TED Translation---Josette Sheeran: Ending hunger now

Well after many years working in trade and economics, four years ago, I found myself working on the front lines of human vulnerability. And I found myself in the places where people are fighting every day to survive and can't even obtain a meal. This red cup comes from Rwanda from a child named Fabian. And I carry this around as a symbol, really, of the challenge and also the hope. Because one cup of food a day changes Fabian's life completely. But what I'd like to talk about today is the fact that this morning, about a billion people on Earth -- or one out of every seven -- woke up and didn't even know how to fill this cup. One out of every seven people.
在貿易及經濟領域工作這麼多年以來 四年前 我發現我在人性弱點 的前線工作 我身處在 人們每天需要為了生存而奮鬥 卻無法得到一餐飯的地方 這個紅色的杯子原本是盧安達的 一個小孩叫做法比恩 我帶著這個杯子 象徵著挑戰 以及希望 因為一天一杯子的食物 就完全的改變了法比恩的生活 但是我今天要談論的 是今天早上 世界上約十億的人口 或是每七個人中就有一個人 起床後卻不知道 要怎麼把這個杯子給填滿 每七個人裡面就會有一個人

First, I'll ask you why should you care? Why should we care? For most people, if they think about hunger, they don't have to go far back on their own family history -- maybe in their own lives, or their parents' lives, or their grandparents' lives -- to remember an experience of hunger. I rarely find an audience where people can go back very far without that experience. Some are driven by compassion, feel it's perhaps one of the fundamental acts of humanity. As Gandhi said, "To a hungry man, a piece of bread is the face of God." Others worry about peace and security, stability in the world. We saw the food riots in 2008, after what I call the silent tsunami of hunger swept the globe when food prices doubled overnight. The destabilizing effects of hunger are known throughout human history. One of the most fundamental acts of civilization is to ensure people can get enough food.
首先，我想問你們為什麼要關心呢? 我們為什麼要在乎？ 對於大部分的人 如果他們想到飢餓 他們不用回溯到家族歷史 也許只要在他們或父母的生活裡 亦或是祖父母的人生 就能記起挨餓的經驗 我很難可以找到一個觀眾 需要想得非常遠才能記起這種經驗 有些人因憐憫心而驅使 覺得這或許 是人性的基本行為 甘地曾說過 對一個挨餓的人，一片麵包就像是上帝的臉 有人擔心著世界上的和平 安全及穩定 我們在2008看到糧食暴動 我稱為飢餓的寧靜海嘯 橫掃過全世界、食物的價格連夜倍增 因饑荒而造成的不穩定 在整個人類的歷史上都經歷過 文明的其中一個基本行為 就是要確保人們可以得到充足的食物

Others think about Malthusian nightmares. Will we be able to feed a population that will be nine billion in just a few decades? This is not a negotiable thing, hunger. People have to eat. There's going to be a lot of people. This is jobs and opportunity all the way up and down the value chain. But I actually came to this issue in a different way. This is a picture of me and my three children. In 1987, I was a new mother with my first child and was holding her and feeding her when an image very similar to this came on the television. And this was yet another famine in Ethiopia. One two years earlier had killed more than a million people. But it never struck me as it did that moment, because on that image was a woman trying to nurse her baby, and she had no milk to nurse. And the baby's cry really penetrated me, as a mother. And I thought, there's nothing more haunting than the cry of a child that cannot be returned with food -- the most fundamental expectation of every human being. And it was at that moment that I just was filled with the challenge and the outrage that actually we know how to fix this problem.
有些人想到馬爾薩斯夢靨 我們能夠在未來的幾十年內 餵飽即將變成九十億的人口嗎? 飢餓不是可以談判的事物 人們需要進食 未來會有更多人 這是份責任也是機會，貫穿了整個價值鏈 但是我對這個議題 有其他的想法 這張照片是我和我的三個孩子 1987年，我當了新手媽媽 我有了的第一個孩子 當我在抱著她餵著她時 有一個和這個非常相似的畫面 在電視上播出 然而這是另外一場在衣索比亞的飢荒 早在一兩年前 導致一百多萬的人死亡 但這個畫面從來沒有像當時如此地讓我震驚 因為那個畫面 是一個女人試著要給她的寶寶餵奶 可是她沒有奶水可以哺乳 這寶寶的哭聲撼動了 當媽媽的我 我想，沒有什麼聲音能夠比 小孩子得不到食物的 哭聲更難忘了 而這是每個人類最基本的需求 在那個時候 我充滿著 疑問及憤怒 因為我們其實知道如何去解決這個問題

This isn't one of those rare diseases that we don't have the solution for. We know how to fix hunger. 100 years ago, we didn't. We actually have the technology and systems. And I was just struck that this is out of place. At our time in history, these images are out of place. Well guess what? This is last week in Northern Kenya. Yet again, the face of starvation at large scale with more than nine million people wondering if they can make it to the next day. In fact, what we know now is that every 10 seconds we lose a child to hunger. This is more than HIV/AIDS, malaria and tuberculosis combined. And we know that the issue is not just production of food.
這並不是那其中一種 我們無法治療的罕見疾病 我們知道怎麼解決飢荒 一百年前的我們無法做到 我們真的擁有這些科技及方法 我很驚訝 因為這不應該存在 在我們現在的歷史，這些景象其實不該出現 你們知道嗎? 上禮拜在北肯亞 再一次的 超過九百萬的人 要面對這場饑荒 他們不知道自己 是否可以活到明天 事實上 我們現在知道 每十秒鐘 就有一個小孩死於飢餓 這個數字 遠比愛滋病 瘧疾及結核病加起來還要高 我們知道這個問題 並不是只有生產食物

