TED2015
BJ Miller: What really matters at the end of life
Bidžej Miler (BJ Miller): Šta je zaista bitno na kraju života
Filmed:
Readability: 3.9
10,470,704 views
Na kraju života, šta najviše želimo? Za mnoge je to prosto uteha, poštovanje i ljubav. Bidžej Miler je doktor u domu za stare koji intenzivno razmišlja o tome kako stvoriti dostojanstven i graciozan kraj života za svoje pacijente. Odvojite vreme da uživate u ovom dirljivom govoru, u kom se postavljaju velika pitanja o tome kako mislimo o smrti i kako odajemo počast životu.
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. Full bio
Using empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death. Full bio
Double-click the English transcript below to play the video.
00:13
Well, we all need a reason to wake up.
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Svima nam je potreban
razlog da se probudimo.
razlog da se probudimo.
00:18
For me, it just took 11,000 volts.
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Meni je trebalo samo 11 000 volti.
Znam da ste previše kulturni da pitate,
00:23
I know you're too polite to ask,
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00:24
so I will tell you.
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pa ću vam reći.
00:27
One night, sophomore year of college,
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Jedne noći, na drugoj godini fakulteta,
00:29
just back from Thanksgiving holiday,
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tek sam se vratio
sa proslave Dana zahvalnosti,
sa proslave Dana zahvalnosti,
00:33
a few of my friends and I
were horsing around,
were horsing around,
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glupirao sam se sa nekoliko prijatelja
00:35
and we decided to climb atop
a parked commuter train.
a parked commuter train.
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i odlučili smo da se popnemo
na vagon putničkog voza.
na vagon putničkog voza.
00:40
It was just sitting there,
with the wires that run overhead.
with the wires that run overhead.
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Samo je stajao,
sa žicama koje su išle iznad njega.
sa žicama koje su išle iznad njega.
00:43
Somehow, that seemed
like a great idea at the time.
like a great idea at the time.
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To se nekako činilo kao sjajna ideja
u tom trenutku.
u tom trenutku.
00:46
We'd certainly done stupider things.
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Svakako smo radili gluplje stvari.
00:50
I scurried up the ladder on the back,
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Namestio sam merdevine pozadi
00:53
and when I stood up,
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i kada sam ustao,
00:55
the electrical current entered my arm,
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električna struja pogodila je moju ruku,
00:58
blew down and out my feet,
and that was that.
and that was that.
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prošla kroz mene preko stopala
i to je bilo to.
i to je bilo to.
01:03
Would you believe that watch still works?
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Da li verujete da sat još uvek radi?
01:08
Takes a licking!
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Kao podmazan!
01:09
(Laughter)
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(Smeh)
01:10
My father wears it now in solidarity.
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Moj otac ga sada nosi iz solidarnosti.
01:15
That night began my formal relationship
with death -- my death --
with death -- my death --
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Te noći počela je moja formalna veza
sa smrću - mojom smrću -
sa smrću - mojom smrću -
01:21
and it also began
my long run as a patient.
my long run as a patient.
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i takođe je počela
moja dugotrajna uloga pacijenta.
moja dugotrajna uloga pacijenta.
01:25
It's a good word.
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To je dobra reč.
01:26
It means one who suffers.
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Označava onog koji pati.
01:28
So I guess we're all patients.
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Pretpostavljam da smo svi pacijenti.
01:31
Now, the American health care system
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Američki sistem zdravstva
01:33
has more than its fair share
of dysfunction --
of dysfunction --
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ima prilično nefunkcionalosti -
01:37
to match its brilliance, to be sure.
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jednako koliko i briljantnosti.
01:39
I'm a physician now,
a hospice and palliative medicine doc,
a hospice and palliative medicine doc,
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Sada sam lekar, u domu za nemoćne
i palijativno zbrinjavanje,
i palijativno zbrinjavanje,
01:44
so I've seen care from both sides.
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tako da sam video negu sa obe strane.
01:47
And believe me: almost everyone
who goes into healthcare
who goes into healthcare
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Verujte mi, skoro svako
ko stupi u zdravstvo
ko stupi u zdravstvo
01:50
really means well -- I mean, truly.
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zaista ima dobre namere - zaista.
01:54
But we who work in it
are also unwitting agents
are also unwitting agents
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Ali mi koji tu radimo
takođe smo nesvesni učesnici
takođe smo nesvesni učesnici
01:58
for a system that too often
does not serve.
does not serve.
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sistema koji često ne funkcioniše.
02:03
Why?
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Zašto?
02:05
Well, there's actually a pretty easy
answer to that question,
answer to that question,
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Odgovor na to pitanje
zapravo je prilično jednostavan
zapravo je prilično jednostavan
02:09
and it explains a lot:
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i objašnjava dosta toga:
02:11
because healthcare was designed
with diseases, not people, at its center.
with diseases, not people, at its center.
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zato što je zdravstvo osmišljeno
tako da su u centru bolesti, a ne ljudi.
tako da su u centru bolesti, a ne ljudi.
02:18
Which is to say, of course,
it was badly designed.
it was badly designed.
