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I was called down to the ward to see him.
我被叫到病房去看他。
His is the little hand.
他的小手可以說是骨瘦如柴。
I was called down to the ward to see him
一名呼吸內科醫生
by a respiratory physician.
將我叫到他的診室。
He said, "Look, there's a guy down here.
他對我說：“那有個病人”
He's got pneumonia,
他得的是肺炎，
and he looks like he needs intensive care.
看樣子他需要入你們的ICU病房。
His daughter's here and she wants everything possible
他的女兒在這，
to be done."
她希望你們能盡一切辦法……
Which is a familiar phrase to us.
這是我們常聽到的一句話。
So I go down to the ward and see Jim,
所以，我去病房去看Jim Smith.
and his skin his translucent like this.
他的皮膚半透明成了這個樣子。
You can see his bones through the skin.
透過他的皮膚，你們以看到他的骨頭。
He's very, very thin,
他可是說是瘦骨嶙峋。
and he is, indeed, very sick with pneumonia,
他的肺炎已是相當嚴重了
and he's too sick to talk to me,
病得連和我們講話的力氣都沒有了
so I talk to his daughter Kathleen, and I say to her,
所以，我問他的女兒Kathleen:
"Did you and Jim ever talk about
"你有沒有和他談過"
what you would want done
你會怎么處理這個事，
if he ended up in this kind of situation?"
如果他到了這種地步？
And she looked at me and said, "No, of course not!"
她看了看我，然后說：”沒有，當然沒有“
I thought, "Okay. Take this steady."
好吧，我當時想，慢慢做她的工作吧。
And I got talking to her, and after a while, she said to me,
我和她談了很久，然后，她對我說：
"You know, we always thought there'd be time."
你知道的，我們也知道，遲早會有那一天的。
Jim was 94.
當時已經94歲了。
And I realized that something wasn't happening here.
這件事讓我覺得，我們可以為這類病人做些事。
There wasn't this dialogue going on
要不是有這件事
that I imagined was happening.
我也想象不到我們會不會去做這件事。
So a group of us started doing survey work,
所以，我們有一個小組開始做一些調查工作，
and we looked at four and a half thousand nursing home
我們走訪了
residents in Newcastle, in the Newcastle area,
Newcastle地區的4500個在養老院生活的老人，
and discovered that only one in a hundred of them
我們發現，他們當中只有1%的人
had a plan about what to do when their hearts stopped beating.
對他們生理死亡后的事有計劃。
One in a hundred.
僅僅1%。
And only one in 500 of them had plan about what to do
只有500分之1的老人
if they became seriously ill.
會對他們病重時有應對計劃。
And I realized, of course, this dialogue
這個對話使我意識到，
is definitely not occurring in the public at large.
我們生活中的很多人肯定也會對我們的身后事沒有計劃的。
Now, I work in acute care.
現在，我在ICU里工作。
This is John Hunter Hospital.
我的醫院叫“John Hunter”醫院。
And I thought, surely, we do better than that.
而過去我一直認為，我們做得比較好。
So a colleague of mine from nursing called Lisa Shaw and I
所以，我和我的同事Lisa Shaw，她來自養老院，
went through hundreds and hundreds of sets of notes
我們一起在醫療檔案室
in the medical records department
翻看了成千上萬本病歷,
looking at whether there was any sign at all
我們想確認是否有
that anybody had had any conversation about
任何人曾經
what might happen to them if the treatment they were
就如果他們的治療失敗
receiving was unsuccessful to the point that they would die.
而導致他們死亡而作出任何安排的談話。
And we didn't find a single record of any preference
可是，我們找不到關于他們的自我選擇，
about goals, treatments or outcomes from any
目標、治療或者最終結果這方面的東西
of the sets of notes initiated by a doctor or by a patient.
醫生記錄或病人自己寫的都沒有。
So we started to realize
我這才意識到
that we had a problem,
我們出了問題，
and the problem is more serious because of this.
而正因為這一點，這個問題變得更嚴重。
What we know is that obviously we are all going to die,
我們大家都知道的是很明顯，我們都會死去，
but how we die is actually really important,
但我們以何種方式死去更重要，
obviously not just to us, but also to how that
很明顯，這不僅對我們重要，
features in the lives of all the people who live on afterwards.
這對那些活著的人也很重要。
How we die lives on in the minds of everybody
其實我們會怎樣死去，
who survives us, and
這在搶救我們的人的心中是心里有數的,
the stress created in families by dying is enormous,
而死亡給一個家庭帶來的壓力是巨大的，
and in fact you get seven times as much stress by dying
事實上，死在ICU所帶來的壓力
in intensive care as by dying just about anywhere else,
是死在其它地方所帶來的壓力的7倍，
so dying in intensive care is not your top option
所以，選擇在ICU結束自己的生活并不是一個明智的決定
if you've got a choice.
如果你有得選擇的話。
