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Dr. BJ Miller: How to Die

2018-11-12 | 🔗

Dr. BJ Miller is a hospice and palliative care specialist who treats patients with life-altering and terminal illnesses at the University of California in San Francisco. Dr. Miller shares his revelations about a subject that is often taboo in our culture: the experience of death. He describes the moment after a person's death, and explains why it is both sacred and unknowable. While a sophomore in college, Dr. Miller suffered a devastating electrical shock throughout his body. He lost half his arm and both his legs below the knee. He talks about how this earth-shattering experience proved to be a spiritual wake-up call and how it left him with an extraordinary sense of what it means to confront death. Dr. Miller discusses why he thinks it’s time for us to rethink the idea that “death is inherently horrible.” He also reveals what he's learned about regret by experiencing “vicarious deathbed moments” in his practice. Dr. Miller’s new book, “A Beginner’s Guide to the End,” will be published in Summer 2019.

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
I'm over Winfrey welcome to supersede conversations. The podcast I believe that one of the most valuable gives you can give yourself is time taking time to be more fully present your journey to become more inspired and connected to the deeper world around us starts right now. Today we ask palliative care, physician and former sinew director of the ground. Breaking Zen hospice project be J Miller. What really matters when we die after witnessing the moment of transition hundreds of times doktor, be J Miller, has come to view life and death.
As mutually inseparable. He also has the unique perspective of facing mortality, as both a doctor and a patient after freak accident caused him to lose three of his limbs when it was a college. Student Dj Miller is passionate in disbelief. It's time for all of us to rethink redesign and re. Imagine everything we ve been taught about death. So, let's start when you say your relationship with death began, that was nineteen years all right. You data crazy thing. Yet when you lost your long legs and arm, tell me what was going on that night been added. You been drinkin little bit. Nobody should actually is mild night as far as we went
and another crazy way? I thought way crazy things, so we just gotten back from Thanksgiving vacation. How many of you there were three of us hang out together that night there was a Sunday night had a few beers, but really mostly decided, go, get a sandwich and walked to the woods collar. Our market in Jersey. I know why we know the law, so we walk into the wall and it just so happens that our path, there's a commuter train that runs across the path and of just sitting there ought off hours and later on the back. He just climate, like you, would a tree jungle Jim. We really really did not think we're getting in anything particular not, but I I happen to be the first one up the latter and at a metal watch on and they get close enough to the power lines in the electricity art to watch. That was that it's like thousands of voltage, leaden thousandfold snuff, to move a commuter train while shot through your body was a failure
good MAC. Can you remember that I really dont remember the night. My first members about food? or days into the hall or deal a maximum? First member was that night being flown to burn unit in New Jersey, just one burning at New Jersey, Saint Cousin, was what was burned so with electricity burn from the inside out and hunters your body and then tries to get out tends to incinerate where it enters and and exits enter my arm and blue down my feet and as your leg tapers all that current slows in the energy gathers and at some point your flesh just can't take it. So you burn for me died out well said, say, but I dont remember that night really exist. For when there are loaded me under the helicopter member being to talk like six, almost six five member, they were trying to fumble with my feet where to put me,
this helicopter thing her vaguely member that then my first members about four or five days into it when you ever? This is kind of like the story or because it just feel strange feeling? So you know that feeling when you wake up from a dream- and it was not a good dream and there's a moment where you realize you look around you too- that was a dream or just doing. Ok, I'm ok, everything's cool! It takes a little many. You can kind of feel it happening. So I woke up in the burn unit and had that sensation I sit oh cooler sits the dream, adorable dream, everything's, cool everything
Clearly, not climate and a burning of ice. You I'm intubated. I've got lines in my juggler, but somehow I still managed to look at this whole scene and think of it as a dream. So Ex debated myself took the ventilator out pulled a neck lines out, because I have the feeling I need to go to the bathroom, so I did all this to get out of the bed. At that point, I still had the feet. Hadn't been amputate, surgically at that was the next day, so I get out of bed, stand on my crispy little feat start heading towards the door to go to the bathroom, still completely clueless and then to the catheter line, ran out of slack and that so the way a Foley catheter works is a little ball. That's in your bladder and keep it secure, but when you pull on it it doesn't go anywhere.
