WEBVTT

00:00:00.528 --> 00:00:04.116
What would be a good end of life?

00:00:04.116 --> 00:00:06.106
And I'm talking about the very end.

00:00:06.106 --> 00:00:09.839
I'm talking about dying.

NOTE Paragraph

00:00:09.839 --> 00:00:13.596
We all think a lot about how to live well.

00:00:13.596 --> 00:00:18.028
I'd like to talk about increasing our chances of dying well.

00:00:18.028 --> 00:00:20.148
I'm not a geriatrician.

00:00:20.148 --> 00:00:22.852
I design reading programs for preschoolers.

00:00:22.852 --> 00:00:24.678
What I know about this topic

00:00:24.678 --> 00:00:29.080
comes from a qualitative study with a sample size of two.

00:00:29.080 --> 00:00:31.785
In the last few years, I helped two friends

00:00:31.785 --> 00:00:34.026
have the end of life they wanted.

00:00:34.026 --> 00:00:37.354
Jim and Shirley Modini spent their 68 years of marriage

00:00:37.354 --> 00:00:40.328
living off the grid on their 1,700-acre ranch

00:00:40.328 --> 00:00:42.419
in the mountains of Sonoma County.

00:00:42.419 --> 00:00:46.343
They kept just enough livestock to make ends meet

00:00:46.343 --> 00:00:49.650
so that the majority of their ranch would remain a refuge

00:00:49.650 --> 00:00:51.883
for the bears and lions and so many other things

00:00:51.883 --> 00:00:53.490
that lived there.

00:00:53.490 --> 00:00:55.503
This was their dream.

NOTE Paragraph

00:00:55.503 --> 00:00:58.786
I met Jim and Shirley in their 80s.

00:00:58.786 --> 00:01:02.267
They were both only children who chose not to have kids.

00:01:02.267 --> 00:01:04.846
As we became friends, I became their trustee

00:01:04.846 --> 00:01:06.675
and their medical advocate,

00:01:06.675 --> 00:01:08.683
but more importantly, I became

00:01:08.683 --> 00:01:12.442
the person who managed their end-of-life experiences.

00:01:12.442 --> 00:01:16.115
And we learned a few things about how to have a good end.

NOTE Paragraph

00:01:16.115 --> 00:01:18.086
In their final years, Jim and Shirley

00:01:18.086 --> 00:01:22.086
faced cancers, fractures, infections, neurological illness.

00:01:22.086 --> 00:01:23.159
It's true.

00:01:23.159 --> 00:01:25.396
At the end, our bodily functions

00:01:25.396 --> 00:01:28.177
and independence are declining to zero.

00:01:28.177 --> 00:01:31.331
What we found is that, with a plan and the right people,

00:01:31.331 --> 00:01:34.885
quality of life can remain high.

00:01:34.885 --> 00:01:36.324
The beginning of the end is triggered

00:01:36.324 --> 00:01:39.215
by a mortality awareness event, and during this time,

00:01:39.215 --> 00:01:43.453
Jim and Shirley chose ACR nature preserves

00:01:43.453 --> 00:01:45.985
to take their ranch over when they were gone.

00:01:45.985 --> 00:01:49.565
This gave them the peace of mind to move forward.

00:01:49.565 --> 00:01:53.041
It might be a diagnosis. It might be your intuition.

00:01:53.041 --> 00:01:56.257
But one day, you're going to say, "This thing is going to get me."

00:01:56.257 --> 00:01:57.813
Jim and Shirley spent this time

00:01:57.813 --> 00:01:59.816
letting friends know that their end was near

00:01:59.816 --> 00:02:04.872
and that they were okay with that.

NOTE Paragraph

00:02:04.872 --> 00:02:07.721
Dying from cancer and dying from neurological illness

00:02:07.721 --> 00:02:09.292
are different.

00:02:09.292 --> 00:02:13.594
In both cases, last days are about quiet reassurance.

00:02:13.594 --> 00:02:17.353
Jim died first. He was conscious until the very end,

00:02:17.353 --> 00:02:19.540
but on his last day he couldn't talk.

00:02:19.540 --> 00:02:21.653
Through his eyes, we knew when he needed to hear again,

00:02:21.653 --> 00:02:24.489
"It is all set, Jim. We're going to take care of Shirley

00:02:24.489 --> 00:02:25.658
right here at the ranch,

00:02:25.658 --> 00:02:29.487
and ACR's going to take care of your wildlife forever."

NOTE Paragraph

00:02:29.487 --> 00:02:32.179
From this experience I'm going to share five practices.

00:02:32.179 --> 00:02:33.994
I've put worksheets online,

00:02:33.994 --> 00:02:36.777
so if you'd like, you can plan your own end.

NOTE Paragraph

00:02:36.777 --> 00:02:39.244
It starts with a plan.

00:02:39.244 --> 00:02:41.761
Most people say, "I'd like to die at home."

00:02:41.761 --> 00:02:43.986
Eighty percent of Americans die in a hospital

00:02:43.986 --> 00:02:45.490
or a nursing home.

00:02:45.490 --> 00:02:49.145
Saying we'd like to die at home is not a plan.

00:02:49.145 --> 00:02:52.362
A lot of people say, "If I get like that, just shoot me."

00:02:52.362 --> 00:02:54.858
This is not a plan either; this is illegal.

