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  • What would be a good end of life?

  • And I'm talking about the very end.

  • I'm talking about dying.

  • We all think a lot about how to live well.

  • I'd like to talk about increasing our chances of dying well.

  • I'm not a geriatrician.

  • I design reading programs for preschoolers.

  • What I know about this topic

  • comes from a qualitative study with a sample size of two.

  • In the last few years, I helped two friends

  • have the end of life they wanted.

  • Jim and Shirley Modini spent their 68 years of marriage

  • living off the grid on their 1,700-acre ranch

  • in the mountains of Sonoma County.

  • They kept just enough livestock to make ends meet

  • so that the majority of their ranch would remain a refuge

  • for the bears and lions and so many other things

  • that lived there.

  • This was their dream.

  • I met Jim and Shirley in their 80s.

  • They were both only children who chose not to have kids.

  • As we became friends, I became their trustee

  • and their medical advocate,

  • but more importantly, I became

  • the person who managed their end-of-life experiences.

  • And we learned a few things about how to have a good end.

  • In their final years, Jim and Shirley

  • faced cancers, fractures, infections, neurological illness.

  • It's true.

  • At the end, our bodily functions

  • and independence are declining to zero.

  • What we found is that, with a plan and the right people,

  • quality of life can remain high.

  • The beginning of the end is triggered

  • by a mortality awareness event, and during this time,

  • Jim and Shirley chose ACR nature preserves

  • to take their ranch over when they were gone.

  • This gave them the peace of mind to move forward.

  • It might be a diagnosis. It might be your intuition.

  • But one day, you're going to say, "This thing is going to get me."

  • Jim and Shirley spent this time

  • letting friends know that their end was near

  • and that they were okay with that.

  • Dying from cancer and dying from neurological illness

  • are different.

  • In both cases, last days are about quiet reassurance.

  • Jim died first. He was conscious until the very end,

  • but on his last day he couldn't talk.

  • Through his eyes, we knew when he needed to hear again,

  • "It is all set, Jim. We're going to take care of Shirley

  • right here at the ranch,

  • and ACR's going to take care of your wildlife forever."

  • From this experience I'm going to share five practices.

  • I've put worksheets online,

  • so if you'd like, you can plan your own end.

  • It starts with a plan.

  • Most people say, "I'd like to die at home."

  • Eighty percent of Americans die in a hospital

  • or a nursing home.

  • Saying we'd like to die at home is not a plan.

  • A lot of people say, "If I get like that, just shoot me."

  • This is not a plan either; this is illegal.

  • (Laughter)

  • A plan involves answering

  • straightforward questions about the end you want.

  • Where do you want to be when you're no longer independent?

  • What do you want in terms of medical intervention?

  • And who's going to make sure your plan is followed?

  • You will need advocates.

  • Having more than one increases your chance

  • of getting the end you want.

  • Don't assume the natural choice is your spouse or child.

  • You want someone who has the time and proximity

  • to do this job well, and you want someone

  • who can work with people under the pressure

  • of an ever-changing situation.

  • Hospital readiness is critical.

  • You are likely to be headed to the emergency room,

  • and you want to get this right.

  • Prepare a one-page summary of your medical history,

  • medications and physician information.

  • Put this in a really bright envelope

  • with copies of your insurance cards, your power of attorney,

  • and your do-not-resuscitate order.

  • Have advocates keep a set in their car.

  • Tape a set to your refrigerator.

  • When you show up in the E.R. with this packet,

  • your admission is streamlined in a material way.

  • You're going to need caregivers.

  • You'll need to assess your personality and financial situation

  • to determine whether an elder care community

  • or staying at home is your best choice.

  • In either case, do not settle.

  • We went through a number of not-quite-right caregivers

  • before we found the perfect team

  • led by Marsha,

  • who won't let you win at bingo just because you're dying

  • but will go out and take videos of your ranch for you

  • when you can't get out there,

  • and Caitlin, who won't let you skip your morning exercises

  • but knows when you need to hear

  • that your wife is in good hands.

  • Finally, last words.

  • What do you want to hear at the very end,

  • and from whom would you like to hear it?

  • In my experience, you'll want to hear

  • that whatever you're worried about is going to be fine.

  • When you believe it's okay to let go, you will.

  • So, this is a topic that normally inspires fear and denial.

  • What I've learned

  • is if we put some time into planning our end of life,

  • we have the best chance of maintaining our quality of life.

  • Here are Jim and Shirley just after deciding

  • who would take care of their ranch.

  • Here's Jim just a few weeks before he died,

  • celebrating a birthday he didn't expect to see.

  • And here's Shirley just a few days before she died

  • being read an article in that day's paper

  • about the significance of the wildlife refuge

  • at the Modini ranch.

  • Jim and Shirley had a good end of life,

  • and by sharing their story with you,

  • I hope to increase our chances of doing the same.

  • Thank you.

  • (Applause)

What would be a good end of life?

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B1 TED shirley ranch plan dying life

【TED】Judy MacDonald Johnston: Prepare for a good end of life (Judy MacDonald Johnston: Prepare for a good end of life)

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    VoiceTube posted on 2013/06/21
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