What would be a good end of life?
什麼是一個生活美好的結尾？
And I'm talking about the very end.
我所說的是最終的結尾。
I'm talking about dying.
我所說的是死亡。
We all think a lot about how to live well.
我們都在想如何更好的生活。
I'd like to talk about increasing our chances of dying well.
而我想要談的是，如何更美好地告別人生。
I'm not a geriatrician.
我並不是老年病學家。
I design reading programs for preschoolers.
我為學前班的孩子設計閱讀課程。
What I know about this topic comes from a qualitative study with a sample size of two.
我對這個話題的了解來源於一個定性的研究，其中有兩個案例。
In the last few years, I helped two friends have the end of life they wanted.
在過去的幾年，我幫助兩個好朋友以他們想要的方式，結束了他們的生命。
Jim and Shirley Modini spent their 68 years of marriage Jim living off the grid on their 1,700-acre ranch in the mountains of Sonoma County. Sonoma
和 Shirley Modini度過了他們68年的婚姻生活生活在遠離城鎮的，1,700英畝的牧場裡縣的山區。
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.
他們餵養了僅僅是能養活他們自己的家禽，所以這大部分的牧場變成了熊，獅子和其他的動物生活在那裡的避難所。
This was their dream.
這正是他們的夢想
I met Jim and Shirley in their 80s.
我在兩個老人年邁八十的時候遇見他們
They were both only children who chose not to have kids.
他們只有一個子女，而他選擇不要孩子。
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.
當我們成為朋友後，我變成了他們的託管人與他們的醫療顧問
但是更重要的是，我成為了幫助他們結束生活的那個人。
And we learned a few things about how to have a good end.
並且我們學到了，如何有個好的結局
In their final years, Jim and Shirley faced cancers, fractures, infections, neurological illness.
在最後的幾年裡， Jim和 Shirley他們面對著癌症，骨折，傳染病和神經上上的疾病。
It's true.
這是真的
At the end, our bodily functions and independence are declining to zero.
人到了最後，我們身體的功能和獨立性會降低到零
What we found is that, with a plan and the right people, quality of life can remain high.
我們發現，如果有正確的計劃和人，他們還是可以擁有高品質的生活
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.
結束的開始是被其他所引起的，像對死亡的意識，並且在此期間
Jim和 Shirley選擇了ACR自然保護區在他們去世後接手牧場。
This gave them the peace of mind to move forward.
這給了他們一片祥和，然後繼續前行
It might be a diagnosis. It might be your intuition.
這可能是個診斷，也可能是你的直覺
But one day, you're going to say, "This thing is going to get me."
有一天，你會說，這樣的事情會打垮我
Jim and Shirley spent this time letting friends know that their end was near and that they were okay with that.
Jim和Shirley用這些時間讓他們的朋友知道，離他們離開人世的時間不遠了，而他們對此沒有埋怨。
Dying from cancer and dying from neurological illness are different.
因為患癌症與神經疾病而死去是不一樣的
In both cases, last days are about quiet reassurance.
兩種情況，最後的幾天都非常安詳
Jim died first. He was conscious until the very end, but on his last day he couldn't talk.
Jim先離去，到最後他都非常的清醒但是在他最後一天，他說不了話。
Through his eyes, we knew when he needed to hear again,
通過他的眼睛，我們知道當他想聽我們說話
"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."
「什麼都很好，Jim。我們會好好照顧 Shirley。就在此時，在牧場ACR會永遠幫你保護好這裡的野生動植物。
From this experience I'm going to share five practices.
從這個經歷中，我想和大家分享五個方案
I've put worksheets online, so if you'd like, you can plan your own end.
我已經把步驟公布在了網上所以如果你願意，你可以計劃你自己結束的方式
It starts with a plan.
這個步驟以著手計劃開始
Most people say, "I'd like to die at home."
很多人會說」我願意死在家裡."
Eighty percent of Americans die in a hospital or a nursing home.
