so my first job in healthcare was when I was in high school and I was a nursing
was in high school and I was a nursing
was in high school and I was a nursing assistant in a nursing home I love this
assistant in a nursing home I love this
assistant in a nursing home I love this job it meant a lot to me it just made a
job it meant a lot to me it just made a
job it meant a lot to me it just made a big impression on my life I was so proud
big impression on my life I was so proud
big impression on my life I was so proud i had my polyester uniform those nasty
i had my polyester uniform those nasty
i had my polyester uniform those nasty white nursing shoes they make you wear I
white nursing shoes they make you wear I
white nursing shoes they make you wear I loved it learn how to make a bed with
loved it learn how to make a bed with
loved it learn how to make a bed with somebody still in it you’re a valuable
somebody still in it you’re a valuable
somebody still in it you’re a valuable skill and I learned a lot I learned a
skill and I learned a lot I learned a
skill and I learned a lot I learned a lot about people when I first started
lot about people when I first started
lot about people when I first started working there seemed like everybody in
working there seemed like everybody in
working there seemed like everybody in the building with either nursing staff
the building with either nursing staff
the building with either nursing staff or old people just sort of like
or old people just sort of like
or old people just sort of like undifferentiated old people but it
undifferentiated old people but it
undifferentiated old people but it didn’t take long before you start
didn’t take long before you start
didn’t take long before you start recognizing people’s individuality you
recognizing people’s individuality you
recognizing people’s individuality you start remembering which lady always like
start remembering which lady always like
start remembering which lady always like to have a teddy bear with her in a
to have a teddy bear with her in a
to have a teddy bear with her in a wheelchair who like to have her nails
wheelchair who like to have her nails
wheelchair who like to have her nails painted bright red recognizing which
painted bright red recognizing which
painted bright red recognizing which ones are hard of hearing and he needs a
ones are hard of hearing and he needs a
ones are hard of hearing and he needs a special diet and what matters to each of
special diet and what matters to each of
special diet and what matters to each of them recognize that some people just
them recognize that some people just
them recognize that some people just really need their privacy others like to
really need their privacy others like to
really need their privacy others like to talk some people will never take pain
talk some people will never take pain
talk some people will never take pain medication because they don’t like it
medication because they don’t like it
medication because they don’t like it when kind of dozy and out of it and
when kind of dozy and out of it and
when kind of dozy and out of it and other people’s don’t mind feeling a
other people’s don’t mind feeling a
other people’s don’t mind feeling a little dozy if it means they don’t have
little dozy if it means they don’t have
little dozy if it means they don’t have to be hurting but over time you get to
to be hurting but over time you get to
to be hurting but over time you get to really know them as people you get to
really know them as people you get to
really know them as people you get to see the pictures by the bedside of their
see the pictures by the bedside of their
see the pictures by the bedside of their kids and grandkids and sometimes you’ll
kids and grandkids and sometimes you’ll
kids and grandkids and sometimes you’ll be looking at them and you’ll look at a
be looking at them and you’ll look at a
be looking at them and you’ll look at a beautiful bride or a little boy holding
beautiful bride or a little boy holding
beautiful bride or a little boy holding on to his brother’s hand and you’ll go
on to his brother’s hand and you’ll go
on to his brother’s hand and you’ll go whoa that’s you right that’s you and you
whoa that’s you right that’s you and you
whoa that’s you right that’s you and you start to see that these aren’t old
start to see that these aren’t old
start to see that these aren’t old people so much as they are people
people so much as they are people
people so much as they are people this is the moment in their lives when
this is the moment in their lives when
this is the moment in their lives when they’re old you start recognizing that
they’re old you start recognizing that
they’re old you start recognizing that this is just one chapter in the whole
this is just one chapter in the whole
this is just one chapter in the whole story of their lives and ever since then
story of their lives and ever since then
story of their lives and ever since then I’ve tried to remember to think about
I’ve tried to remember to think about
I’ve tried to remember to think about people in terms of stories because it’s
people in terms of stories because it’s
people in terms of stories because it’s really easy to make the mistake of
really easy to make the mistake of
really easy to make the mistake of thinking of a person and how they seemed