So that I fell to the floor and in a second the same reverse happen. I realise how this was all real. This was real in that millisecond became extremely clear, but it had well here was in well, it was intense Were you feel filled and that moment with whacked regret horror. Why did this happen to me? Oh, no one of the great things about. I never had the. Why me really really not that's not cried to meet us most credit. My family, my mom, I grew up with a mother whose disabled she had polio and she has post polio syndromes over a progressive illness where she's progressively disable. And so much of my childhood was spent with her navigating the planet from wheelchair and those very in my bones. Sensitized disability, as an idea construct as a concept
and I just knew it happen to good people. So there is no part of me that was surprised that this has happened to me in a way I feel so fortunate cuz. I got to sidestep. I watch some of my pee in similar situations have to go through a couple years and like a hating themselves, practically hating, the yeah yeah. I've talked a lot to people who went through that. You did not go really here at what point we able to look back and see actually the beauty. This accident brought into your life takes a long time to get takes a while to get there. There were moments even in the hospital where you use and believe you're alive, and you can't believe all this effort going to help you survive and all the human innovation around you helping. You live and the devotion, and in those there were plenty of. If a moment's, even in the Burundian it excite cried the day I had to leave the burning it had become my home. So you, your frame of reference, get really strange and everything's altered.
But beauty wasn't out of reach immediately, but until I can really feel it in my book, in a daily way and be that took a couple years and they were so slow awakening. So how did this accident help you get in touch with the true meaning of your life? So I think the first thing I did at that age Pyramid Princeton. No, I was caught up in you take these tests to get here and there to get there and it was a sort of this future oriented airing or what everyone else is doing exactly you got here and it's it's a kind of a prison. If you're, not careful- and I was in that prison like so many of Us- and the first thing that this did for me- was just make it possible to compare myself to anyone else for a little while, like I, I I couldn't be seduced into think
I should be doing more or otherwise getting through the day going to the bathroom was hard enough. You know whatever the simplest things soda recalibrate at me, and that was the first gift was tests at least to cease the endless striving endless, comparing and contrasting myself to other here, and it force you to do what a cartel he says you now and in all of his books based moment is the only thing that really matters. It forces you to do that in a way that you you can't help, but do yeah yeah exactly that's that's related! That's a second great lesson was being present mean that was just at all. You have you dont, there's no promise of a future. The past is the passive minutes. It's just empirically true, but now I could feel that truth
true, but now I could feel that truth. It was not a recreational thought. It was a therapeutic thought. So now do you look back at that that accident, and can you say that in some ways it was a gift to you here I mean you know at some point in the lessons: can pile up yet the beautiful moments the exchanges with others, the shared vulnerabilities they stack up pretty quickly and before you know it if you're honest the good that's come from, it is so potent that I can't regret I can't I would be fully myself if I, if I regretted the situation of course, I can't take it back either, a minute or other ways to learn these lessons. You don't gotta, you don't need to go through that Canada. Or do you didn't take your time to figure that out that you are the same person without your limbs and how out and no matter how many limbs you lose your still you you know. I have said this is getting caught.
My mama didn't take me too long to get there because in some way, Oprah why her others here watching her all those years and all being a sort of hypnotic, it's kind of a hypersensitive kid, maybe because of my There is in my mom watching the planet respond to her. I don't know eyebrows as little on the melancholy bent and in a way If I were totally honest. I reckon the feeling of well now I look like I feel now now my body fits me away. Because I didn't have any ownership of my own ordeal but my suffering, everyone thought that I had a silver spoon in my mouth. I was given this education. I had so much Access, I could own nothing. I had I looked okay, I was a decent athlete, so in a way complain about anything, and yet I had a real misery and me as a women being trying to reconcile themselves on the plan and now. Finally, I looked a little bit.