One of my mentors in life was Norman Borlaug, my hero. But today I'm going to talk about access to food, because actually this year and last year and during the 2008 food crisis, there was enough food on Earth for everyone to have 2,700 kilocalories. So why is it that we have a billion people who can't find food? And I also want to talk about what I call our new burden of knowledge. In 2008, Lancet compiled all the research and put forward the compelling evidence that if a child in its first thousand days -- from conception to two years old -- does not have adequate nutrition, the damage is irreversible. Their brains and bodies will be stunted. And here you see a brain scan of two children -- one who had adequate nutrition, another, neglected and who was deeply malnourished. And we can see brain volumes up to 40 percent less in these children. And in this slide you see the neurons and the synapses of the brain don't form. And what we know now is this has huge impact on economies, which I'll talk about later. But also the earning potential of these children is cut in half in their lifetime due to the stunting that happens in early years.
我生命裡的一位啟蒙者 是我的英雄諾曼‧布勞格 今天我要跟大家探討食物的取得 因為在今年及去年 還有2008的糧食危機中 地球上的食物是足夠的 可以讓每個人攝取兩千七百卡的熱量 為什麼 有十億的人沒有辦法 找到食物? 我也想要探討 我所謂的知識新負擔 在2008年 刺胳針雜誌集結了研究結果 且提出了令人信服的證據 如果一個長了一千天的小孩-- 從受孕到兩歲-- 沒有足夠的營養 傷害是無法挽回的 他們的腦袋和身體發育不良 在這你會看到兩位小朋友的腦部掃描圖 其中一位有足夠的營養 另一位則被忽略 非常的營養不良 我們可以看見 這些孩子的腦容量 少了百分之四十 這張投影片裡 你會看到腦神經元及突觸 無法成形 我們現在知道的是這將對經濟造成很大的影響 晚點我會談論到 這些小孩未來人生的收入潛力 會因為小時候的 營養不良 而只有一半的收入

So this burden of knowledge drives me. Because actually we know how to fix it very simply. And yet, in many places, a third of the children, by the time they're three already are facing a life of hardship due to this. I'd like to talk about some of the things I've seen on the front lines of hunger, some of the things I've learned in bringing my economic and trade knowledge and my experience in the private sector. I'd like to talk about where the gap of knowledge is.
知識的重擔驅使著我 事實上我們知道怎樣簡單地 解決問題 然而，在很多地區 有三分之一的孩童 在他們三歲的時候 就得因為這個缺陷 面對一生中的苦難 我想要探討 我在飢荒前線看到的一些事 有些我學到的事 藉由我經濟及貿易上的知識 及我在私人領域的經驗 我會談到知識的隔閡

Well first, I'd like to talk about the oldest nutritional method on Earth, breastfeeding. You may be surprised to know that a child could be saved every 22 seconds if there was breastfeeding in the first six months of life. But in Niger, for example, less than seven percent of the children are breastfed for the first six months of life, exclusively. In Mauritania, less than three percent. This is something that can be transformed with knowledge. This message, this word, can come out that this is not an old-fashioned way of doing business; it's a brilliant way of saving your child's life. And so today we focus on not just passing out food, but making sure the mothers have enough enrichment, and teaching them about breastfeeding.
首先我要談論到地球上最古老的營養方法 餵母奶 或許你會驚訝的知道 每22秒就有一個小孩可以獲救 如果孩子出生後的六個月內餵哺母乳 舉例來說，在尼日 只有少於百分之七的孩童 在出生後的 六個月內是吃母奶的 在茅里塔尼亞則是低與百分之三 這些都是可以靠智慧去改變的 這個訊息、文字都是可以傳達出去的 這不是過時做生意的方法 這是個聰明方法 能夠拯救你孩子的生命 我們今天不單單只是專注在分配食物而已 而是確保媽媽們都擁有足夠的營養 以及教導她們哺乳的知識

The second thing I'd like to talk about: if you were living in a remote village somewhere, your child was limp, and you were in a drought, or you were in floods, or you were in a situation where there wasn't adequate diversity of diet, what would you do? Do you think you could go to the store and get a choice of power bars, like we can, and pick the right one to match? Well I find parents out on the front lines very aware their children are going down for the count. And I go to those shops, if there are any, or out to the fields to see what they can get, and they cannot obtain the nutrition. Even if they know what they need to do, it's not available.
我想談論的第二件事情是 如果你住在某個遙遠地區的村莊 你的孩子跛腳 你卻身在乾旱或是水災裡 或是你身處在一個沒有很多食物選擇的地方 你要怎麼做? 你覺得你會到超商 然後像我們一樣買個營養棒 選擇一個合適的嗎? 我發現在前線的家長們 很擔心他們的孩子 我到那些商店，即使在商店 或別的地方找到他們可以得到的食物 他們卻得不到營養 即便他們知道他們必須做些什麼，卻買不到

And I'm very excited about this, because one thing we're working on is transforming the technologies that are very available in the food industry to be available for traditional crops. And this is made with chickpeas, dried milk and a host of vitamins, matched to exactly what the brain needs. It costs 17 cents for us to produce this as, what I call, food for humanity. We did this with food technologists in India and Pakistan -- really about three of them. But this is transforming 99 percent of the kids who get this. One package, 17 cents a day -- their malnutrition is overcome. So I'm convinced that if we can unlock the technologies that are commonplace in the richer world to be able to transform foods. And this is climate-proof. It doesn't need to be refrigerated, it doesn't need water, which is often lacking. And these types of technologies, I see, have the potential to transform the face of hunger and nutrition, malnutrition out on the front lines.
我對於我們目前致力於 的事情感到非常興奮 我們要把食品產業 用的科技 應用到 傳統農作物上 這是綜合了雞豆、奶粉 以及維他命 主要是為了腦部需求 我們花17分錢去製造這個產品 我稱這個為慈愛食物 我們在印度及巴基斯坦 和食品技術人員研發的 大約三個人 這可以改變拿到這種產品 百分之九十九的兒童 一天一包17分錢 就能解決營養失調的問題 我深信 要是我們把這種 在富有世界裡很平凡的科技 用來轉變食物 這個是能抗氣候的 不需要放進冰箱，也不需要水 因為常常會缺水 這種科技 我覺得這是有潛力的 可以改變饑荒和食物，以及把營養不良 從前線踢開