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Što bi reklo, osmišljeno je loše.
02:22
And nowhere are the effects
of bad design more heartbreaking
of bad design more heartbreaking
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Efekti ovog lošeg dizajna
nisu nigde više srceparajući
nisu nigde više srceparajući
02:28
or the opportunity
for good design more compelling
for good design more compelling
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i prilika za dobar dizajn ubedljivija
02:31
than at the end of life,
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nego na kraju života,
02:33
where things are so distilled
and concentrated.
and concentrated.
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gde su stvari toliko filtrirane
i koncentrisane.
i koncentrisane.
02:38
There are no do-overs.
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Nema drugih prilika.
02:42
My purpose today is
to reach out across disciplines
to reach out across disciplines
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Moja svrha danas je
da krenem preko više disciplina
da krenem preko više disciplina
02:46
and invite design thinking
into this big conversation.
into this big conversation.
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i unesem razmišljanje o dizajnu
u ovaj veliki razgovor.
u ovaj veliki razgovor.
02:51
That is, to bring intention and creativity
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To jest, da uvedem nameru i kreativnost
02:56
to the experience of dying.
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u iskustvo umiranja.
03:01
We have a monumental
opportunity in front of us,
opportunity in front of us,
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Ispred sebe imamo ogromnu priliku,
03:05
before one of the few universal issues
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jedno od nekoliko univerzalnih pitanja
03:09
as individuals as well as a civil society:
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za nas kao pojedince i građansko društvo:
03:12
to rethink and redesign how it is we die.
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da ponovo osmislimo kako umiremo.
03:19
So let's begin at the end.
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Počnimo od kraja.
03:23
For most people, the scariest thing
about death isn't being dead,
about death isn't being dead,
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Za većinu ljudi, najstrašnija stvar
u vezi sa smrću nije biti mrtav.
u vezi sa smrću nije biti mrtav.
03:27
it's dying, suffering.
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U pitanju je umiranje, patnja.
03:29
It's a key distinction.
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To je ključna razlika.
03:32
To get underneath this,
it can be very helpful
it can be very helpful
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Kako bismo razlučili ovo,
može biti korisno
može biti korisno
03:34
to tease out suffering
which is necessary as it is,
which is necessary as it is,
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da razdvojimo patnju
koja je sama po sebi neophodna
koja je sama po sebi neophodna
03:39
from suffering we can change.
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sa patnjom koju možemo izmeniti.
03:42
The former is a natural,
essential part of life, part of the deal,
essential part of life, part of the deal,
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Prva je prirodan, ključni deo života,
deo celog paketa
deo celog paketa
03:47
and to this we are called
to make space, adjust, grow.
to make space, adjust, grow.
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i ovde smo pozvani da napravimo mesta,
prilagodimo se, rastemo.
prilagodimo se, rastemo.
03:55
It can be really good
to realize forces larger than ourselves.
to realize forces larger than ourselves.
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Zaista može biti dobro da shvatimo
da postoje sile veće od nas samih.
da postoje sile veće od nas samih.
04:01
They bring proportionality,
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One donose proporciju,
04:04
like a cosmic right-sizing.
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poput svemirskog prilagođavanja veličine.
04:08
After my limbs were gone,
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Nakon što su otišli moji udovi -
04:11
that loss, for example,
became fact, fixed --
became fact, fixed --
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na primer, taj gubitak,
postao je fiksirana činjenica -
postao je fiksirana činjenica -
04:15
necessarily part of my life,
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neophodni deo mog života,
04:19
and I learned that I could no more
reject this fact than reject myself.
reject this fact than reject myself.
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i naučio sam da ne mogu da odbijam
ovu činjenicu koliko ni da odbijam sebe.
ovu činjenicu koliko ni da odbijam sebe.
04:27
It took me a while,
but I learned it eventually.
but I learned it eventually.
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Bilo mi je potrebno dosta vremena,
ali na kraju sam to naučio.
ali na kraju sam to naučio.
04:30
Now, another great thing
about necessary suffering
about necessary suffering
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Još jedna sjajna stvar
u vezi sa neophodnom patnjom
u vezi sa neophodnom patnjom
04:33
is that it is the very thing
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je da je to baš ona stvar
04:36
that unites caregiver and care receiver --
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koja povezuje onog koji pruža
i onog koji prima negu -
i onog koji prima negu -
04:41
human beings.
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ljudska bića.
04:45
This, we are finally realizing,
is where healing happens.
is where healing happens.
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Konačno shvatamo
da se ovde dešava lečenje.
da se ovde dešava lečenje.
04:49
Yes, compassion -- literally,
as we learned yesterday --
as we learned yesterday --
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Kako smo saznali juče,
bukvalno je saosećanje to -
bukvalno je saosećanje to -
04:53
suffering together.
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zajednička patnja.
04:56
Now, on the systems side,
on the other hand,
on the other hand,
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U drugu ruku, sa strane sistema,
05:00
so much of the suffering
is unnecessary, invented.
is unnecessary, invented.
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dosta patnje je nepotrebno i izmišljeno.