但是百分之八十的美國人，在醫院裡死去或者是養老院
Saying we'd like to die at home is not a plan.
所以說想死在家裡，並不是一個計劃
A lot of people say, "If I get like that, just shoot me."
很多人又會說「如果我像那樣，一槍打死我」
This is not a plan either; this is illegal.
這也不是，因為不合法
A plan involves answering straightforward questions about the end you want.
這個計劃是能包含了回應的直接了當關於你想如何結束的問題
Where do you want to be when you're no longer independent?
如果你不能再獨立，你希望自己在哪裡？
What do you want in terms of medical intervention?
你希望醫療保護的幹預麼？
And who's going to make sure your plan is followed?
誰能讓你的計劃繼續緊接著進行
You will need advocates.
你需要顧問
Having more than one increases your chance of getting the end you want.
擁有多個顧問增加了你獲得想要的結果的可能性
Don't assume the natural choice is your spouse or child.
不要斷然的說你的配偶和孩子是你最合適的選擇
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.
你需要的是一個有時間和親近感的人，如果你需要順利的進行，你需要這樣的人。那些可以與有壓力的人一起工作的人，有著變化莫測的可能性。
Hospital readiness is critical.
醫院隨時準備就緒很重要
You are likely to be headed to the emergency room, and you want to get this right.
你可能隨時被帶入急救室而你也希望準確無誤的做到這一點
Prepare a one-page summary of your medical history, medications and physician information.
所以，準備一頁你的醫療病史藥物治療，和醫生信息
Put this in a really bright envelope with copies of your insurance cards, your power of attorney, and your do-not-resuscitate order.
把這些放在一個很明顯的信封裡並一同放入你的保險卡，和委託書與你不想要恢復的命令
Have advocates keep a set in their car.
把這些留一份給你的顧問
Tape a set to your refrigerator.
並把錄像放入冰箱裡
When you show up in the E.R. with this packet,your admission is streamlined in a material way.
當你出現在急診室，帶著這樣的包裹你把許可用合法的文件合理化
You're going to need caregivers.
你將需要看護人
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.
你需要評估你的人格和財政狀況去決定你是否需要養老社區或者呆在家裡，是你最好的選擇
In either case, do not settle.
不管哪種情況，都不要定下來
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.
我們看到過一些不太稱職的看護，在我們找到最好的團隊之前，以Marcia領導的團隊，我們不會因為你將死去就敷衍了事，我們會將你所擁有的錄成視頻，當你如果不能離開療養院，而Caitlin不過讓你省略每天的晨練，但是知道什麼時候你想聽到，你的妻子被照顧得很好
Finally, last words.
最後，遺言
What do you want to hear at the very end, and from whom would you like to hear it?
在生命的最後，你想聽到什麼，想聽誰說這些？
In my experience, you'll want to hear that whatever you're worried about is going to be fine.
從我的經驗來說，你想聽到的是那些你擔心的事情，都會好起來
When you believe it's okay to let go, you will.
當你真正的相信了，你就放下了，你會的
So, this is a topic that normally inspires fear and denial.
所以，這是一個關於鼓勵恐懼與否定的話題
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.
我學到的是如果我們有計劃的規劃人生的最後我們會有最大的可能去維護我們生活的質量
Here are Jim and Shirley just after deciding who would take care of their ranch.
這是Jim和 Shirley，當他們決定了之後誰會照看他們的牧場
Here's Jim just a few weeks before he died, celebrating a birthday he didn't expect to see.
這是Jim死之前的幾個星期意外的收穫到了一個慶生會
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.
這是Shirley，她離去前的幾天看到自己上了報紙-關於野生動植物避難所的重要性。
At the Modini ranch，Jim and Shirley had a good end of life, and by sharing their story with you,
在Modini牧場Jim 和 Shirley有了很好的結束，在這裡分享著他們的故事
I hope to increase our chances of doing the same.
我希望能大家也能有同樣美滿的結點
Thank you.
謝謝