The part and in a way it was a little bit welcome. I don't mean that no melodramatic way, but I did feel my identity quickly. Ship shifted relatively quickly to accommodate this because it felt Sworder right don't go anywhere more to come after this short break, is episode, is supported by hallmark cards. We say I love you too. The people we care about all the time so much so that sometimes it can start to feel a little bit like a habit if you're king for a way to make those three little words mean a little more this Valentine's day. Try sing them with a hallmark card, because when you share your love in a hallmark, hard you're taking that everyday reminder and turning it into the kind of love they can hold on to, that stays with them. Long after Valentine's day since hallmark has so many kinds of Valentine's day cards. You can find one for every important relationship in your life this year for every Valentine's day cards you buy hallmark will give up
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own cross to bear to those of us who are poor and just trying to get a male dont. Think of it. That way, of course, not now and it's I don't make too much of it, but it's kind of a quiet suffering that you really can't share with us you sound ungrateful yeah, but for my money- and this is what help me understand honest, I think, being Human being is just plain hard and if I think about some the people. I know some and most miserable people I know, are of great privilege. I think the human condition, of having an imagination being able to imagine a world that you don't have one way or another to have this. Of power. No, the questions, but not enough pout. Another answers I mean you, however, you haven't you describe being a human being, I think, is a very difficult proposition period and figuring out wire here and what that means, and it does help to have some new push against whether it's an injury or perhaps poverty, not that I can describe that, but something they re
against us too, to motivate you to mobilise our energies to push against and invite for to fight for in a way, I think death gives us that nice boy can do something to shove, against the fulcrum. This pole, to bounce, Oh for sure, if we didn't have death, nobody will ever get anything done no MA. Am there will be a damn thing ever knows? Why would you go to bed I'll? Do it tomorrow the digital bar waiting pushing against us? Nobody would ever do anything now yeah. Now I find myself giving talks more often yeah and we'll think I loved ass God. It's because I think that we absorbed decided a death is bad. Death is inherently negative. It's nothing but losing control it
All models are negative again, but I ask this question most audiences. I say if you could push the button and live forever. Would you push that? But I mean it's a silly question depending on the connected, but still he get the point and I'd say I've asked a question maybe thirty times and of thousands of people by now, and maybe ten percent of people say they push that button. That tells me a lot of death is unnecessary, this ogre that we all don't want anything actually at some point, we kind of welcome it. So I just use to kind of help us rephrase the whole idea the death is inherently horrible. I don't think it is most of us. I don't off how you'd answer that question. I know I wouldn't push that button. I wouldn't pushing either I'd ask for. Could you give me, a little by little time, but now when push the button there
cousin I'd, never do anything to supply. Yet what's the point rights, the yen and the as yet, absolutely so for people who are listening, who have you know something dramatic happened to them? That changes? What was normal has, I think, most people, so many people wanted to be like to be here, and I want to be the quote normal. They want to be like those people, yeah yeah. What is a fine thing. Is we grow up to spend so much time is at a young age trying to be like everybody else and at some point that shift you wanna be like just like whole body, these just like you, but I have to say to be really clear, but I mean it took me a few years time. Good to feel what we're saying when I could say these words pretty quickly a guy, the ideas, but I feel it in my bones.
