Sure." (Laughter) 00:11:21.453 --> 00:11:23.318 So that one didn't really run, 00:11:23.318 --> 00:11:24.988 but I was very struck by this. 00:11:24.988 --> 00:11:26.701 Now, I'm an aging hippie. 00:11:26.701 --> 00:11:29.198 I don't know, I don't think I look like that anymore, but 00:11:29.198 --> 00:11:31.698 I had, two of my kids were born at home in the '80s 00:11:31.698 --> 00:11:35.166 when home birth was a big thing, and we baby boomers 00:11:35.166 --> 00:11:37.862 are used to taking charge of the situation, 00:11:37.862 --> 00:11:41.260 so if you just replace all these words of birth, 00:11:41.260 --> 00:11:44.341 I like "Peace, Love, Natural Death" as an option. 00:11:44.341 --> 00:11:45.857 I do think we have to get political 00:11:45.857 --> 00:11:48.455 and start to reclaim this process from 00:11:48.455 --> 00:11:50.422 the medicalized model in which it's going. NOTE Paragraph 00:11:50.422 --> 00:11:52.462 Now, listen, that sounds like a pitch for euthanasia. 00:11:52.462 --> 00:11:54.654 I want to make it absolutely crystal clear to you all, 00:11:54.654 --> 00:11:57.318 I hate euthanasia. I think it's a sideshow. 00:11:57.318 --> 00:11:59.505 I don't think euthanasia matters. 00:11:59.505 --> 00:12:01.656 I actually think that, 00:12:01.656 --> 00:12:04.205 in places like Oregon, 00:12:04.205 --> 00:12:07.677 where you can have physician-assisted suicide, 00:12:07.677 --> 00:12:09.894 you take a poisonous dose of stuff, 00:12:09.894 --> 00:12:11.770 only half a percent of people ever do that. 00:12:11.770 --> 00:12:14.476 I'm more interested in what happens to the 99.5 percent 00:12:14.476 --> 00:12:16.232 of people who don't want to do that. 00:12:16.232 --> 00:12:18.566 I think most people don't want to be dead, 00:12:18.566 --> 00:12:20.663 but I do think most people want to have some control 00:12:20.663 --> 00:12:23.405 over how their dying process proceeds. 00:12:23.405 --> 00:12:24.545 So I'm an opponent of euthanasia, 00:12:24.545 --> 00:12:27.198 but I do think we have to give people back some control. 00:12:27.198 --> 00:12:30.671 It deprives euthanasia of its oxygen supply. 00:12:30.671 --> 00:12:32.023 I think we should be looking at stopping 00:12:32.023 --> 00:12:33.062 the want for euthanasia, 00:12:33.062 --> 00:12:37.757 not for making it illegal or legal or worrying about it at all. NOTE Paragraph 00:12:37.757 --> 00:12:41.333 This is a quote from Dame Cicely Saunders, 00:12:41.333 --> 00:12:42.702 whom I met when I was a medical student. 00:12:42.702 --> 00:12:45.581 She founded the hospice movement. 00:12:45.581 --> 00:12:47.772 And she said, "You matter because you are, 00:12:47.772 --> 00:12:50.294 and you matter to the last moment of your life." 00:12:50.294 --> 00:12:52.551 And I firmly believe that 00:12:52.551 --> 00:12:55.637 that's the message that we have to carry forward. 00:12:55.637 --> 00:12:58.656 Thank you. (Applause)