05:04
It serves no good purpose.
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Nema nikakvu svrhu.
05:06
But the good news is,
since this brand of suffering is made up,
since this brand of suffering is made up,
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Ali dobra vest je to
da pošto je ova patnja izmišljena,
da pošto je ova patnja izmišljena,
05:10
well, we can change it.
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možemo je promeniti.
05:13
How we die is indeed
something we can affect.
something we can affect.
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Zaista možemo uticati
na to kako umiremo.
na to kako umiremo.
05:18
Making the system sensitive
to this fundamental distinction
to this fundamental distinction
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Možemo napraviti sistem da je osetljiv
na ovu ključnu razliku
na ovu ključnu razliku
05:22
between necessary
and unnecessary suffering
and unnecessary suffering
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između potrebne i nepotrebne patnje
05:25
gives us our first of three
design cues for the day.
design cues for the day.
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i to nam daje prvi od tri
zadatka za dizajn danas.
zadatka za dizajn danas.
05:30
After all, our role as caregivers,
as people who care,
as people who care,
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Naša uloga kao nekog ko pruža negu
05:34
is to relieve suffering --
not add to the pile.
not add to the pile.
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ipak je da olakšamo patnju,
a ne da je gomilamo.
a ne da je gomilamo.
05:42
True to the tenets of palliative care,
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Za one kojima je potrebna
palijativna nega,
palijativna nega,
05:44
I function as something
of a reflective advocate,
of a reflective advocate,
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ja sam nešto
poput zastupnika za prisećanje,
poput zastupnika za prisećanje,
05:47
as much as prescribing physician.
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isto koliko i lekar.
05:51
Quick aside: palliative care -- a very
important field but poorly understood --
important field but poorly understood --
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Usput, palijativna nega, veoma bitno polje
ali često slabo shvaćeno,
ali često slabo shvaćeno,
05:57
while it includes, it is not
limited to end of life care.
limited to end of life care.
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iako obuhvata brigu pri kraju života,
nije ograničena samo na to.
nije ograničena samo na to.
06:00
It is not limited to hospice.
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Nije ograničena samo na staračke domove.
06:02
It's simply about comfort
and living well at any stage.
and living well at any stage.
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Radi se o komforu i dobrom životu
u bilo kom dobu života.
u bilo kom dobu života.
06:06
So please know that you don't
have to be dying anytime soon
have to be dying anytime soon
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Molim vas da imate na umu
da ne morate da umrete uskoro
da ne morate da umrete uskoro
06:10
to benefit from palliative care.
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kako biste imali prednosti
od palijativne nege.
od palijativne nege.
06:13
Now, let me introduce you to Frank.
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Upoznaću vam s Frenkom,
koji ilustruje ovo o čemu pričam.
06:17
Sort of makes this point.
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06:19
I've been seeing Frank now for years.
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Frenka viđam već godinama.
06:21
He's living with advancing prostate cancer
on top of long-standing HIV.
on top of long-standing HIV.
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On živi sa uznapredovalim rakom prostate
pored dugotrajnog HIV-a.
pored dugotrajnog HIV-a.
Radimo na njegovom bolu u kostima
i izmorenosti,
i izmorenosti,
06:26
We work on his bone pain and his fatigue,
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06:28
but most of the time we spend thinking
out loud together about his life --
out loud together about his life --
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ali većinu vremena provodimo
misleći naglas o njegovom životu,
misleći naglas o njegovom životu,
06:32
really, about our lives.
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zapravo o našim životima.
06:35
In this way, Frank grieves.
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Na ovaj način Frenk boluje.
06:37
In this way, he keeps up with
his losses as they roll in,
his losses as they roll in,
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Na ovaj način, drži korak
sa svojim gubicima kako nastaju,
sa svojim gubicima kako nastaju,
06:41
so that he's ready to take in
the next moment.
the next moment.
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tako da je spreman
da upije sledeći trenutak.
da upije sledeći trenutak.
06:45
Loss is one thing,
but regret, quite another.
but regret, quite another.
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Gubitak je jedno,
dok je žaljenje nešto sasvim drugo.
dok je žaljenje nešto sasvim drugo.
06:51
Frank has always been an adventurer --
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Frenk je uvek bio avanturista -
06:53
he looks like something
out of a Norman Rockwell painting --
out of a Norman Rockwell painting --
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izgleda kao da je izašao
iz slike Normana Rokvela -
iz slike Normana Rokvela -
06:56
and no fan of regret.
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i ne voli žaljenje.
06:58
So it wasn't surprising
when he came into clinic one day,
when he came into clinic one day,
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Stoga nije iznenadilo
kad je jednog dana došao na kliniku
kad je jednog dana došao na kliniku
07:01
saying he wanted to raft
down the Colorado River.
down the Colorado River.
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i izjavio da želi da ide splavom
niz reku Kolorado.
niz reku Kolorado.
07:05
Was this a good idea?
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Da li je ovo bila dobra ideja?
07:07
With all the risks to his safety
and his health, some would say no.
and his health, some would say no.