The next thing I want to talk about is school feeding. 80 percent of the people in the world have no food safety net. When disaster strikes -- the economy gets blown, people lose a job, floods, war, conflict, bad governance, all of those things -- there is nothing to fall back on. And usually the institutions -- churches, temples, other things -- do not have the resources to provide a safety net. What we have found working with the World Bank is that the poor man's safety net, the best investment, is school feeding. And if you fill the cup with local agriculture from small farmers, you have a transformative effect. Many kids in the world can't go to school because they have to go beg and find a meal. But when that food is there, it's transformative. It costs less than 25 cents a day to change a kid's life.
接下來我想談論學校食物供給 世界上有百分之八十的人 並沒有食物安全網 當災難發生時 經濟不穩、人們失去工作 水災、戰爭、衝突 糟糕的政府，這些事 沒有什麼可以讓我們依靠 通常有些機構--- 像是教堂、廟宇、或其他機構 並沒有資源 可以提供安全網 我發現和世界銀行合作時 窮人的安全網 最好的投資就是學校的食物供給 要是把杯子裝滿 農夫們種的當地農作物 就可以得到改變的影響 世界上很多小孩沒辦法上學 因為他們要去行乞找飯吃 只要這個食物在那 就是一個轉變了 一天只要花不到25分錢就可以改變一個孩子的生活


But what is most amazing is the affect on girls. In countries where girls don't go to school and you offer a meal to girls in school, we see enrollment rates about 50 percent girls and boys. We see a transformation in attendance by girls. And there was no argument, because it's incentive. Families need the help. And we find that if we keep girls later, they'll stay in school until they're 16, and won't get married if there's food in school. Or if they get an extra ration of food at the end of the week -- it costs about 50 cents -- will keep a girl in school, and they'll give birth to a healthier child, because the malnutrition is sent generation to generation.
最讓人驚嘆的是女孩們的影響 有些國家女孩子無法上學 不過只要提供女孩們在學校的一餐 我們看到上學的比例 是男女各百分之五十 我們看到女孩子出席率的轉變 沒有任何的爭論 這很激勵人心 這些家庭需要幫助 我們發現，要是把女孩們留在學校多一點的時間 她們就會在學校留到十六歲 只要學校還有食物，就還不會結婚 如果她們在周末的時候 得到多餘的食物配給 食物價值五十分錢 女孩就可以繼續上學 她們將來可以生出比較健康的寶寶 因為營養失調 是代代相傳的

We know that there's boom and bust cycles of hunger. We know this. Right now on the Horn of Africa, we've been through this before. So is this a hopeless cause? Absolutely not. I'd like to talk about what I call our warehouses for hope. Cameroon, Northern Cameroon, boom and bust cycles of hunger every year for decades. Food aid coming in every year when people are starving during the lean seasons. Well two years ago, we decided, let's transform the model of fighting hunger, and instead of giving out the food aid, we put it into food banks. And we said, listen, during the lean season, take the food out. You manage, the village manages these warehouses. And during harvest, put it back with interest, food interest. So add in five percent, 10 percent more food. For the past two years, 500 of these villages where these are have not needed any food aid -- they're self-sufficient. And the food banks are growing. And they're starting school feeding programs for their children by the people in the village. But they've never had the ability to build even the basic infrastructure or the resources. I love this idea that came from the village level: three keys to unlock that warehouse. Food is gold there. And simple ideas can transform the face, not of small areas, of big areas of the world.

我們知道飢荒的起落循環 我們知道 現在在非洲之角，我們曾經經歷過這樣的事 所以這是絕望的原因嗎? 當然不是 我想要談論我們的希望倉庫 咯麥隆、北咯麥隆，飢荒的起落循環 年復一年的持續數十年 每年都有糧食救助 在歉收時期挨餓的人們 然而兩年前 我們決定轉變對抗饑荒的形式 我們把食物存放在糧食銀行而不是給予食物救援 仔細聽 我們在歉收時期把食物拿出來＿ 讓你們或村莊去管理這個倉庫 收穫時，再把食物放回去連帶利息 食物的利息 每次多加個5%、10%的食物 過去的兩年 有500個村莊有這種銀行 不需要任何食物救援—他們自給自足 糧食銀行也在成長 他們自己也開始為自己的孩子開辦 學校食物供給 不過他們還是沒有能力 建立起最基礎的基本建設 或是資源 我喜歡村民的想法： 三把鑰匙打開倉庫 食物在那就像黃金 簡單的想法就可以改變 不只是小區域 或是世界上的大區域

I'd like to talk about what I call digital food. Technology is transforming the face of food vulnerability in places where you see classic famine. Amartya Sen won his Nobel Prize for saying, "Guess what, famines happen in the presence of food because people have no ability to buy it." We certainly saw that in 2008. We're seeing that now in the Horn of Africa where food prices are up 240 percent in some areas over last year. Food can be there and people can't buy it.
接下來我想談論數位食物 科技正在改變 食物缺乏的狀態 在那些以前發生飢荒的地方 阿馬蒂亞‧森得到諾貝爾獎 是因為他說「饑荒都發生在食物前 因為人們沒有能力去購買」 我們在2008年目睹這一切 我們在非洲之角看到 某些地區食物的價錢比前一年 貴了2.4倍 食物就在那，可是人們買不起

Well this picture -- I was in Hebron in a small shop, this shop, where instead of bringing in food, we provide digital food, a card. It says "bon appetit" in Arabic. And the women can go in and swipe and get nine food items. They have to be nutritious, and they have to be locally produced. And what's happened in the past year alone is the dairy industry -- where this card's used for milk and yogurt and eggs and humus -- the dairy industry has gone up 30 percent. The shopkeepers are hiring more people. It is a win-win-win situation that starts the food economy moving. We now deliver food in over 30 countries over cellphones, transforming even the presence of refugees in countries, and other ways.