00:02:54.858 --> 00:02:58.912
(Laughter)

00:02:58.912 --> 00:03:01.739
A plan involves answering

00:03:01.739 --> 00:03:04.097
straightforward questions about the end you want.

00:03:04.097 --> 00:03:06.794
Where do you want to be when you're no longer independent?

00:03:06.794 --> 00:03:09.691
What do you want in terms of medical intervention?

00:03:09.691 --> 00:03:12.065
And who's going to make sure your plan is followed?

NOTE Paragraph

00:03:12.065 --> 00:03:13.542
You will need advocates.

00:03:13.542 --> 00:03:15.173
Having more than one increases your chance

00:03:15.173 --> 00:03:16.933
of getting the end you want.

00:03:16.933 --> 00:03:19.513
Don't assume the natural choice is your spouse or child.

00:03:19.513 --> 00:03:21.838
You want someone who has the time and proximity

00:03:21.838 --> 00:03:24.429
to do this job well, and you want someone

00:03:24.429 --> 00:03:26.668
who can work with people under the pressure

00:03:26.668 --> 00:03:29.029
of an ever-changing situation.

NOTE Paragraph

00:03:29.029 --> 00:03:30.723
Hospital readiness is critical.

00:03:30.723 --> 00:03:32.627
You are likely to be headed to the emergency room,

00:03:32.627 --> 00:03:34.406
and you want to get this right.

00:03:34.406 --> 00:03:37.269
Prepare a one-page summary of your medical history,

00:03:37.269 --> 00:03:39.557
medications and physician information.

00:03:39.557 --> 00:03:41.831
Put this in a really bright envelope

00:03:41.831 --> 00:03:44.667
with copies of your insurance cards, your power of attorney,

00:03:44.667 --> 00:03:47.067
and your do-not-resuscitate order.

00:03:47.067 --> 00:03:48.689
Have advocates keep a set in their car.

00:03:48.689 --> 00:03:50.576
Tape a set to your refrigerator.

00:03:50.576 --> 00:03:52.811
When you show up in the E.R. with this packet,

00:03:52.811 --> 00:03:56.534
your admission is streamlined in a material way.

NOTE Paragraph

00:03:56.534 --> 00:03:59.139
You're going to need caregivers.

00:03:59.139 --> 00:04:02.769
You'll need to assess your personality and financial situation

00:04:02.769 --> 00:04:05.793
to determine whether an elder care community

00:04:05.793 --> 00:04:08.192
or staying at home is your best choice.

00:04:08.192 --> 00:04:10.899
In either case, do not settle.

00:04:10.899 --> 00:04:14.265
We went through a number of not-quite-right caregivers

00:04:14.265 --> 00:04:16.865
before we found the perfect team

00:04:16.865 --> 00:04:19.104
led by Marsha,

00:04:19.104 --> 00:04:25.826
who won't let you win at bingo just because you're dying

00:04:25.826 --> 00:04:28.402
but will go out and take videos of your ranch for you

00:04:28.402 --> 00:04:30.828
when you can't get out there,

00:04:30.828 --> 00:04:33.555
and Caitlin, who won't let you skip your morning exercises

00:04:33.555 --> 00:04:35.161
but knows when you need to hear

00:04:35.161 --> 00:04:38.753
that your wife is in good hands.

NOTE Paragraph

00:04:38.753 --> 00:04:41.380
Finally, last words.

00:04:41.380 --> 00:04:42.731
What do you want to hear at the very end,

00:04:42.731 --> 00:04:45.339
and from whom would you like to hear it?

00:04:45.339 --> 00:04:47.666
In my experience, you'll want to hear

00:04:47.666 --> 00:04:51.668
that whatever you're worried about is going to be fine.

00:04:51.668 --> 00:04:55.620
When you believe it's okay to let go, you will.

NOTE Paragraph

00:04:55.620 --> 00:05:01.490
So, this is a topic that normally inspires fear and denial.

00:05:01.490 --> 00:05:03.596
What I've learned

00:05:03.596 --> 00:05:06.531
is if we put some time into planning our end of life,

00:05:06.531 --> 00:05:09.945
we have the best chance of maintaining our quality of life.

00:05:09.945 --> 00:05:12.525
Here are Jim and Shirley just after deciding

00:05:12.525 --> 00:05:14.997
who would take care of their ranch.

00:05:14.997 --> 00:05:18.357
Here's Jim just a few weeks before he died,

00:05:18.357 --> 00:05:21.731
celebrating a birthday he didn't expect to see.

00:05:21.731 --> 00:05:25.749
And here's Shirley just a few days before she died

00:05:25.749 --> 00:05:27.760
being read an article in that day's paper

00:05:27.760 --> 00:05:30.085
about the significance of the wildlife refuge

00:05:30.085 --> 00:05:32.341
at the Modini ranch.

NOTE Paragraph

00:05:32.341 --> 00:05:35.094
Jim and Shirley had a good end of life,

00:05:35.094 --> 00:05:37.527
and by sharing their story with you,

00:05:37.527 --> 00:05:40.382
I hope to increase our chances of doing the same.

NOTE Paragraph

00:05:40.382 --> 00:05:41.669
Thank you.

NOTE Paragraph

00:05:41.669 --> 00:05:46.748
(Applause)