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Sa svim rizicima po njegovo zdravlje
i bezbednost, neki bi rekli da nije.
i bezbednost, neki bi rekli da nije.
07:11
Many did, but he went for it,
while he still could.
while he still could.
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Mnogi su to rekli, ali je on to uradio,
dok je još mogao.
dok je još mogao.
07:15
It was a glorious, marvelous trip:
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Bilo je to spektakularno,
sjajno putovanje:
sjajno putovanje:
07:20
freezing water, blistering dry heat,
scorpions, snakes,
scorpions, snakes,
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ledena voda, žestoka suva vrućina,
škorpije, zmije,
škorpije, zmije,
07:26
wildlife howling off the flaming walls
of the Grand Canyon --
of the Grand Canyon --
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divlje zveri koje zavijaju
sa vrelih zidova Velikog kanjona -
sa vrelih zidova Velikog kanjona -
07:31
all the glorious side of the world
beyond our control.
beyond our control.
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sve sjajne strane sveta
koje su van naše kontrole.
koje su van naše kontrole.
07:36
Frank's decision, while maybe dramatic,
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Iako je dramatična, Frenkova odluka
07:38
is exactly the kind
so many of us would make,
so many of us would make,
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je upravo onakva
kakvu bi većina nas donela,
kakvu bi većina nas donela,
07:40
if we only had the support to figure out
what is best for ourselves over time.
what is best for ourselves over time.
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kada bimso samo imali podršku da shvatimo
šta je tokom vremena za nas najbolje.
šta je tokom vremena za nas najbolje.
07:49
So much of what we're talking about today
is a shift in perspective.
is a shift in perspective.
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Dosta toga o čemu danas pričamo
znači promenu u perspektivi.
znači promenu u perspektivi.
Nakon moje nesreće,
kada sam se vratio na fakultet,
kada sam se vratio na fakultet,
07:54
After my accident,
when I went back to college,
when I went back to college,
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07:56
I changed my major to art history.
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promenio sam smer na istoriju umetnosti.
08:00
Studying visual art, I figured
I'd learn something about how to see --
I'd learn something about how to see --
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Proučavajući vizuelnu umetnost, mislio sam
da ću naučiti nešto o tome kako da gledam,
da ću naučiti nešto o tome kako da gledam,
08:05
a really potent lesson
for a kid who couldn't change
for a kid who couldn't change
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zaista bitna lekcija za dečka
koji nije mogao da promeni
koji nije mogao da promeni
08:09
so much of what he was seeing.
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većinu toga što je gledao.
08:12
Perspective, that kind of alchemy
we humans get to play with,
we humans get to play with,
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Perspektiva, ta vrsta alhemije
sa kojom se igramo,
sa kojom se igramo,
08:16
turning anguish into a flower.
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pretvaranje bola u cvet.
08:21
Flash forward: now I work
at an amazing place in San Francisco
at an amazing place in San Francisco
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Prebacimo se unapred: sada radim
na neverovatnom mestu u San Francisku
na neverovatnom mestu u San Francisku
08:25
called the Zen Hospice Project,
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koje se zove Dom za stare - projekat Zen,
08:28
where we have a little ritual
that helps with this shift in perspective.
that helps with this shift in perspective.
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gde imamo mali ritual koji pomaže
sa ovom promenom u perspektivi.
sa ovom promenom u perspektivi.
08:32
When one of our residents dies,
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Kad god neki od naših stanovnika premine,
08:35
the mortuary men come, and as we're
wheeling the body out through the garden,
wheeling the body out through the garden,
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dolaze ljudi iz mrtvačnice,
i dok guramo telo na kolicima kroz baštu
i dok guramo telo na kolicima kroz baštu
08:39
heading for the gate, we pause.
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ka kapiji, zaustavimo se.
08:42
Anyone who wants --
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Svako ko želi -
08:44
fellow residents, family,
nurses, volunteers,
nurses, volunteers,
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drugi stanovnici, porodica,
medicinske sestre, volonteri,
medicinske sestre, volonteri,
08:46
the hearse drivers too, now --
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vozači pogrebnog vozila -
08:49
shares a story or a song or silence,
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podeli priču, pesmu ili ćuti
08:53
as we sprinkle the body
with flower petals.
with flower petals.
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dok telo posipamo laticama cveća.
08:57
It takes a few minutes;
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To traje nekoliko minuta,
08:59
it's a sweet, simple parting image
to usher in grief with warmth,
to usher in grief with warmth,
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to je simpatična, jednostavna
slika opraštanja da se bol uvede
slika opraštanja da se bol uvede
09:04
rather than repugnance.
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s toplinom umesto odbijanjem.
09:08
Contrast that with the typical experience
in the hospital setting,
in the hospital setting,
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Uporedite to sa tipičnim iskustvom
u bolničkom okruženju,
u bolničkom okruženju,
09:13
much like this -- floodlit room
lined with tubes and beeping machines
lined with tubes and beeping machines
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slično ovom - svetlost reflektora u sobi
prepunoj cevčica i mašina koje pište
prepunoj cevčica i mašina koje pište
09:18
and blinking lights that don't stop
even when the patient's life has.
even when the patient's life has.