這張圖，是我在西伯恩的小商店裡 我們不是直接給予食物 而是提供數位食物，一張卡 上面寫著阿拉伯文的「請慢用」 太太們可以到商店後揮一揮卡 就可以得到九種食物 食物得要是營養的 並且由當地生產 過去這一年的 乳製品產業 用這張卡買牛奶、優格 蛋和豆泥醬 乳製品產業業績上升三成 店老闆請更多的員工 這是個三贏的局面 讓糧食經濟開始滾動 我們現在透過手機，食物傳遞到 30多個國家 甚至可以改變某些國家難民的出現 或出現的方式



Perhaps most exciting to me is an idea that Bill Gates, Howard Buffett and others have supported boldly, which is to ask the question: What if, instead of looking at the hungry as victims -- and most of them are small farmers who cannot raise enough food or sell food to even support their own families -- what if we view them as the solution, as the value chain to fight hunger? What if from the women in Africa who cannot sell any food -- there's no roads, there's no warehouses, there's not even a tarp to pick the food up with -- what if we give the enabling environment for them to provide the food to feed the hungry children elsewhere? And Purchasing for Progress today is in 21 countries. And guess what? In virtually every case, when poor farmers are given a guaranteed market -- if you say, "We will buy 300 metric tons of this. We'll pick it up. We'll make sure it's stored properly." -- their yields have gone up two-, three-, fourfold and they figure it out, because it's the first guaranteed opportunity they've had in their life. And we're seeing people transform their lives. Today, food aid, our food aid -- huge engine -- 80 percent of it is bought in the developing world. Total transformation that can actually transform the very lives that need the food.
對我來說最開心的 是比爾‧蓋斯、霍華‧巴菲特和其他人 大力支持這個想法 他們問 要是，不要把挨餓當成是受害者 他們大部分都是小農民 卻無法種足夠的食物去賣 甚至是養活家人 要是我們把他們當成是解決辦法 當成是價值鏈對上饑荒呢?＿ 要是在非洲的婦女 她們不能賣任何的食物 在那沒有道路、沒有倉庫 也沒有防水布可以把食物裝起 要是我們提供他們環境 可以讓他們在其他地方 用食物養育他們挨餓的孩子們 現在「購買為了進步」計畫在21個國家實行 你們知道嗎? 幾乎在每個案例裡 當窮的農夫得到肯定的市場 只要你說「我們會買下這個300公噸 我們會整理且確保這些都安置好」 他們的產量上升了兩倍、三倍、四倍 他們會知道 因為這會是他們人生中第一個確定的機會 我們看見人們改變他們的生活 今天，我們的糧食救援 這個大方法 有百分之八十是從開發中國家買來的 完全的轉變 可以真的改變需要食物的人們

Now you'd ask, Can this be done at scale? These are great ideas, village-level ideas. Well I'd like to talk about Brazil, because I've taken a journey to Brazil over the past couple of years, when I read that Brazil was defeating hunger faster than any nation on Earth right now. And what I've found is, rather than investing their money in food subsidies and other things, they invested in a school feeding program. And they require that a third of that food come from the smallest farmers who would have no opportunity. And they're doing this at huge scale after President Lula declared his goal of ensuring everyone had three meals a day. And this zero hunger program costs .5 percent of GDP and has lifted many millions of people out of hunger and poverty. It is transforming the face of hunger in Brazil, and it's at scale, and it's creating opportunities. I've gone out there; I've met with the small farmers who have built their livelihoods on the opportunity and platform provided by this.
你現在會想問，這可以規模性的完成嗎? 有很多好的想法是從村莊來的 接下來我想要談論巴西 因為在過去幾年我曾經到巴西旅遊過 當我得知巴西正在對抗饑荒 處理速度比其他國家還要快 我發現到 除了投入金錢在食物補助金 及其他東西 他們也投資在學校食物供給計畫上 他們要求三分之一的食物 是要沒有機會的小農夫們種的 總統盧拉宣示他的目標 確保每個人一天都有三餐 他們正在大規模的進行 這零飢荒的計畫 需要犧牲0.5%國內生產總值(GDP) 就可以讓數百萬的人 脫離挨餓及貧窮 這改變在巴西的飢荒 也創造了很多的機會 我到過那邊也見了那些建立起 自己生計的小農夫們 都是藉由這個機會及政策 的提供

Now if we look at the economic imperative here, this isn't just about compassion. The fact is studies show that the cost of malnutrition and hunger -- the cost to society, the burden it has to bear -- is on average six percent, and in some countries up to 11 percent, of GDP per year. And if you look at the 36 countries with the highest burden of malnutrition, that's 260 billion lost from a productive economy every year. Well, the World Bank estimates it would take about 10 billion dollars, 10.3, to address malnutrition in those countries. You look at the cost-benefit analysis, and my dream is to take this issue, not just from the compassion argument, but to the finance ministers of the world, and say we cannot afford to not invest in the access to adequate, affordable nutrition for all of humanity.
現在，我們看這裡經濟優先權的話 這不是只有同情 事實上，研究指出 營養不良及飢荒的花費 造成這個社會 要去支撐的負擔 平均一年要百分之6 或有些國家甚至是一年百分之11 的GDP 如果你看營養不良負擔最高的 前36個國家 每一年都要損失生產性經濟 2.6兆 世界銀行估計 大概要花費一百億 130億 才能在這些國家處理營養失調的問題 你們看這個成本收益的分析 我的夢想是將這個問題 不只是從同情的理由出發 而是帶到全世界的財政部長前 說我們無法 不去讓 全人類得到足夠且負擔的起的 食物

The amazing thing I've found is nothing can change on a big scale without the determination of a leader. When a leader says, "Not under my watch," everything begins to change. And the world can come in with enabling environments and opportunities to do this. And the fact that France has put food at the center of the G20 is really important. Because food is one issue that cannot be solved person by person, nation by nation. We have to stand together. And we're seeing nations in Africa. WFP's been able to leave 30 nations, 30 nations, because they have transformed the face of hunger in their nations.
我發現到令人吃驚的事情 要是沒有領導者的決心 就沒有事情可以大規模的改變 當一個領導者說：「在我的注意之下」 事情就開始改變了 整個世界可以一起加入 藉由有利的環境及機會來幫忙 事實上，法國 已經在G20中心安置食物 這很重要 因為糧食是一個議題 卻無法只靠一個人或一個國家解決問題 我們必須站在一起 看到非洲的國家們 WFP可以把問題留給這30個國家 因為他們已經轉變 他們國家飢荒的狀況