And stop comparing myself to the old self, the old body and took on honesty a few years before subduing. Where did it take actually practising what you were saying, putting into practice on a daily basis? Yes, what you intellectually understood? Yes, yes and I was earlier- and I had this ruthless sort of it was just a trick sort of like I was looking for silver linings wherever I could find them, and I want to early silver linings was, I used to, like you, know, I'd walk in an ocean. I'd be afraid of this stuff, China is a sting rare somewhere, so one of my early silver linings just to pull myself forward was oh well now I don't have to worry about stepping on the sting rang, a great, it was silly you out of it, are somewhere start somewhere and did you start collecting these little silver linings and that's how you start re framing the whole thing for yourself and making perspective with it and
art and learning how to see in this human talent of how to look at something not so much what you see, but how you see that helped tongue, but you I was putting into daily practice what we're talking about so art studying art change. The way you saw yeah you're Self Europe could do tat and end the world. Yet after graduating, with a degree in art history, be J decided to pursue a medical degree, but not The field many would expect working with amputees. Dj found himself drawn to palliative care, focuses on providing relief from chronic pain or for those near death. So how do you get from art history to palliative care? Ok, so study art dad got me really focus and how does the end the human condition, what it meant to be a human being? That became the subject matter which was obviously therapeutic for me to think about a made me help me find a new continents feel like I had a place in this world
I didn't know what I was gonna do for a living. I really had no idea, but I knew I wanted to be of service. I knew I wanted to have fun. I knew I wanted to feel like creative existence doesn't that's all I knew so then what that was well medicine. A great way I mean I could imagine if a doctor looking like me, came into my room and I was sitting in the bed boy that would have been potent yes, that was the impulse I didn't take any undergraduate doctor. You ve been through some thing: yeah yeah, that helps right. I mean the pigeons and is still to this day with my patients. I can get to trust much more quickly than some of my colleagues, because one looked no, you know I was in the bed and that helps a very powerful. You know I've been in tat helps. I don't have to prove anything that way: to his work, designed hospice project spent six years, developing a patient care philosophy.
So the spiritual values of compassion and service and rooted in a belief that death is sacred and unknowable dj has Its expanded on those ideals by creating the centre four dying in living, it's a non profit website he created to be- vital source of information on quality of life, death and everything in between so what has being around the dying talk to you about living at the great question Oprah, one great lesson is dying. People are still living in outside to realise at sea it as part of life and a separate I'm from being dead and dying is his final moments of a life and therefore very potent essential, really concentrated part of life. But it's part of life to that's. The first lesson is all right:
dying as part of the deal and I'm still living when I'm dying. That's that's a really important lesson, you start realizing that what makes anything precious except that it ends so dying, is what creates preciousness. What's what gives us the impulse to make meaning because it it proved death proves life. I heard that statement once and it makes sense to me. You know you're alive, because you're gonna die someday approves you're alive. So another big thrust of this open which you learn is time is short. The decision to make our of consequence. Delaying things that you love or want or seek not calling grandma whatever it is. You can't you have no promise of tomorrow. So live your life today it has published a singular best lesson about, die, hosted, teach living for me and
So I love this ritual you all created at the Zen hospice project because any time we ve seen in a movie, which is how most people have seen people die, most people have not actually witnessed it themselves. It's cool and isolating and removed, and everything, but the arm and comforting and you all have created a ritual of its a flower Palliser money when someone dies in mortuary guys come to pigs the body in are taken. The person's remains out of the house. For the last time I won gathers round they sprinkle with loud petals and some people, sing a song recite, a story that they heard from the person or some shared memory or just silence, but the most beautiful parties has the floor pat on seeing this body listen so clearly done. There's no life left
body, and you see it as a memory is very mundane. Amazing feeling missed it is the show that had ever was, but you honor with flowers and we watch the body, walk, roll out the house and that's the final image for the families. Contrast that without typical hospital death, and I see you with tubes and machines and all this vulgarity in grotesqueness, which is essential to some degree and important, but it can often scar. Families are necessarily the final images can be so barbaric they have to and that such for very different grieving process the flower pedals, so you mentioned that moment where the body becomes the shell. An you sense when the person it the Spirit goes and there is some kind of lingering in the air here. Something that remains is the person spirit. Isn't that their sole? Whether what is that