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i trepćućih svetala koja se ne gase
čak ni kada se ugasi život pacijenta.
čak ni kada se ugasi život pacijenta.
09:23
Cleaning crew swoops in,
the body's whisked away,
the body's whisked away,
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Dolazi ekipa za čišćenje,
telo se na brzinu odnosi
telo se na brzinu odnosi
09:26
and it all feels as though that person
had never really existed.
had never really existed.
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i imate osećaj kao da ta osoba
nikada zapravo nije ni postojala.
nikada zapravo nije ni postojala.
09:33
Well-intended, of course,
in the name of sterility,
in the name of sterility,
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Namera je dobra, naravno,
u ime sterilnosti,
u ime sterilnosti,
09:35
but hospitals tend to assault our senses,
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ali bolnice obično napadaju naša čula
09:39
and the most we might hope for
within those walls is numbness --
within those walls is numbness --
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i najviše čemu se možemo nadati
unutar tih zidova je obamrlost,
unutar tih zidova je obamrlost,
09:44
anesthetic, literally
the opposite of aesthetic.
the opposite of aesthetic.
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anestetika, bukvalna suprotnost estetici.
09:50
I revere hospitals for what they can do;
I am alive because of them.
I am alive because of them.
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Slavim bolnice zbog onoga što one mogu -
zahvaljujući njima sam živ.
zahvaljujući njima sam živ.
09:56
But we ask too much of our hospitals.
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Ali od naših bolnica tražimo previše.
09:59
They are places for acute trauma
and treatable illness.
and treatable illness.
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To su mesta za akutne traume
i izlečive bolesti.
i izlečive bolesti.
10:03
They are no place to live and die;
that's not what they were designed for.
that's not what they were designed for.
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Nisu mesta za živeti i umreti,
nisu za to smišljena.
nisu za to smišljena.
10:10
Now mind you -- I am not
giving up on the notion
giving up on the notion
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Ipak, ne odustajem od toga
10:12
that our institutions
can become more humane.
can become more humane.
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da naše institucije mogu postati humanije.
10:16
Beauty can be found anywhere.
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Lepota se može pronaći svuda.
10:21
I spent a few months in a burn unit
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Proveo sam nekoliko meseci
u odeljenju za opekotine
u odeljenju za opekotine
10:23
at St. Barnabas Hospital
in Livingston, New Jersey,
in Livingston, New Jersey,
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u bolnici Sv. Barnabas u Livingstonu
u Nju Džerziju
u Nju Džerziju
10:26
where I got really
great care at every turn,
great care at every turn,
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gde su se sjajno brinuli o meni
na svakom koraku,
na svakom koraku,
10:30
including good
palliative care for my pain.
palliative care for my pain.
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uključujući i dobru palijativnu negu
za moj bol.
za moj bol.
10:33
And one night, it began to snow outside.
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Jedne noći, napolju je počeo da pada sneg.
10:37
I remember my nurses
complaining about driving through it.
complaining about driving through it.
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Sećam se da su se medicinske sestre
žalile što su morale da voze kroz njega.
žalile što su morale da voze kroz njega.
10:42
And there was no window in my room,
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U mojoj sobi nije bilo prozora,
10:44
but it was great to just imagine it
coming down all sticky.
coming down all sticky.
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ali bilo je sjajno samo zamišljati ga
kako pada, sav lepljiv.
kako pada, sav lepljiv.
10:49
Next day, one of my nurses
smuggled in a snowball for me.
smuggled in a snowball for me.
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Sutradan je jedna od sestara
za mene prokrijumčarila grudvu.
za mene prokrijumčarila grudvu.
10:53
She brought it in to the unit.
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Donela ju je na odeljenje.
10:56
I cannot tell you the rapture I felt
holding that in my hand,
holding that in my hand,
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Ne mogu da vam objasnim ushićenje
dok sam je držao u ruci
dok sam je držao u ruci
11:02
and the coldness dripping
onto my burning skin;
onto my burning skin;
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i hladnoću koja je kapala
na moju uzavrelu kožu,
na moju uzavrelu kožu,
11:05
the miracle of it all,
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čudo svega toga,
11:07
the fascination as I watched it melt
and turn into water.
and turn into water.
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oduševljenje dok sam gledao
kako se topi i pretvara u vodu.
kako se topi i pretvara u vodu.
11:15
In that moment,
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Tog trenutka,
11:17
just being any part of this planet
in this universe mattered more to me
in this universe mattered more to me
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samo to da budem bilo koji deo planete
u ovom univerzumu bilo mi je bitnije
u ovom univerzumu bilo mi je bitnije
11:21
than whether I lived or died.
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od toga da li sam živ ili mrtav.
11:24
That little snowball packed
all the inspiration I needed
all the inspiration I needed
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Ta grudvica sadržala je u sebi
svu inspiraciju koja mi je bila potrebna
svu inspiraciju koja mi je bila potrebna
11:27
to both try to live
and be OK if I did not.
and be OK if I did not.