What I would like to offer here is a challenge. I believe we're living at a time in human history where it's just simply unacceptable that children wake up and don't know where to find a cup of food. Not only that, transforming hunger is an opportunity, but I think we have to change our mindsets. I am so honored to be here with some of the world's top innovators and thinkers. And I would like you to join with all of humanity to draw a line in the sand and say, "No more. No more are we going to accept this." And we want to tell our grandchildren that there was a terrible time in history where up to a third of the children had brains and bodies that were stunted, but that exists no more.
我希望在這提出一個挑戰 我相信在我們這個人類史上的時間點 我們無法接受 竟然有孩子起床後 並不知道在哪裡可以找到一杯的食物 不僅 改變饑荒 是個契機 我也覺得我們該改變自己的心態 我很榮幸可以在這 和世界上頂尖的創新家以及思想家一起 我希望你們可以和大家一起 在沙地上畫一條線 並說「不再有了 我們不會再接受像這樣的事」 我們要告訴未來的子孫們 在歷史上曾經有很糟糕的時期 大約有三分之一的孩童 他們的大腦及身體發育不良 不過現在已經看不到了

Thank you.

謝謝大家


(Applause)
(掌聲)

TED Translation---Charity Tillemann-Dick: Singing after a double lung transplant

You'll never sing again, said her doctor. But in a story from the very edge of medical possibility, operatic soprano Charity Tillemann-Dick tells a double story of survival -- of her body, from a double lung transplant, and of her spirit, fueled by an unwavering will to sing. A powerful story from TEDMED 2010.

她的醫生告訴她：「妳再也無法唱歌了。」從醫學的可能性邊緣的一個故事裡，歌劇女高音伽綠地．提利曼．迪克訴說了一個存活下來的故事－她的身體在雙肺移植手術中後功存活下來，她的意志，充滿著堅持歌唱心願。這是TEDMED2010充滿力量的故事。

You may not know this, but you are celebrating an anniversary with me. I'm not married, but one year ago today, I woke up from a month-long coma, following a double lung transplant. Crazy, I know. Insane. Thank you.

你或許不知道， 不過你現在正和我慶祝一個週年紀念日。 我還沒結婚， 不過一年前的今天， 在雙肺移植手術後我從一個月長的 昏迷中清醒。 我知道，這很瘋狂，很危險。 謝謝。

Six years before that, I was starting my career as an opera singer in Europe, when I was diagnosed idiopathic pulmonary hypertension -- also known as PH It happens when there's a thickening in the pulmonary veins, making the right side of the heart work overtime, and causing what I call the reverse-Grinch effect. My heart was three and a half sizes too big. Physical activity becomes very difficult for people with this condition. And usually after two to five years, you die. I went to see this specialist, and she was top-of-the-field and told me I had to stop singing. She said, "Those high notes are going to kill you." While she didn't have any medical evidence to back up her claim that there was a relationship between operatic arias and pulmonary hypertension, she was absolutely emphatic I was singing my own obituary. I was very limited by my condition, physically. But I was not limited when I sang. And as air came up from my lungs, through my vocal cords and passed my lips as sound, it was the closest thing I had ever come to transcendence. And just because of someone's hunch, I wasn't going to give it up.

在手術的六年前， 我才剛開始我的事業， 在歐洲擔任一位歌劇歌手。 我被診斷出患有"原發性肺動脈高血壓"--- 就是所知的PH(肺高血壓)。 這種症狀發生在 當肺靜脈血管增厚時， 會讓右邊的心臟 超時工作，而造成我所說的 反向鬼靈精效應(故事裡的鬼靈精心臟縮小)。 我的心臟大上了 3.5倍， 擁有這種症狀的人 身體活動變的很吃力， 通常二到五年後 就會死去。 我去找這症狀的專家， 她是這領域的佼佼者， 而她告訴我該停止唱歌，她說：「那些高音符會害死你。」然而她沒有任何醫學上的證據 可以證實她說的 歌劇詠歎調 和PH 是有關連性的， 她非常的確定 我唱出的是自己的訃聞。 我完全受限於我身體的狀況，但我唱歌時就毫無限制了。當空氣從肺部升起 穿過我的聲帶 透過我的雙唇變成音樂，那是我做過 最棒的事了。我不因為別人的直覺而就這樣放棄歌唱。
Thankfully, I met Reda Girgis, who is dry as toast, but he and his team at Johns Hopkins didn't just want me to survive. They wanted me to live a meaningful life. This meant making trade-offs. I come from Colorado. It's a mile high, and I grew up there with my 10 brothers and sisters and two adoring parents. Well, the altitude exacerbated my symptoms. So I moved to Baltimore to be near my doctors and enrolled in conservatory nearby. I couldn't walk as much as I used to, so I opted for five-inch heels. And I gave up salt, I went vegan, and I started taking huge doses of -- sildenafil -- also known as Viagra.
幸好我遇到瑞達．葛蓋斯， 他挺無聊的， 但是，他和他在約翰霍普金斯醫院裡的團隊 希望我不只是只有存活下來， 他們希望我 過的是有意義的人生， 意思就是我該做個取捨了。 我從科羅拉多州來， 住在海拔一英里高的地方， 和我的十個兄弟姐妹 以及我很愛的爸媽一起成長。 然而，這樣的高海拔加重了我的病情， 所以我搬到離我的醫生比較近的巴爾的摩港市， 就讀在附近的音樂學院。 我沒辦法像以前一樣走的多， 所以我選擇五吋高的高跟鞋。 我不吃含鹽的食物， 開始吃全素， 也開始服用大量的 昔多芬--- 就是大家所知的威爾剛。

(Laughter)
 (笑聲)

