Prepare for a good end of life
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0:01 - 0:04What would be a good end of life?
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0:04 - 0:06And I'm talking about the very end.
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0:06 - 0:10I'm talking about dying.
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0:10 - 0:14We all think a lot about how to live well.
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0:14 - 0:18I'd like to talk about increasing our chances of dying well.
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0:18 - 0:20I'm not a geriatrician.
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0:20 - 0:23I design reading programs for preschoolers.
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0:23 - 0:25What I know about this topic
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0:25 - 0:29comes from a qualitative study with a sample size of two.
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0:29 - 0:32In the last few years, I helped two friends
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0:32 - 0:34have the end of life they wanted.
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0:34 - 0:37Jim and Shirley Modini spent their 68 years of marriage
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0:37 - 0:40living off the grid on their 1,700-acre ranch
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0:40 - 0:42in the mountains of Sonoma County.
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0:42 - 0:46They kept just enough livestock to make ends meet
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0:46 - 0:50so that the majority of their ranch would remain a refuge
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0:50 - 0:52for the bears and lions and so many other things
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0:52 - 0:53that lived there.
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0:53 - 0:56This was their dream.
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0:56 - 0:59I met Jim and Shirley in their 80s.
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0:59 - 1:02They were both only children who chose not to have kids.
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1:02 - 1:05As we became friends, I became their trustee
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1:05 - 1:07and their medical advocate,
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1:07 - 1:09but more importantly, I became
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1:09 - 1:12the person who managed their end-of-life experiences.
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1:12 - 1:16And we learned a few things about how to have a good end.
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1:16 - 1:18In their final years, Jim and Shirley
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1:18 - 1:22faced cancers, fractures, infections, neurological illness.
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1:22 - 1:23It's true.
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1:23 - 1:25At the end, our bodily functions
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1:25 - 1:28and independence are declining to zero.
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1:28 - 1:31What we found is that, with a plan and the right people,
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1:31 - 1:35quality of life can remain high.
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1:35 - 1:36The beginning of the end is triggered
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1:36 - 1:39by a mortality awareness event, and during this time,
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1:39 - 1:43Jim and Shirley chose ACR nature preserves
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1:43 - 1:46to take their ranch over when they were gone.
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1:46 - 1:50This gave them the peace of mind to move forward.
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1:50 - 1:53It might be a diagnosis. It might be your intuition.
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1:53 - 1:56But one day, you're going to say, "This thing is going to get me."
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1:56 - 1:58Jim and Shirley spent this time
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1:58 - 2:00letting friends know that their end was near
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2:00 - 2:05and that they were okay with that.
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2:05 - 2:08Dying from cancer and dying from neurological illness
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2:08 - 2:09are different.
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2:09 - 2:14In both cases, last days are about quiet reassurance.
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2:14 - 2:17Jim died first. He was conscious until the very end,
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2:17 - 2:20but on his last day he couldn't talk.
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2:20 - 2:22Through his eyes, we knew when he needed to hear again,
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2:22 - 2:24"It is all set, Jim. We're going to take care of Shirley
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2:24 - 2:26right here at the ranch,
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2:26 - 2:29and ACR's going to take care of your wildlife forever."
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2:29 - 2:32From this experience I'm going to share five practices.
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2:32 - 2:34I've put worksheets online,
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2:34 - 2:37so if you'd like, you can plan your own end.
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2:37 - 2:39It starts with a plan.
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2:39 - 2:42Most people say, "I'd like to die at home."
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2:42 - 2:44Eighty percent of Americans die in a hospital
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2:44 - 2:45or a nursing home.
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2:45 - 2:49Saying we'd like to die at home is not a plan.
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2:49 - 2:52A lot of people say, "If I get like that, just shoot me."
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2:52 - 2:55This is not a plan either; this is illegal.
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2:55 - 2:59(Laughter)
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2:59 - 3:02A plan involves answering
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3:02 - 3:04straightforward questions about the end you want.
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3:04 - 3:07Where do you want to be when you're no longer independent?
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3:07 - 3:10What do you want in terms of medical intervention?
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3:10 - 3:12And who's going to make sure your plan is followed?
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3:12 - 3:14You will need advocates.