thinking of a person and how they seemed
thinking of a person and how they seemed to us at that moment but that’s all they
to us at that moment but that’s all they
to us at that moment but that’s all they are like if you’re for playing with kids
are like if you’re for playing with kids
are like if you’re for playing with kids and you think of well this is a child
and you think of well this is a child
and you think of well this is a child instead of this is a person who is a
instead of this is a person who is a
instead of this is a person who is a child now and will be an old person
child now and will be an old person
child now and will be an old person someday or like if someone cuts you off
someday or like if someone cuts you off
someday or like if someone cuts you off in traffic and you think this is a jerk
in traffic and you think this is a jerk
in traffic and you think this is a jerk instead of this person is driving like a
instead of this person is driving like a
instead of this person is driving like a jerk right now it’s hard to remember
jerk right now it’s hard to remember
jerk right now it’s hard to remember that we are our whole stories and this
that we are our whole stories and this
that we are our whole stories and this is really true in health care we can get
is really true in health care we can get
is really true in health care we can get so distracted in healthcare by the
so distracted in healthcare by the
so distracted in healthcare by the symptoms and conditions and diagnoses
symptoms and conditions and diagnoses
symptoms and conditions and diagnoses that we kind of lose sight of the whole
that we kind of lose sight of the whole
that we kind of lose sight of the whole person it can even happen to us when
person it can even happen to us when
person it can even happen to us when we’re the patient you can kind of lose
we’re the patient you can kind of lose
we’re the patient you can kind of lose track of who you are and what matters
track of who you are and what matters
track of who you are and what matters most to you in this sort of maze of test
most to you in this sort of maze of test
most to you in this sort of maze of test results and treatment options it’s not
results and treatment options it’s not
results and treatment options it’s not entirely surprising that this could
entirely surprising that this could
entirely surprising that this could happen right because medicine is focused
happen right because medicine is focused
happen right because medicine is focused on fixing our bodies and there is a lot
on fixing our bodies and there is a lot
on fixing our bodies and there is a lot to know of our bodies and about how they
to know of our bodies and about how they
to know of our bodies and about how they work and about what we can do to fix
work and about what we can do to fix
work and about what we can do to fix them but medicine is at its best when it
them but medicine is at its best when it
them but medicine is at its best when it recognizes us as more than bodies but as
recognizes us as more than bodies but as
recognizes us as more than bodies but as embodied authors of our life stories
this loss of perspective is especially
this loss of perspective is especially poignant and notable when we reach end
poignant and notable when we reach end
poignant and notable when we reach end of life in the last few years you may
of life in the last few years you may
of life in the last few years you may have noticed kind of an uptick in
have noticed kind of an uptick in
have noticed kind of an uptick in attention to the fact that many people
attention to the fact that many people
attention to the fact that many people get a lot of invasive treatment and a
get a lot of invasive treatment and a
get a lot of invasive treatment and a lot of interventions in the last weeks
lot of interventions in the last weeks
lot of interventions in the last weeks and months and sometimes even years of
and months and sometimes even years of
and months and sometimes even years of their lives and these interventions can
their lives and these interventions can
their lives and these interventions can extend the quantity of our lives but
extend the quantity of our lives but
extend the quantity of our lives but sometimes at a great cost to the quality
sometimes at a great cost to the quality
sometimes at a great cost to the quality of our lives the interventions are not
of our lives the interventions are not
of our lives the interventions are not the problem the problem is not the chemo
the problem the problem is not the chemo
the problem the problem is not the chemo the problem is not the feeding tubes and
the problem is not the feeding tubes and
the problem is not the feeding tubes and the ventilators and things that can that
the ventilators and things that can that
the ventilators and things that can that can extend our lives the problem when
can extend our lives the problem when
can extend our lives the problem when there is one is continuing to look to
there is one is continuing to look to
there is one is continuing to look to these interventions when they can’t
these interventions when they can’t
these interventions when they can’t restore us back to a life that is
restore us back to a life that is
restore us back to a life that is meaningful to us if you’ve ever heard of
meaningful to us if you’ve ever heard of