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i da pokušam da živim
i da se pomirim sa time ako ne mogu.
i da se pomirim sa time ako ne mogu.
11:31
In a hospital, that's a stolen moment.
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To je ukraden trenutak u bolnici.
11:36
In my work over the years,
I've known many people
I've known many people
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Tokom godina svog rada,
poznavao sam mnoge ljude
poznavao sam mnoge ljude
11:39
who were ready to go, ready to die.
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koji su bili spremni da idu,
spremni da umru.
spremni da umru.
11:43
Not because they had found
some final peace or transcendence,
some final peace or transcendence,
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Ne zato što su pronašli neki konačni mir
ili transcendenciju,
ili transcendenciju,
11:47
but because they were so repulsed
by what their lives had become --
by what their lives had become --
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već zato što su bili toliko zgađeni
time šta je njihov život postao,
time šta je njihov život postao,
11:54
in a word, cut off, or ugly.
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jednom rečju odsečen ili ružan.
12:03
There are already record numbers of us
living with chronic and terminal illness,
living with chronic and terminal illness,
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Već su rekordni brojevi nas koji živimo
sa hroničnom ili smrtnom bolešću
sa hroničnom ili smrtnom bolešću
12:09
and into ever older age.
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do sve starijeg doba.
12:11
And we are nowhere near ready
or prepared for this silver tsunami.
or prepared for this silver tsunami.
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I nimalo nismo spremni ili pripremljeni
za ovaj srebrni cunami.
za ovaj srebrni cunami.
Potrebna nam je dovoljno dinamična
infrastruktura koja može da se izbori
infrastruktura koja može da se izbori
12:19
We need an infrastructure
dynamic enough to handle
dynamic enough to handle
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12:22
these seismic shifts in our population.
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sa ovim seizmičkim kretanjima populacije.
12:27
Now is the time to create
something new, something vital.
something new, something vital.
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Sada je vreme da se stvori nešto novo,
nešto vitalno.
nešto vitalno.
12:30
I know we can because we have to.
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Znam da možemo jer moramo.
12:33
The alternative is just unacceptable.
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Alternativa je prosto neprihvatljiva.
12:35
And the key ingredients are known:
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Ključni sastojci su poznati:
12:37
policy, education and training,
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princip rada, obrazovanje i obuka,
12:41
systems, bricks and mortar.
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sistemi, cigla i malter.
12:44
We have tons of input
for designers of all stripes to work with.
for designers of all stripes to work with.
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Imamo dosta informacija
za sve vrste dizajnera o tome šta da rade.
za sve vrste dizajnera o tome šta da rade.
12:49
We know, for example, from research
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Iz istraživanja na primer znamo
12:51
what's most important to people
who are closer to death:
who are closer to death:
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šta je najbitnije ljudima
koji su blizu smrti:
koji su blizu smrti:
12:54
comfort; feeling unburdened
and unburdening to those they love;
and unburdening to those they love;
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komfor, osećaj neopterećnosti
i da nisu teret svojim voljenima,
i da nisu teret svojim voljenima,
13:01
existential peace; and a sense
of wonderment and spirituality.
of wonderment and spirituality.
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egzistancijalni mir i osećaj
čuđenja i duhovnosti.
čuđenja i duhovnosti.
13:08
Over Zen Hospice's nearly 30 years,
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Tokom skoro 30 godina
Doma za stare - projekta Zen
Doma za stare - projekta Zen
13:12
we've learned much more
from our residents in subtle detail.
from our residents in subtle detail.
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naučili smo dosta toga od naših stanovnika
iz suptilnih detalja.
iz suptilnih detalja.
13:17
Little things aren't so little.
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Male stvari nisu tako male.
13:21
Take Janette.
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Pogledajmo Džanet.
13:22
She finds it harder to breathe
one day to the next due to ALS.
one day to the next due to ALS.
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Jednog dana joj je teže da diše
zbog Lu Gerigove bolesti.
zbog Lu Gerigove bolesti.
13:26
Well, guess what?
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Pogodite šta?
13:28
She wants to start smoking again --
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Želi da ponovo počne da puši,
13:31
and French cigarettes, if you please.
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francuske cigarete, ako može.
13:36
Not out of some self-destructive bent,
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Ne iz nekog samouništilačkog hira,
13:39
but to feel her lungs filled
while she has them.
while she has them.
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već da oseti ispunjena pluća
dok ih još uvek ima.
dok ih još uvek ima.
13:44
Priorities change.
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Prioriteti se menjaju.
13:47
Or Kate -- she just wants to know
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Ili Kejt - ona samo želi da zna
13:50
her dog Austin is lying
at the foot of her bed,
at the foot of her bed,
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da njen pas Ostin leži
u dnu njenog kreveta,
u dnu njenog kreveta,
13:54
his cold muzzle against her dry skin,
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njegova hladna njuška
naspram njene suve kože
naspram njene suve kože
13:57
instead of more chemotherapy
coursing through her veins --
coursing through her veins --
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umesto još hemoterapije
koja bi joj tekla venama -
koja bi joj tekla venama -
14:00
she's done that.