My father and my grandfather were always looking for the newest thing in alternative or traditional therapies for PH, but after six months, I couldn't walk up a small hill, I couldn't climb a flight of stairs, I could barely stand up without feeling like I was going to faint. I had a heart catheterization, where they measure this internal arterial pulmonary pressure, which is supposed to be between 15 and 20. Mine was 146. I like to do things big. And it meant one thing: There is a big gun treatment for pulmonary hypertension called Flolan. And it's not just a drug, it's a way of life. doctors insert a catheter in your chest, which is attached to a pump that weighs about four and a half pounds. Every day, 24 hours, that pump is at your side, administering medicine directly to your heart. And it's not a particularly preferable medicine in many senses. This is a list of the side effects: If you eat too much salt, like a peanut butter and jelly sandwich, you'll probably end up in the ICU. If you go through a metal detector, you'll probably die. If you get a bubble in your medicine -- because you have to mix it every morning -- and it stays in there, you probably die. If you run out of medicine, you definitely die.
我的父親和祖父總是嘗試著在傳統及非傳統的 PH治療下 找尋新的事物， 但六個月後， 我無法走上小山丘，無法爬上一段樓梯． 我幾乎無法好好站著， 而不覺得自己快要昏倒了。 我有一個心導管， 醫生會在這心導管測出內部肺動脈壓力， 通常數據應該是15到20， 我的則是146。 我喜歡做大事， 而這代表一件事， 有一種肺高血壓的重要治療 叫作依前列醇， 這不只是種藥物， 也是種生活方式。 醫生在你的胸口放入導管 連接著幫浦， 大概4.5磅重， 每一天，24小時，幫浦都在你的身旁， 供給藥物， 直達你的心臟。 在很多方面來說， 這並不是一個 特別推薦的藥物， 這邊有一個副作用的清單， 如果吃太多鹽巴， 像是花生醬和果醬三明治， 你可能就要待在加護病房了。 如果你經過金屬探測器， 就可能會沒命。 如果你的藥有氣泡在裡頭--- 因為每天早上必須要混合藥物--- 然後氣泡留在藥裡， 你也許會沒命。 如果你的藥沒了，你一定會沒命。

No one wants to go on Flolan. But when I needed it, it was a godsend. Within a few days, I could walk again. Within a few weeks, I was performing. And in a few months, I debuted at the Kennedy Center. The pump was a little bit problematic when performing, so I'd attach it to my inner thigh with the help of the girdle and an ACE bandage. Literally hundreds of elevator rides were spent with me alone stuffing the pump into my Spanx, hoping the doors wouldn't open unexpectedly. And the tubing coming out of my chest was a nightmare for costume designers. I graduated from graduate school in 2006, and I got a fellowship to go back to Europe. A few days after arriving, I met this wonderful, old conductor who started casting me in all of these roles. And before long, I was commuting between Budapest, Milan and Florence. Though I was attached to this ugly, unwanted, high-maintenance, mechanical pet, my life was kind of like the happy part in an opera -- very complicated, but in a good way.
沒有人想要服用依前列醇， 但是，當我需要這種藥時， 這就像上天賜與的。 幾天內，我可以再度的走起路來， 幾個禮拜內，我開始上台表演， 幾個月內， 我在甘迺迪中心首次亮相。 在表演時，這個幫浦會有些麻煩， 所以我會把這個移到大腿內側， 用腰帶和繃帶固定者。 其實好多次 自己一個人搭著電梯時， 會把幫浦塞進我的緊身衣裡， 希望電梯門不要突然打開。 從我胸口突出的導管， 對服裝設計師來說真是個夢靨啊。 我在2006時從研究所畢業， 也我拿到了一筆獎學金讓我可以回到歐洲。 到歐洲的幾天後， 我遇見了這位年邁又很棒的樂團指揮， 他開始幫我選派角色。 不久前，我還在布達佩斯 米蘭和佛羅倫斯 三地往返， 雖然我和， 這個難看、不受歡迎 又很難搞的機器寵物連在一起， 我的生命就像歌劇裡的開心的部分--- 非常的複雜， 不過是在好的方面。

Then in February of 2008, my grandfather passed away. He was a big figure in all of our lives, and we loved him very much. It certainly didn't prepare me for what came next. Seven weeks later, I got a call from my family. My father had been in a catastrophic car accident, and he died. At 24, my death would have been entirely expected. But his -- well the only way I can articulate how it felt was that it precipitated my medical decline. Against my doctors' and family's wishes, I needed to go back for the funeral. I had to say goodbye in some way, shape or form. But soon I was showing signs of right-heart failure, and I had to return to sea level, doing so knowing that I probably would never see my home again.
在2008年 的二月， 我的祖父過世了， 他在我們的心目中是重要的人物， 我們也非常地愛他， 這件事當然讓我無法 為之後到來的事作準備。 七個禮拜後， 我接到一通家裡打來的電話， 我的父親遭遇一場非常嚴重的車禍， 結果他就這樣死了。 在我24歲時，死亡對我來說， 是無法預期到的， 但他的離去--- 唯一可以讓我訴說這個感受的狀況是 這件事造成 我的身體狀況下降。 不顧我的醫生和家人的期望， 我一定要趕到喪禮， 我必須要說聲再見， 不論是用什麼樣的方式或形式。 但是，很快的，我的右邊心臟出現的衰竭的訊號， 我必須要回到海平面上， 就是大家知道的 我可能再也無法看到我的家。