meaningful to us if you’ve ever heard of initiatives like the conversation
initiatives like the conversation
initiatives like the conversation project books like being mortal and
project books like being mortal and
project books like being mortal and knocking on heaven’s door you’ll be
knocking on heaven’s door you’ll be
knocking on heaven’s door you’ll be familiar with this question about
familiar with this question about
familiar with this question about whether we should be using medicine in
whether we should be using medicine in
whether we should be using medicine in this very automatic algorithmic way
this very automatic algorithmic way
this very automatic algorithmic way where we look at a condition and we look
where we look at a condition and we look
where we look at a condition and we look at the intervention condition and the
at the intervention condition and the
at the intervention condition and the intervention so that at some point in
intervention so that at some point in
intervention so that at some point in life people are so focused on doctor’s
life people are so focused on doctor’s
life people are so focused on doctor’s appointments and and getting to
appointments and and getting to
appointments and and getting to treatment that they’re not thinking
treatment that they’re not thinking
treatment that they’re not thinking about what do I want this phase of life
about what do I want this phase of life
about what do I want this phase of life to look like how do I want to spend my
to look like how do I want to spend my
to look like how do I want to spend my time and who do I want to spend my time
time and who do I want to spend my time
time and who do I want to spend my time with
with
with so these folks are suggesting that
so these folks are suggesting that
so these folks are suggesting that instead of doctors asking themselves
instead of doctors asking themselves
instead of doctors asking themselves what intervention is appropriate for
what intervention is appropriate for
what intervention is appropriate for this condition they should be asking us
this condition they should be asking us
this condition they should be asking us what is most troubling to you what do
what is most troubling to you what do
what is most troubling to you what do you want most and what do you want most
you want most and what do you want most
you want most and what do you want most to avoid they suggest that these
to avoid they suggest that these
to avoid they suggest that these questions can help people at the moment
questions can help people at the moment
questions can help people at the moment when they are patients to retain
when they are patients to retain
when they are patients to retain authorship of their life stories there’s
authorship of their life stories there’s
authorship of their life stories there’s no getting around the fact that illness
no getting around the fact that illness
no getting around the fact that illness injury pain death are wrenching awful
injury pain death are wrenching awful
injury pain death are wrenching awful experiences there’s there’s really no
experiences there’s there’s really no
experiences there’s there’s really no way around that and the reason they’re
way around that and the reason they’re
way around that and the reason they’re so awful is because when you’re
so awful is because when you’re
so awful is because when you’re seriously ill something important is
seriously ill something important is
seriously ill something important is being threatened your ability to
being threatened your ability to
being threatened your ability to communicate your ability to be mobile
communicate your ability to be mobile
communicate your ability to be mobile your independence your ability to work
your independence your ability to work
your independence your ability to work to enjoy the activities you enjoy and
to enjoy the activities you enjoy and
to enjoy the activities you enjoy and when these things are threatened bigger
when these things are threatened bigger
when these things are threatened bigger things are threatened like our
things are threatened like our
things are threatened like our self-esteem our relationships our
self-esteem our relationships our
self-esteem our relationships our identities often in a moment like that
identities often in a moment like that
identities often in a moment like that medicine can help us and that happens
medicine can help us and that happens
medicine can help us and that happens all the time and it’s fabulous when it
all the time and it’s fabulous when it
all the time and it’s fabulous when it does and then there are also times when
does and then there are also times when
does and then there are also times when medicine can’t help us but it’s
medicine can’t help us but it’s
medicine can’t help us but it’s important to a person to try anyway
important to a person to try anyway
important to a person to try anyway because if they’re going down they’re
because if they’re going down they’re
because if they’re going down they’re going to go down swinging and they just
going to go down swinging and they just
going to go down swinging and they just want to keep fighting and that’s good
want to keep fighting and that’s good
want to keep fighting and that’s good too but there are also times
too but there are also times
too but there are also times when this approach can keep us from