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s tim je završila.
14:02
Sensuous, aesthetic gratification,
where in a moment, in an instant,
where in a moment, in an instant,
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Čulno, estetsko zadovoljenje,
gde u trenutku, momentalno
gde u trenutku, momentalno
14:07
we are rewarded for just being.
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budemo nagrađeni
samo zato što postojimo.
samo zato što postojimo.
14:15
So much of it comes down to
loving our time by way of the senses,
loving our time by way of the senses,
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Toliko toga se svodi na obožavanje
našeg vremena samo kroz čula,
našeg vremena samo kroz čula,
14:19
by way of the body -- the very thing
doing the living and the dying.
doing the living and the dying.
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kroz telo - baš onu stvar
koja živi i koja umire.
koja živi i koja umire.
Verovatno najdirljivija prostorija
14:26
Probably the most poignant room
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14:27
in the Zen Hospice guest house
is our kitchen,
is our kitchen,
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u gostinskoj kući našeg doma
je naša kuhinja,
je naša kuhinja,
14:30
which is a little strange when you realize
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što je pomalo čudno kada shvatite
14:32
that so many of our residents
can eat very little, if anything at all.
can eat very little, if anything at all.
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da većina naših stanovnika
može da pojede veoma malo, skoro ništa.
može da pojede veoma malo, skoro ništa.
14:36
But we realize we are providing
sustenance on several levels:
sustenance on several levels:
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Ali shvatamo da pružamo potporu
na više nivoa:
na više nivoa:
14:41
smell, a symbolic plane.
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miris, simbolički nivo.
14:46
Seriously, with all the heavy-duty stuff
happening under our roof,
happening under our roof,
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Zaista, uz sve ozbiljne stvari
koje se dešavaju pod našim krovom,
koje se dešavaju pod našim krovom,
14:51
one of the most tried and true
interventions we know of,
interventions we know of,
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jedna od najboljih i isprobanih
intervencija za koju znamo
intervencija za koju znamo
14:55
is to bake cookies.
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je pečenje kolača.
15:10
As long as we have our senses --
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Dok god imamo naša čula -
15:11
even just one --
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čak i samo jedno -
15:13
we have at least
the possibility of accessing
the possibility of accessing
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makar imamo mogućnost pristupa onome
15:17
what makes us feel human, connected.
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što nas čini ljudima, povezanima.
15:22
Imagine the ripples of this notion
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Zamislite efekte ove ideje
15:25
for the millions of people
living and dying with dementia.
living and dying with dementia.
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za milione ljudi
koji žive i umiru sa demencijom.
koji žive i umiru sa demencijom.
15:29
Primal sensorial delights that say
the things we don't have words for,
the things we don't have words for,
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Iskonski čulni užici koji govore
stvari za koje nemamo reči,
stvari za koje nemamo reči,
15:33
impulses that make us stay present --
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impulsi od kojih ostajemo prisutni -
15:36
no need for a past or a future.
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nema potrebe za prošlošću ili budućnošću.
15:42
So, if teasing unnecessary suffering out
of the system was our first design cue,
of the system was our first design cue,
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Ako je prva naznaka za dizajn bila
izvlačenje nepotrebne patnje iz sistema,
izvlačenje nepotrebne patnje iz sistema,
15:50
then tending to dignity
by way of the senses,
by way of the senses,
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onda je druga naznaka za dizajn
15:53
by way of the body --
the aesthetic realm --
the aesthetic realm --
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pažnja o dostojanstvu kroz čula,
15:57
is design cue number two.
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kroz telo i estetski realm.
15:59
Now this gets us quickly to the third
and final bit for today;
and final bit for today;
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Ovo nas vodi ka trećoj
i poslednjoj stvari za danas.
i poslednjoj stvari za danas.
16:03
namely, we need to lift our sights,
to set our sights on well-being,
to set our sights on well-being,
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Naime, treba da prebacimo
svoj fokus na dobrostanje,
svoj fokus na dobrostanje,
16:10
so that life and health and healthcare
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tako da život i zdravlje i nega
16:13
can become about making life
more wonderful,
more wonderful,
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mogu da imaju veze sa tim
da život bude lepši,
da život bude lepši,
16:16
rather than just less horrible.
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umesto da bude manje užasan.
16:20
Beneficence.
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Milosrđe.
Ovo je ono što pogađa razliku
između modela brige
između modela brige
16:22
Here, this gets right at the distinction
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16:25
between a disease-centered and a patient-
or human-centered model of care,
or human-centered model of care,
249
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5134
koji se okreće oko bolesti
i onog koji se okreće oko pacijenta,
i onog koji se okreće oko pacijenta,
16:30
and here is where caring
becomes a creative, generative,
becomes a creative, generative,
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i ovde nega postaje
čin kreativnosti, stvaranja
čin kreativnosti, stvaranja
16:33
even playful act.
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čak i igre.
16:36
"Play" may sound like a funny word here.
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"Igra" možda ovde zvuči čudno.
16:39
But it is also one of our
highest forms of adaptation.
highest forms of adaptation.
