What Really Matters

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At the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.

ABOUT THE SPEAKER

BJ Miller · Palliative care physician
Using empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death.


Excerpts:

For most people, the scariest thing about death isn’t being dead, it’s dying, suffering. It’s a key distinction.

We know from research what’s most important to people who are closer to death: comfort; feeling unburdened and unburdening to those they love; existential peace; and a sense of wonderment and spirituality.

So much of life comes down to loving our time by way of the senses, by way of the body — the very thing doing the living and the dying.

As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.

So, if teasing unnecessary suffering out of the system was our first design cue, then tending to dignity by way of the senses, by way of the body — the aesthetic realm — is design cue number two. Now this gets us quickly to the third and final bit for today; namely, we need to lift our sights, to set our sights on well-being, so that life and health and healthcare can become about making life more wonderful, rather than just less horrible.

Here, this gets right at the distinction between a disease-centered and a patient- or human-centered model of care, and here is where caring becomes a creative, generative, even playful act. “Play” may sound like a funny word here. But it is also one of our highest forms of adaptation. Consider every major compulsory effort it takes to be human. The need for food has birthed cuisine. The need for shelter has given rise to architecture. The need for cover, fashion. And for being subjected to the clock, well, we invented music. So, since dying is a necessary part of life, what might we create with this fact? By “play” I am in no way suggesting we take a light approach to dying or that we mandate any particular way of dying. There are mountains of sorrow that cannot move, and one way or another, we will all kneel there. Rather, I am asking that we make space — physical, psychic room, to allow life to play itself all the way out — so that rather than just getting out of the way, aging and dying can become a process of crescendo through to the end. We can’t solve for death.

We can design towards it. Parts of me died early on, and that’s something we can all say one way or another. I got to redesign my life around this fact, and I tell you it has been a liberation to realize you can always find a shock of beauty or meaning in what life you have left, like that snowball lasting for a perfect moment, all the while melting away. If we love such moments ferociously, then maybe we can learn to live well — not in spite of death, but because of it. Let death be what takes us, not lack of imagination.


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Five Wishes of the Dying

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Five Wishes, from the book “The Top Five Regrets of the Dying.”

Bronnie Ware, an Australian nurse, spent years working in palliative care, caring for patients in the last 12 weeks of their lives. She recorded their dying epiphanies into a book called “The Top Five Regrets of the Dying.”

“When questioned about any regrets they had or anything they would do differently,” she says, “common themes surfaced again and again.”

Here are the top five regrets of the dying, as witnessed by Ware:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

“This was the most common regret of all. Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realise, until they no longer have it.”


2. I wish I hadn’t worked so hard.

“This came from every male patient that I nursed. Women also spoke of this regret, but as most were from an older generation, many had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.”

3. I wish I’d had the courage to express my feelings.

“Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming.”


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4. I wish I had stayed in touch with my friends.

“Often they would not truly realise the full benefits of old friends. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. Everyone misses their friends when they are dying.”

5. I wish that I had let myself be happier.

Many did not realise until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions, as well as their physical lives.

Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again.”

What’s your greatest regret so far, and what will you set out to achieve or change before you die?

 

 

 

 

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