when this approach can keep us from
when this approach can keep us from being present in these very painful but
being present in these very painful but
being present in these very painful but sacred meaningful moments in life and it
sacred meaningful moments in life and it
sacred meaningful moments in life and it can feed our denial that like it or not
can feed our denial that like it or not
can feed our denial that like it or not life is changing and it can rob us of
life is changing and it can rob us of
life is changing and it can rob us of the opportunities to say the things that
the opportunities to say the things that
the opportunities to say the things that for example dr. IRA Barack says we all
for example dr. IRA Barack says we all
for example dr. IRA Barack says we all need to hear especially at end of life I
need to hear especially at end of life I
need to hear especially at end of life I love you please forgive me I forgive you
love you please forgive me I forgive you
love you please forgive me I forgive you thank you if we can’t come to terms with
thank you if we can’t come to terms with
thank you if we can’t come to terms with the fact that death is not optional that
the fact that death is not optional that
the fact that death is not optional that it is in fact the final chapter of every
it is in fact the final chapter of every
it is in fact the final chapter of every story then our chance to have a good
story then our chance to have a good
story then our chance to have a good hand in writing that final chapter is
hand in writing that final chapter is
hand in writing that final chapter is going to be compromised and if medicine
going to be compromised and if medicine
going to be compromised and if medicine can’t come to terms with the fact that
can’t come to terms with the fact that
can’t come to terms with the fact that death the death of a patient is not
death the death of a patient is not
death the death of a patient is not always a failure then medicines ability
always a failure then medicines ability
always a failure then medicines ability to help us in these moments will be
to help us in these moments will be
to help us in these moments will be compromised so I want to suggest that
compromised so I want to suggest that
compromised so I want to suggest that the antidote to this situation is that
the antidote to this situation is that
the antidote to this situation is that we should all be reflecting on two
we should all be reflecting on two
we should all be reflecting on two things the first is what is the purpose
things the first is what is the purpose
things the first is what is the purpose of medicine what do we want it to do for
of medicine what do we want it to do for
of medicine what do we want it to do for us I know that seems like a silly
us I know that seems like a silly
us I know that seems like a silly question
question
question in fact if you ever want to really
in fact if you ever want to really
in fact if you ever want to really confuse a room full of medical students
confuse a room full of medical students
confuse a room full of medical students go ahead and ask them that what is
go ahead and ask them that what is
go ahead and ask them that what is medicine for they kept their like do you
medicine for they kept their like do you
medicine for they kept their like do you not know this they say well medicine is
not know this they say well medicine is
not know this they say well medicine is to save lives okay fair enough but we
to save lives okay fair enough but we
to save lives okay fair enough but we need a more finessed answer because if
need a more finessed answer because if
need a more finessed answer because if all medicine is is for saving lives no
all medicine is is for saving lives no
all medicine is is for saving lives no matter what that’s what puts us in
matter what that’s what puts us in
matter what that’s what puts us in danger of creating a lot of misery so
danger of creating a lot of misery so
danger of creating a lot of misery so maybe a better answer and here I’m
maybe a better answer and here I’m
maybe a better answer and here I’m paraphrasing the bioethicists Daniel
paraphrasing the bioethicists Daniel
paraphrasing the bioethicists Daniel Callahan may be a better more finesse to
Callahan may be a better more finesse to
Callahan may be a better more finesse to answer is that medicine is for the care
answer is that medicine is for the care
answer is that medicine is for the care and cure of those who can be cured and
and cure of those who can be cured and
and cure of those who can be cured and the care of those who can’t be cured or
the care of those who can’t be cured or
the care of those who can’t be cured or put another way it is for the prevention
put another way it is for the prevention
put another way it is for the prevention of a premature death and the pursuit of
of a premature death and the pursuit of
of a premature death and the pursuit of a peaceful death and here i’m not
a peaceful death and here i’m not
a peaceful death and here i’m not talking about physician assisted suicide
talking about physician assisted suicide
talking about physician assisted suicide or anything like that I’m talking about
or anything like that I’m talking about
or anything like that I’m talking about recognizing both the immense potential