I canceled most of my engagements that summer, but I had one left in Tel Aviv, so I went. After one performance, I could barely drag myself from the stage to the taxicab. I sat down and felt the blood rush down from my face. And in the heat of the desert, I was freezing cold. My fingers started turning blue, and I was like, "What is going on here?" I heard my heart's valves snapping open and closed. The cab stopped, and I pulled my body from it feeling each ounce of weight as I walked to the elevator. I fell through my apartment door and crawled to the bathroom where I found my problem: I had forgotten to mix in the most important part of my medicine. I was dying. And if I didn't mix that stuff up fast, I would never leave that apartment alive. I started mixing, and I felt like everything was going to fall out through one hole or another, but I just kept on going. Finally, with the last bottle in and the last bubble out, I attached the pump to the tubing and lay there hoping it would kick in soon enough. If it didn't, I'd probably see my father sooner than I anticipated. Thankfully, in a few minutes, I saw the signature hive-like rash appear on my legs, which is a side effect of the medication, and I knew I'd be okay.
我取消掉我那年夏天大部分的約會， 不過我還有一個特拉維夫之約，所以我就去了。 在一場表演後， 我幾乎無法自己 從舞台上走到計程車上， 我坐了下來，感覺到血液 從臉上往下衝， 身處在這個熾熱的沙漠， 我卻感覺到寒冷， 我的指尖開始發紫， 我在想「現在到底發生什麼事了?」 我感覺我心臟的瓣膜 很用力地開開關關。 計程車停下後 我把我的身體從車內拖出來， 走到電梯的路上， 我感受到身體上的每一盎司的重量， 我倒在我的房門口， 爬進浴室裡， 然後我發現問題了， 我忘了混和 我藥裡面最重要的部分， 我瀕臨頻死， 而且要是我不趕快混和這些藥， 我就無法活著走出這個房間了。 我開始混和藥物， 我覺得好像每一樣東西都要這個洞口或別的洞口掉出來， 不過我就還是繼續調配藥物。 終於，最後一個罐子到進去，最後一個泡泡跑出來， 我把這個幫浦接上管子， 然後躺在那，希望這個藥可以 快點生效， 如果沒有的話，我想我有可能 比我預期的還要快看到我爸。 感謝上天，幾分鐘內 我看到蜂巢狀的疹出現 在我腿上， 這是這個藥物的副作用， 我知道，我沒事了。

We're not big on fear in my family, but I was scared. I went back to the States, anticipating I'd return to Europe, but the heart catheterization showed that I wasn't going anywhere farther that a flight-for-life from Johns Hopkins Hospital. I performed here and there, but as my condition deteriorated so did my voice. My doctor wanted me to get on the list for a lung transplant; I didn't. I had two friends who had recently died months after having very challenging surgeries. I knew another young man, though, who had PH who died while waiting for one. I wanted to live. I thought stem cells were a good option, but they hadn't developed to a point where I could take advantage of them yet. I officially took a break from singing, and I went to the Cleveland Clinic to be reevaluated for the third time in five years, for transplant. I was sitting there kind of unenthusiastically talking with the head transplant surgeon, and I asked him if I needed a transplant, what I could do to prepare. He said, "Be happy. A happy patient is a healthy patient." It was like in one verbal swoop he had channeled my thoughts on life and medicine and Confucius. I still didn't want a transplant, but in a month, I was back in the hospital with some severely [unclear] kankles -- very attractive. And it was right-heart failure.
我的家人們不輕易感到害怕， 但我很擔心。 我回到美國 期待我還可能會到歐洲， 但是我的心導管， 顯示出我不能到 比醫療直升機到約翰霍浦金斯大學醫院還要遠的地方。 我在各個地方表演， 但是，當我的身體狀況開始惡化後， 我的聲音也開始變糟了。 我的醫生希望將我排進肺移植手術的名單裡， 我不想要。 我有兩個朋友在經歷過非常挑戰性的手術後， 幾個月後的最近，他們也死去了 我還知道另一個年輕人，他得到肺高血壓， 在等待移植時也離開這個世界了。 我還想活下來， 我認為幹細胞或許是一個不錯的選擇， 不過這項技術還不到成熟的階段， 所以我也沒辦法從這上面得到幫助。 我終於開始休假不唱歌， 為了移植手術 出發到克里夫蘭診所， 這是五年內的第三次評估。 我坐著，和負責移植手術的外科醫生談話時 沒有任何的精力， 然後我問他：「要是我需要移植手術 我需要事前準備什麼呢?」 他說：「要開心。 當一個快樂的病人， 就是健康的病人。」 這個言語的衝擊 他改變了我對於 生命、藥物 和孔子的思想 。 我仍然不想要做移植手術 但是在一個月內 因為嚴重的腳踝腫脹 我回到醫院--- 看起來很美。 這是因為右心臟的衰竭。

I finally decided it was time to take my doctor's advice. It was time for me to go to Cleveland and to start the agonizing wait for a match. But the next morning, while I was still in the hospital, I got a telephone call. It was my doctor in Cleveland, Marie Budev. And they had lungs. It was a match. They were from Texas. And everybody was really happy for me, but me. Because, despite their problems, I had spent my whole life training my lungs, and I was not particularly enthusiastic about giving them up. I flew to Cleveland. And my family rushed there in hopes that they would meet me and say what we knew might be our final goodbye. But organs don't wait. And I went into surgery before I could say goodbye. The last thing I remember was lying on a white blanket, telling my surgeon that I needed to see my mother again, and to please try and save my voice. I fell into this apocalyptic dreamworld.
我終於決定 是時候該聽醫生的建議了， 是時候該去克里夫蘭診所 開始焦慮的等待 可配對的肺。 但是，隔日早晨 當我還在醫院時， 我接到一通電話， 是我在克里夫蘭診所的醫生 瑪麗．布戴夫， 他們有肺 可以配對了， 這對肺是從德州來。 大家為我感到非常開心， 但除了我以外 因為，除了肺的問題以外， 我花了我全部的人生去訓練我的肺， 所以我沒有很想要 放棄我的肺。 我飛到克里夫蘭， 我的家人們也都衝到那，， 他們希望可以見到我， 對我說 可能是最後一次的再見， 不過器官總是等不了， 在我可以說聲再見前， 我就進手術房了， 我所記得的最後一件事 是我躺在白色的毯子上 告訴我的醫生我需要再看一次我的母親 還有試著挽救我的聲音。 我陷入了世界末日般的幻境。

