These are the tips for a better life from a doctor who treated terminally ill patients for decades

“What would you do if today was your last day?”

Over 20 years as a transplant doctor at Stanford University Medical Center, I asked thousands of patients this same question when I met with them for the first time to discuss the possibility of receiving a lung transplant that could save their lives. It was a way to get them to talk and for me to learn about the things the person valued in life: in short, it was not a question of whether the person wanted to continue living, which was obvious because the patient was in my office, but rather why I wanted to continue living.

Listening to your answers was a unique privilege. Most of us don't get to ask that question of people who had weeks, months, and sometimes years to contemplate what life really meant to them. Ultimately, they taught me the difference between the mere span of life and the span of health. Listening to them and sharing some of their stories was like participating in a unique master class.

If we knew how we would spend our last day, we could make decisions about how to spend our next-to-last day, last year, last decade, and every day thereafter.

When I met Nancy in my office, she was emaciated and I could tell that she knew death was an imminent possibility. I learned that she had been tormented by a feeling of not being enough, instilled by her parents from an early age: she was never smart enough, she was never thin enough. She felt like she had to do more, be more. Every day during her youth she walked with that great weight on her shoulders. But then she found a drug that made her feel better. With methamphetamine, she felt that she could conquer the world, that she could be whatever she wanted, without caring what other people thought. That feeling lasted until her addiction developed into a potentially fatal lung disease called pulmonary hypertension. When I asked: “What would you do if today were your last day?”, she thought for a moment and then said quietly: “All my life I have tried to be what others wanted me to be: the bright, smart young woman, the one who achieved stardom.” Then he paused. “So, on my last day, I would just like to live up to my own expectations,” and he nodded slowly to make his point clear. “That way, at least, I could have a day of peace.”

I asked my nurse to put her on the organ waiting list as soon as possible. It occurred to me that every time I asked thousands of patients that question, not one of them responded, “Gee, I wish I had lived my life according to other people's expectations, that would have been great!”

“If we knew how we were going to spend our last day, we could make decisions about how to spend our second-to-last day, last year, last decade, and every day from then on.”

I asked myself: Have we really spent enough time thinking about how we would live if we were free of expectations? And would we regret living by our own decisions at the end of our days? I am pleased to share that Nancy did have the opportunity to start living the way she wanted, and with two healthy lungs.

Not all patients are like Nancy. In medical school we are taught to treat everyone the same, but Larry tested me.

When Larry, a white man, learned that his life had been saved through a transplant with a lung donated by a black man, he strongly questioned why he had not been informed sooner and given the opportunity to refuse the transplant. lung. His words left everyone present in the clinic room speechless, because they resonated with the weight of hatred, ignorance and secular prejudices.

But as the months of recovery passed, something changed inside Larry. Perhaps the question of how he would live out his last day lingered, or his new health made him appreciate the gift of life, but in any case, it sparked a curiosity in him about the person who had given him a second chance. . He sought out his donor's family, thanked them sincerely, and connected closely with people he had previously viewed through a prism of ignorance. In a moment of profound humility, at one of our postoperative checkups, Larry admitted that he had formed many of his beliefs from ignorance. He was even ashamed that he had spent much of his life judging people by their race, recognizing that “everyone's blood is red”. I told him that he was right.

All that really matters book

Although I have advocated for patients who need a transplant regardless of their race or socioeconomic status, I wondered about the prejudices we carry within us that we are not fully aware of. Larry, for example, was so blinded by them that he was willing to give back a healthy lung. Instead of falling into a cycle of depressing thoughts about deep-seated biases and harmful judgments, I asked myself: What opportunities for growth, connection, and happiness might we discover if we shed the protective layers against those we consider “others”? And how does taking into account the duration of health, and not just that of life, encourage us to do so? Apparently, most people wouldn't waste their last day judging and hating others.

Lastly, meet Katherine, who had been sick most of her life with cystic fibrosis and had been hospitalized more than 40 times during her 31 years on this planet. When she was not in the hospital, Katherine followed a treatment regimen that took her 4 to 6 hours a day. The rest of the time, exhausted, she tried to rebuild her life. That life included a man named Henry, whom she met through a dating app. When Katherine told Henry, after a few dates, that she had cystic fibrosis, Henry replied, “I know.” “How?” Katherine asked.

“My sister had it too. She died when we were little. “I helped my parents take care of her.” Henry knew what the disease was like, long before he met Katherine, and perhaps had received his own master class on how to live the experience with his sister. Instead of running away from Katherine, Henry ran closer to her. They got married and ended up at my transplant clinic one day, when Katherine's lungs were getting worse and she was bedridden, on oxygen 24 hours a day.

They held hands while I explained the transplant process. When I was done with the logistics, I asked Katherine, “What would you do if today was your last day?” Then Katherine was in tears before I could finish the question. I looked at Henry, and he was crying too.

“That's the easiest question of the day, doctor,” he said. “I would spend it with Henry, walking through a park near our house, holding his hand, telling him how much I love him and how he helps me move forward. Because when we couldn't walk anymore, when I gave up, I would sit with him on a bench overlooking one of the lakes in the park, and I would tell him that his love had made me the luckiest person alive, not just now, but always.”

I had no more questions for Katherine.

Luckily, because most transplants are successful, including Katherine's, my patients had the opportunity to correct course, to hit the most powerful reset button there is. However, they are not exceptions to the rule: The clock runs the same for all of us. If we truly accept the fact that we don't have life forever, could we identify what really matters to us and make the necessary changes to live with it as our north star?

I think if we all did that, we would stop trying to find what matters to us on screens, social media, or cable news.

We are one of the sickest, most depressed, most anxious, most stressed cultures in the world, and yet we are obsessed with longevity. It seems strange that we are obsessed with longevity, but the quality of our lives is usually terrible. So what keeps us obsessed with trying to live longer when we have not yet determined what our best life would be?

My hunch is that while we spend a remarkable amount of time on external things like our appearance, overloading our schedules, going through our to-do lists, and of course, somehow finding time to read news on the Internet, we barely spend any time on our own. inner life, to deepen our personal discovery. This is what I learned from the 20-year master class that my patients gave me: it is important that we dedicate time to contemplative, meditative work, look inwhich includes asking ourselves the difficult question of what we would do if we had one day to live.

Spend time now thinking about what really matters to you. You will win if you spend each day as if it were your last, because one day it will be.

The patients' names were changed to protect their privacy.

Dr. David Weill was director of the Center for Advanced Lung Diseases and the Lung Transplant Program at Stanford University Medical Center. Dr. Weill's memoir, Exhale: Hope, Healing, and A Life in Transplant was published in 2021 and his novel, All That Really Matters, is available.