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3:14 - 3:15Having more than one increases your chance
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3:15 - 3:17of getting the end you want.
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3:17 - 3:20Don't assume the natural choice is your spouse or child.
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3:20 - 3:22You want someone who has the time and proximity
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3:22 - 3:24to do this job well, and you want someone
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3:24 - 3:27who can work with people under the pressure
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3:27 - 3:29of an ever-changing situation.
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3:29 - 3:31Hospital readiness is critical.
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3:31 - 3:33You are likely to be headed to the emergency room,
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3:33 - 3:34and you want to get this right.
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3:34 - 3:37Prepare a one-page summary of your medical history,
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3:37 - 3:40medications and physician information.
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3:40 - 3:42Put this in a really bright envelope
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3:42 - 3:45with copies of your insurance cards, your power of attorney,
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3:45 - 3:47and your do-not-resuscitate order.
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3:47 - 3:49Have advocates keep a set in their car.
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3:49 - 3:51Tape a set to your refrigerator.
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3:51 - 3:53When you show up in the E.R. with this packet,
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3:53 - 3:57your admission is streamlined in a material way.
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3:57 - 3:59You're going to need caregivers.
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3:59 - 4:03You'll need to assess your personality and financial situation
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4:03 - 4:06to determine whether an elder care community
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4:06 - 4:08or staying at home is your best choice.
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4:08 - 4:11In either case, do not settle.
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4:11 - 4:14We went through a number of not-quite-right caregivers
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4:14 - 4:17before we found the perfect team
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4:17 - 4:19led by Marsha,
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4:19 - 4:26who won't let you win at bingo just because you're dying
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4:26 - 4:28but will go out and take videos of your ranch for you
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4:28 - 4:31when you can't get out there,
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4:31 - 4:34and Caitlin, who won't let you skip your morning exercises
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4:34 - 4:35but knows when you need to hear
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4:35 - 4:39that your wife is in good hands.
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4:39 - 4:41Finally, last words.
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4:41 - 4:43What do you want to hear at the very end,
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4:43 - 4:45and from whom would you like to hear it?
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4:45 - 4:48In my experience, you'll want to hear
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4:48 - 4:52that whatever you're worried about is going to be fine.
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4:52 - 4:56When you believe it's okay to let go, you will.
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4:56 - 5:01So, this is a topic that normally inspires fear and denial.
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5:01 - 5:04What I've learned
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5:04 - 5:07is if we put some time into planning our end of life,
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5:07 - 5:10we have the best chance of maintaining our quality of life.
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5:10 - 5:13Here are Jim and Shirley just after deciding
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5:13 - 5:15who would take care of their ranch.
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5:15 - 5:18Here's Jim just a few weeks before he died,
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5:18 - 5:22celebrating a birthday he didn't expect to see.
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5:22 - 5:26And here's Shirley just a few days before she died
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5:26 - 5:28being read an article in that day's paper
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5:28 - 5:30about the significance of the wildlife refuge
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5:30 - 5:32at the Modini ranch.
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5:32 - 5:35Jim and Shirley had a good end of life,
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5:35 - 5:38and by sharing their story with you,
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5:38 - 5:40I hope to increase our chances of doing the same.
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5:40 - 5:42Thank you.
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5:42 - 5:47(Applause)
- Title:
- Prepare for a good end of life
- Speaker:
- Judy MacDonald Johnston
- Description:
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Thinking about death is frightening, but planning ahead is practical and leaves more room for peace of mind in our final days. In a solemn, thoughtful talk, Judy MacDonald Johnston shares 5 practices for planning for a good end of life.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 06:03
Morton Bast edited English subtitles for Prepare for a good end of life | ||
Morton Bast edited English subtitles for Prepare for a good end of life | ||
Thu-Huong Ha approved English subtitles for Prepare for a good end of life | ||
Thu-Huong Ha edited English subtitles for Prepare for a good end of life | ||
Thu-Huong Ha edited English subtitles for Prepare for a good end of life | ||
Morton Bast accepted English subtitles for Prepare for a good end of life | ||
Morton Bast edited English subtitles for Prepare for a good end of life | ||
Joseph Geni edited English subtitles for Prepare for a good end of life |