recognizing both the immense potential
recognizing both the immense potential and the very real limits of the role
and the very real limits of the role
and the very real limits of the role that medicine can play in our lives
that medicine can play in our lives
that medicine can play in our lives about when to use medicine to focus on
about when to use medicine to focus on
about when to use medicine to focus on cure and when to use medicine to focus
cure and when to use medicine to focus
cure and when to use medicine to focus on comfort
on comfort
on comfort the second thing that we all need to be
the second thing that we all need to be
the second thing that we all need to be reflecting on is what matters what
reflecting on is what matters what
reflecting on is what matters what matters most what matters most to us as
matters most what matters most to us as
matters most what matters most to us as individuals for each of us when the time
individuals for each of us when the time
individuals for each of us when the time and life comes for trade-offs when
and life comes for trade-offs when
and life comes for trade-offs when illness threatens the things that matter
illness threatens the things that matter
illness threatens the things that matter what are we most afraid of what are the
what are we most afraid of what are the
what are we most afraid of what are the things in life that make life good what
things in life that make life good what
things in life that make life good what are we willing to live without what are
are we willing to live without what are
are we willing to live without what are we not willing to live without when I
we not willing to live without when I
we not willing to live without when I suggest this to people they say well
suggest this to people they say well
suggest this to people they say well aren’t you just the Bluebird of
aren’t you just the Bluebird of
aren’t you just the Bluebird of happiness this is depressing but I don’t
happiness this is depressing but I don’t
happiness this is depressing but I don’t think it is depressing I don’t think
think it is depressing I don’t think
think it is depressing I don’t think that living with awareness of our own
that living with awareness of our own
that living with awareness of our own mortality is depressing it because it’s
mortality is depressing it because it’s
mortality is depressing it because it’s not about sitting there thinking about
not about sitting there thinking about
not about sitting there thinking about all the terrible things that could
all the terrible things that could
all the terrible things that could happen to you it’s about living with
happen to you it’s about living with
happen to you it’s about living with deep recognition and appreciation for
deep recognition and appreciation for
deep recognition and appreciation for what is happening now it’s about living
what is happening now it’s about living
what is happening now it’s about living with gratitude and it’s about knowing
with gratitude and it’s about knowing
with gratitude and it’s about knowing that these things are that much more
that these things are that much more
that these things are that much more precious because they’re finite it’s
precious because they’re finite it’s
precious because they’re finite it’s kind of like the composer Leonard
kind of like the composer Leonard
kind of like the composer Leonard Bernstein said once that to achieve
Bernstein said once that to achieve
Bernstein said once that to achieve great things two things are needed a
great things two things are needed a
great things two things are needed a plan and not quite enough time
so I’m going to tell you about someone
so I’m going to tell you about someone that I think did this really well in his
that I think did this really well in his
that I think did this really well in his life my grandfather grants love fishing
life my grandfather grants love fishing
life my grandfather grants love fishing love to work in his garden like the good
love to work in his garden like the good
love to work in his garden like the good game of cards and a good cigar loved
game of cards and a good cigar loved
game of cards and a good cigar loved sappy musicals and he loved eat and he
sappy musicals and he loved eat and he
sappy musicals and he loved eat and he loved us and we loved him when he was in
loved us and we loved him when he was in
loved us and we loved him when he was in the 60s he was diagnosed with heart
the 60s he was diagnosed with heart
the 60s he was diagnosed with heart disease and between good medicine and
disease and between good medicine and
disease and between good medicine and good luck and given up those cigars and
good luck and given up those cigars and
good luck and given up those cigars and my grandmother watching his diet like a
my grandmother watching his diet like a
my grandmother watching his diet like a hawk he did great got back to his life
hawk he did great got back to his life
hawk he did great got back to his life did all the things he did when he was in
did all the things he did when he was in
did all the things he did when he was in his 80s he came down with pneumonia and
his 80s he came down with pneumonia and
his 80s he came down with pneumonia and it got worse and he had to go to the
it got worse and he had to go to the
it got worse and he had to go to the hospital and it got worse and it got to