During the thirteen-and-a-half hour surgery, I flatlined twice, 40 quarts of blood were infused into my body. And in my surgeon's 20-year career, he said it was among the most difficult transplants that he's ever performed. They left my chest open for two weeks. You could see my over-sized heart beating inside of it. I was on a dozen machines that were keeping my alive. An infection ravaged my skin. I had hoped my voice would be saved, but my doctors knew that the breathing tubes going down my throat might have already destroyed it. If they stayed in, there was no way I would ever sing again. So my doctor got the ENT -- the top guy at the clinic -- to come down and give me surgery to move the tubes around my voice box. He said it would kill me. So my own surgeon performed the procedure in a last-ditch attempt to save my voice.
在這十三個半小時的手術裡， 我死過兩次， 40夸脫的血液 注入了我的身體， 在我醫生的20年職涯裡， 他說這次的手術是他有史以來 最難的一次了。 他們把我的胸膛打開兩個禮拜， 你們可以看見我過大的心臟 在胸腔裡跳動， 我身旁有一打的機器 幫助我活下去， 我的皮膚因感染而受到損害， 我只希望我的聲音還是完好的， 但我的醫生知道， 深入我喉嚨裡的呼吸管 可能已經毀掉我的聲音了， 如果管子持續放在我喉嚨裡，我就ㄧ定無法再唱歌。 所以我的醫生找來醫院裡 耳鼻喉科的頂尖醫生--- 來幫我做手術， 幫我把管子移到我喉嚨周圍， 他說這會導致我死亡， 所以我的醫生盡最大的力氣， 執行這項手術保住我的聲音。

Though my mom couldn't say goodbye to me before the surgery, she didn't leave my side in the months of recovery that followed. And if you want an example of perseverance, grit and strength in a beautiful, little package, it is her. One year ago to this very day, I woke up. I was 95 lbs. There were a dozen tubes coming in and out of my body. I couldn't walk, I couldn't talk, I couldn't eat, I couldn't move, I certainly couldn't sing, I couldn't even breathe, but when I looked up and I saw my mother, I couldn't help but smile.
雖然我的母親在手術前無法跟我 說聲再見， 但是在接下來幾個月手術後的恢復期， 她都陪在我身邊。 如果你想要一個例子 將毅力、 勇氣和力量 集中在一個美麗的小盒子裡， 那就是我母親了。 ㄧ年前 的這一天， 我醒來了。 我95磅重， 我的身體穿進穿出 數十支管子， 我無法走路，我無法說話， 我無法進食，我無法移動， 我也一定無法歌唱 甚至是無法呼吸。 但是當我抬頭往上看， 我看見我的媽媽， 我情不自禁地笑了。

Whether by a Mack truck or by heart failure or faulty lungs, death happens. But life isn't really just about avoiding death, is it? It's about living. Medical conditions don't negate the human condition. And when people are allowed to pursue their passions, doctors will find they have better, happier and healthier patients. My parents were totally stressed out about me going and auditioning and traveling and performing all over the place, but they knew that it was much better for me to do that than be preoccupied with my own mortality all of the time. And I'm so grateful they did.
無論是因為馬克卡車 或是心臟衰竭 亦或是有缺陷的肺， 死亡還是會發生， 不過生命並不是只有逃避死亡，不是嗎? 生命是關於活出自我， 疾病的狀況並不能否認人生的狀況， 當人們被允許 可以去追求理想時， 醫生就會發現病患變的更好， 更開心也更健康。 我爸媽對於我 走路、試演、旅行和 在各個地方表演感到很緊張， 但他們知道這對我來說比起 我被死亡的想法佔據著還要更好， 我也很感激他們是這樣想的。

This past summer when I was running and singing and dancing and playing with my nieces and my nephews and my brothers and my sisters and my mother and my grandmother in the Colorado Rockies, I couldn't help but think of that doctor who told me that I couldn't sing. And I wanted to tell her, and I want to tell you, we need to stop letting disease divorce us from our dreams. When we do, we will find that patients don't just survive, we thrive. And some of us might even sing.

去年夏天，當我在科羅拉多落磯山上， 和我的姪女、姪子、哥哥、姐姐們 還有我媽媽和祖母一起跑步、唱歌 跳舞和玩耍時， 我不禁想起那位醫生曾經告訴我 無法再度唱歌的話， 而我希望告訴她， 也希望能告訴你們， 我們應該要阻止疾病 讓我們和我們的夢想分離， 當我們這樣想， 我們會發現病人們 並不只是為了生存而活下來， 而是活得更好， 而有些人， 或許甚至可以唱歌。♫
(Applause) [Singing: French]
(掌聲) (♫唱歌：法文♫)

Thank you. (Applause) Thank you. And I'd like to thank my pianist, Monica Lee. (Applause) Thank you so much. Thank you.

謝謝 (掌聲) 謝謝 我要感謝我的鋼琴手，莫妮卡．李 (掌聲) 真的很感謝你們 謝謝

Steve Jobs

Today is the most important day in 2011, I believe.  When the news about Steve Jobs were all over news and on Internet, I knew the impact he had created.  What he brought to our world is more than the Apple products he invented, but his passion of life and life style.  I started to know about Steve Jobs when I listened to his commencement speech in Stanford University in 2005 in my interpretation class.  It was my in-class material., however, I learned more than the class taught me.  His speech was really inspiring and full of his life experiences.  With plain English words, he delivered his speech well.  I highly recommended everyone to see his speech, especially today belongs to him.  R.I.P.

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.

The first story is about connecting the dots.

I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?

It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: "We have an unexpected baby boy; do you want him?"

They said: "Of course." My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made.

The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.

It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms, I returned coke bottles for the 5 cents deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on.

Let me give you one example:

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligrapher. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, its likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.

Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something - your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

My second story is about love and loss.

I was lucky – I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation - the Macintosh - a year earlier, and I had just turned 30. And then I got fired.

How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down – that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley.

But something slowly began to dawn on me – I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I retuned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.

I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work.

And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all   matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.

My third story is about death.

When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.

Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything – all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important.

Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.

This was the closest I've been to facing death, and I hope its the closest I get for a few more decades.

Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma - which is living with the results of other people's thinking. Don't let the noise of other's opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960's, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and Polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: it was idealistic, and overflowing with neat tools and great notions.

Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: "Stay Hungry. Stay Foolish." It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

Stay Hungry. Stay Foolish.

Thank you all very much.