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Ali to je jedan od naših
najviših oblika adaptacije.
najviših oblika adaptacije.
16:42
Consider every major compulsory effort
it takes to be human.
it takes to be human.
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Razmislite o svakom većem obaveznom naporu
koji je potreban da budete čovek.
koji je potreban da budete čovek.
16:47
The need for food has birthed cuisine.
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Potreba za hranom stvorila je kuhinju.
16:49
The need for shelter
has given rise to architecture.
has given rise to architecture.
256
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2588
Potreba za skloništem
dala je zamah arhitekturi.
dala je zamah arhitekturi.
16:52
The need for cover, fashion.
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Potreba za odeždom - modu.
16:54
And for being subjected to the clock,
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A što se tiče prolaska vremena,
16:57
well, we invented music.
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pa, izmislili smo muziku.
17:03
So, since dying
is a necessary part of life,
is a necessary part of life,
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Pošto je smrt obavezan deo života,
17:06
what might we create with this fact?
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šta da uradimo s ovom činjenicom?
17:12
By "play" I am in no way suggesting
we take a light approach to dying
we take a light approach to dying
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Pod "igrom" ne podrazumevam
da zauzmemo lak pristup umiranju
da zauzmemo lak pristup umiranju
17:15
or that we mandate
any particular way of dying.
any particular way of dying.
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ili da zahtevamo neki naročit
način da se umre.
način da se umre.
17:18
There are mountains of sorrow
that cannot move,
that cannot move,
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Postoje planine bola
koje ne mogu da se izmeste,
koje ne mogu da se izmeste,
17:20
and one way or another,
we will all kneel there.
we will all kneel there.
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i na jedan ili drugi način,
svi ćemo tamo pokleknuti.
svi ćemo tamo pokleknuti.
17:24
Rather, I am asking that we make space --
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Umesto toga tražim da stvorimo prostora -
17:28
physical, psychic room, to allow life
to play itself all the way out --
to play itself all the way out --
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fizičkog, mentalnog prostora,
da dozvolimo životu da se potpuno odigra,
da dozvolimo životu da se potpuno odigra,
17:34
so that rather than just
getting out of the way,
getting out of the way,
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umesto da se samo sklonimo sa puta,
17:37
aging and dying can become
a process of crescendo through to the end.
a process of crescendo through to the end.
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starenje i smrt mogu da postanu
proces nalik krešendu sve do kraja.
proces nalik krešendu sve do kraja.
17:44
We can't solve for death.
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Ne možemo da rešimo smrt.
17:50
I know some of you are working on this.
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Znam da neki od vas rade na ovome.
17:52
(Laughter)
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(Smeh)
17:57
Meanwhile, we can --
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U međuvremenu, možemo -
17:58
(Laughter)
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(Smeh)
18:00
We can design towards it.
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Možemo da dizajniramo za smrt.
18:04
Parts of me died early on,
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Delovi mene umrli su rano
18:05
and that's something we can all say
one way or another.
one way or another.
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i to je nešto što svi možemo reći
na ovaj ili onaj način.
na ovaj ili onaj način.
18:08
I got to redesign my life
around this fact,
around this fact,
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Ponovo sam osmislio svoj život
oko ove činjenice
oko ove činjenice
18:11
and I tell you it has been a liberation
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i mogu da vam kažem da je bilo oslobođenje
18:14
to realize you can always find
a shock of beauty or meaning
a shock of beauty or meaning
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da shvatim da uvek možete pronaći
šok lepote ili značenje
šok lepote ili značenje
18:17
in what life you have left,
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u životu koji vam je preostao,
18:20
like that snowball lasting
for a perfect moment,
for a perfect moment,
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nalik na grudvu
koja je trajala savršen trenutak
koja je trajala savršen trenutak
18:22
all the while melting away.
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dok se topila.
18:26
If we love such moments ferociously,
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Ukoliko žestoko volimo te trenutke,
18:32
then maybe we can learn to live well --
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možda možemo naučiti da živimo dobro -
18:35
not in spite of death,
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ne uprkos smrti,
18:37
but because of it.
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već zbog nje.
18:42
Let death be what takes us,
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Neka smrt bude ono što nas odnosi,
18:44
not lack of imagination.
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a ne nedostatak mašte.
18:48
Thank you.
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Hvala vam.
18:50
(Applause)
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(Aplauz)
ABOUT THE SPEAKER
BJ Miller - Palliative care physicianUsing empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death.
Why you should listen
Palliative care specialist BJ Miller helps patients face their own deaths realistically, comfortably, and on their own terms. Miller is cultivating a model for palliative care organizations around the world, and emphasizing healthcare’s quixotic relationship to the inevitability of death. He is a hospice and palliative medicine physician and sees patients and families at the UCSF Helen Diller Family Comprehensive Cancer Center.
Miller’s passion for palliative care stems from personal experience -- a shock sustained while a Princeton undergraduate cost him three limbs and nearly killed him. But his experiences form the foundation of a hard-won empathy for patients who are running out of time.
BJ Miller | Speaker | TED.com