hospital and it got worse and it got to
hospital and it got worse and it got to where he couldn’t breathe without a
where he couldn’t breathe without a
where he couldn’t breathe without a ventilator and so the question was would
ventilator and so the question was would
ventilator and so the question was would he want a ventilator would he want to go
he want a ventilator would he want to go
he want a ventilator would he want to go on life support and the answer to that
on life support and the answer to that
on life support and the answer to that question is always another question the
question is always another question the
question is always another question the second question is will that
second question is will that
second question is will that intervention get him back to the things
intervention get him back to the things
intervention get him back to the things that matter most and the answer at that
that matter most and the answer at that
that matter most and the answer at that time was probably probably maybe not
time was probably probably maybe not
time was probably probably maybe not everything and not for sure because
everything and not for sure because
everything and not for sure because nothing in this life is for sure but
nothing in this life is for sure but
nothing in this life is for sure but probably enough
probably enough
probably enough so we went on the ventilator and he got
so we went on the ventilator and he got
so we went on the ventilator and he got better and he got home yeah maybe a
better and he got home yeah maybe a
better and he got home yeah maybe a little slow down maybe a little weaker
little slow down maybe a little weaker
little slow down maybe a little weaker but he got back to the life he’d left
but he got back to the life he’d left
but he got back to the life he’d left and then some months try of his 90th
and then some months try of his 90th
and then some months try of his 90th birthday he had a stroke massive stroke
birthday he had a stroke massive stroke
birthday he had a stroke massive stroke and so the question would he want
and so the question would he want
and so the question would he want intensive medical interventions at this
intensive medical interventions at this
intensive medical interventions at this time and the second question will those
time and the second question will those
time and the second question will those get him back to what matters but the
get him back to what matters but the
get him back to what matters but the answer at that time was no no medicine
answer at that time was no no medicine
answer at that time was no no medicine can keep his body going but it can’t get
can keep his body going but it can’t get
can keep his body going but it can’t get him back to enough of the things that
him back to enough of the things that
him back to enough of the things that made life sweet for him so instead of
made life sweet for him so instead of
made life sweet for him so instead of the ICU instead of the needles and the
the ICU instead of the needles and the
the ICU instead of the needles and the tubes and the machines he had hospice he
tubes and the machines he had hospice he
tubes and the machines he had hospice he had good nursing care he had family
had good nursing care he had family
had good nursing care he had family around him love forgiveness gratitude
around him love forgiveness gratitude
around him love forgiveness gratitude and that is how his story
want to leave you with a poem this is
want to leave you with a poem this is from the American poet Jane Kenyon and
from the American poet Jane Kenyon and
from the American poet Jane Kenyon and this is called otherwise I got out of
this is called otherwise I got out of
this is called otherwise I got out of bed on too strong legs it might have
bed on too strong legs it might have
bed on too strong legs it might have been otherwise I ate cereal sweet milk
been otherwise I ate cereal sweet milk
been otherwise I ate cereal sweet milk right flawless peach it might have been
right flawless peach it might have been
right flawless peach it might have been otherwise I took the dog uphill to the
otherwise I took the dog uphill to the
otherwise I took the dog uphill to the Birchwood all day long I did the work i
Birchwood all day long I did the work i
Birchwood all day long I did the work i love at noon i lay down with my mate it
love at noon i lay down with my mate it
love at noon i lay down with my mate it might have been otherwise we ate dinner
might have been otherwise we ate dinner
might have been otherwise we ate dinner together at a table with silver
together at a table with silver
together at a table with silver candlesticks it might have been
candlesticks it might have been
candlesticks it might have been otherwise I slept in a bed in a room
otherwise I slept in a bed in a room
otherwise I slept in a bed in a room with pictures on the walls and a planned
with pictures on the walls and a planned
with pictures on the walls and a planned another day just like this day but one
another day just like this day but one
another day just like this day but one day I know it will be otherwise thank
day I know it will be otherwise thank
day I know it will be otherwise thank [Applause]
[Applause]
[Applause] [Music]
”
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