[MUSIC]
I have a very complicated relationship with death.
As a medical student I've learned about death.
I've been with patients as they've died, and I can even talk about death.
After all, I did title my talk, Let's Talk About Death.
>> [LAUGH] >> But in my heart, I don't accept death.
I find it excruciating.
Death just seems so unfair, so out of my control, so final.
Every since I was little, I've had this horrible fear that I would die and
not have a chance to say good-bye.
After my grandmother passed away when I was 13,
I started writing a ton of notes to everyone I knew to say good-bye.
With the idea that maybe somehow they would be sent out
in the event that I met an unexpected end.
I pictured death by lightning.
I was a pretty dramatic child.
>> [LAUGH] >> But I figured if I couldn't control
death, then at the very least, I could try to make sure that my final actions
were according to what I valued, making sure that the people I love feel loved.
Now fast forward to my training at the hospital.
I'd like to tell you about a patient.
Let's call him Sam.
Sam was fantastic, he was 78 years old, he had a huge family.
And he loved telling me stories about his old surfing days.
Sam had cancer and kidney disease and blood clots.
He could no longer move on his own.
When I met Sam,
he had been brought in to the hospital by an ambulance with internal bleeding.
Sam was in a lot of pain.
But even despite that, every time I would walk into his room he would look at me and
say, hey baby, how you doin'?
>> [LAUGH] >> Grandpa still had game.
Unfortunately though, his situation quickly became worse.
As his medical team, we decided to briach the topic of death.
We asked him, what would you want,
Sam, in case your heart stops beating, or you stop breathing.
Sam, would have nothing of it.
Sam got angry, and his family got angry.
And frankly, I got pretty angry at the situation too.
But, we had reached medicine's limits.
Sam, ultimately went home, with no plan.
He ended up coming back, several times to the hospital,
until he finally passed away at the hospital.
In a cold sterile environment surrounded by machines.
I've often wondered what would Sam's final year have looked like,
had he tried hospice?
Hospice is a service for the dying, which optimizes for comfort and
symptom management rather than focusing on trying to find one more cure.
The research tells us that for folks who try hospice,
they often live longer and more peaceful lives than those who don't.
I don't know what Sam would have wanted.
We never talked about death.
But what I do know is that Sam had never thought about death.
And that's the case for most of us.
And what that means is, that when we get to the point where we can more or
less anticipate death,
the time that we have left becomes more about death and less about life.
By show of hands, how many of us are uncomfortable talking or
planning for death?
Me too.
We don't think about death.
We don't talk about death.
We don't plan for death.
So I'd like to challenge us all today to change our conversation,
to change our culture to include death.
Because when we plan for
a meaningful death, not only do we die better, but we also live better.
So before we move on,
I'd like to lay out a few basic facts to put us all on the same page.
Number one.
Until Google comes up with a cure, we're all going to die.
>> [LAUGH] >> Number two.
God forbid that somebody actually gets struck by lightning, but
the majority of us will die of terminal illness or old age.
So let's focus on the latter two.
And number three there's no wrong choice when it comes to how you want
to spend the end of life but often times it is a choice.
Modern medicine has made tremendous advances.
But has also convinced us that maybe we can cure death.
We can't.
So instead, the conversation becomes how do we want to die?
We spend our whole lives planning for our milestones, writing our narratives,
planning for that big job, or the wedding, or even A LOWkeynotes talk.
>> [LAUGH] >> But
yet the final chapter still sneaks up on us.
In the US, most of us don't die the way we want to.
While the majority of elderly folks have indicated that they'd like to die at home,
only 25% actually do.
In medicine, our default is to throw a ton of interventions at you,
in an effort to prolong life.
But that often comes at the cost of quality time and spending your last time,
perhaps the way you want.
The details of why we die are different for everyone.
But if we set our goals ahead of time, then our doctors can help us figure
out which interventions will help us meet those goals.
I'd like to tell you about a community in Lacrosse, Wisconsin.
It's a town in which they had a huge widespread initiative
to get everyone to write their advanced directives or
the documents which you can specify what you want at the end of life.
They changed their culture.
They changed their conversation.
They even changed their health care system to adjust to the need.
And the result?
96% of people had an advance directive on file when they died.
And most people wanted to die at home, and that's how they died, on their own terms.
For me the most important reason why I care so
deeply about this is because of the impact that it could have on my family.
When we specify how we want to die,
when we set our wishes forth we take the burden of choice away from our families.
The research tells us that those who have a plan in place,
their families suffer less stress, less anxiety, less depression.
And they are free to grieve rather then second guess their judgement.
Planning for death will never take away grief.
Grief is inevitable.
But second guessing is not.
So let's change our conversation.
Let's think about death.
Let's plan for death.
Let's talk about death.
Step one, thinking about death.
In medicine we're talk to ask several questions
when we start off the end of life discussion.
Question such as, what matters most to you?
What are your hopes?
What are your goals?
And what are you willing to trade-off for them?
You might recognize these questions as the very same ones that we
use when we think about life.
In fact, the career office has given us a fantastic resource to help guide this.
>> [LAUGH] >> Bet you'll never look at that
the same way again.
>> [LAUGH]
>> Step two, talk about death.
Sit down with your parents, your grandparents, your friends, anybody.
Ask them how do they want to die, and tell them what you want.
As the business school has taught us, maybe role play it out first.
And we won't know all of the details, but if we paint the broad strokes early,
then we'll be able to fill in those details better later.
Again, there are few good resources that can help guide this.
So, check out The Conversation Project, Death with Dinner or
read Atul Gawande's book being Mortal.
And finally, Step 3 three, write your advanced directives.
Change them over time and tell your family, your friends, and
your doctors about this.
And even if you don't write an advanced directive, at the very least,
make sure that you designate a proxy and everyone knows about it.
Planning for death will never take away the pain of loss,
the pain of losing someone who is close to us, and not having them with us anymore.
I'm not sure that I'll ever be okay with death.
I'll never stop missing my grandma, or Sam, or
the countless other people whose hands I've had the privilege of holding.
But I believe that if we plan for
a meaningful death we can die the way that we lived,
on our own terms, because life is so precious.
So let's talk about death.
Because in planning for a meaningful death,
we allow ourselves to lead a meaningful life.
Thank you.
>> [APPLAUSE]
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