So you know: I've been around people who are just about to die people and bodies that I'm just not died, and there is a lingering sense, its true there's, a feeling. It's a palpable. Yeah there's a lingering- and I don't know that's in my mind or fats in the air or fat spirit. One I have gone really one thing that minders help me with was too not need, no need to have, for everything didn't even know the answers anymore. I love not knowing the answers. Unimportant is just a sacred and gorgeous moment, and you can feel that this is it just is justice, but I'm said to above been around folks who I'll be sitting there talking with the family, we're having a conversation and the person dies and middle conversation in its seamless. It's almost Gorgeously protract, MIKE the word mundane, it oh mamma it just they were here. Then there
and there's a there's a moment where it's just so matter fact that is it just is that's it sort of charm and its beauty, and then we start heaping meaning upon it. But in that, oh man, it's such a profound stunning moment to see the boy Finally, as a show and devoid of that person, and in that permanent transition around the body, you, you you're, really in touch with the continuum of life. That life is proceeding at individuals gone, but life goes What do you want us to know about what? and how we should be thinking about design our life and our death, because you think the or feel that their inseparable right, I believe they are so somewhat stuff just mother nature at work, but then there's this human element about how we design the healthcare system, how a design hospitals Because a lot of the suffering you witness around serious illness or dying is unnecessary
the waiting two weeks. Do you get a call from your doktor about a test results with a touch result was run, in half an hour of its the your car getting till it because a half of it and build enough parking spaces, while you're in seeing your mother and her death bed in the healthcare system. Most importantly, the twentyth century was designed around diseases, idea was did life's work. Therefore, then you get a disease in it sucks. Then you can. You can fix the disease and get back self up, two wonderful that was kind of the thinking, but it turns out that illness suffering death or wait four percent, than that their way they they're gonna come no matter what we do so the healthcare system right now in rhinoceros reckoning, and so the system needs a switch from this disease, centric the focus and the disease to focusing on the person to focusing on what it means to be a human being. You know, I'm doesn't have to be the gnarly bad hotbed of stuff I think a lot of us imagine
in some of our anxieties, are unnecessary. And many the people that I hope care for by a time that they actually die, there really ready to go there done after done, that's ok, the hard part is very much for the family lenihan with, and so that's why fighting death should not always be the gulf. Not necessarily talk people out of it. That's the weather, lotta people in and go down swinging. That's the rays, and I help That's not mind demanded a certain way of dying by they. Most of us crave a certain piece and that peace is accessible, and I guess to answer your question most succinctly. My money. The way we can prepare ourselves to die well is too low, well and to live without regret, and that means checking yourself pretty much on a daily love on a daily basis and my doing what I care about my doing. Where love I told the people I care about that, I love them. So it is of fundamental things: you check a seven, a daily basis by the end of a life. You won't have stuck but all that many regrets regret a bitch regrets.
It's really hard losses, hard start, putting regret and guilt and other things on top of that does it need to be that? Have you been with me who, in their final moments, are living that space of regret here. Actually the saddest thing. It is sad, but you know it's also import did. I regret, because you know there's this phrase: it nobody's gonna regret not spending more time in the EP. Is nobody to regret. You know it's true. What you're spreadsheet look like a true. What did what are they regret? So I love these vicarious deathbed moments that I have yes, and there are some real true to that like. Why didn't I? Why did I spend so much time with this? by hated what I spend so much time married to that person, a really respect what you know whatever and there's some real true to that in an open, very
has to do with time and how you spend how you value your time, but you know it's also kind of true here is when you watch the power of just accompanying someone in bearing witness some of that regret, just kids to go away, because regret too, is also on avoid Oh, I wouldn't make all this exact same decisions now that I've met in my pathway. The Sab is being seen. Sab is being felt and heard and witnessed that helps them regret fade so nice, so yeah I've seen those vicarious. Those deathbed regrets, but have also also watch them just follow. The wayside, pretty sweetly being seen and heard by whoever, in that moment by family by family volunteers by analysis by in the moment who are dead sit with someone who's in agony who may smell funny who's, not themselves. You know the whole thing dying, isn't necessarily so pretty, which is extra,
when someone can sit with you and be with you in that state. It's an amazing thing to offer some not presents an amazing thing to give in, and he is a lot of wounds quickly. Wow. What do you say to someone who is lost their beloved? What are the words? How do you comfort How can you be a comfort, I think, Durham? There are many opinions on that very question. For my money: there aren't really. Bona fide guaranteed words: I've I've! the I'm so sorry and people by what about well, I'm not these are in any way. The point is language is deeply imperfect, yeah. But to answer your question, one of the things that I think is so owned, is in that moment of sharing grief or someone witnessing them sit in that hot stew. With someone for a moment like we're talking about that, bearing witness sit in that uncomfortable Spain,
that awkward, spare yes and where you dont know. Where are you don't know what to say, and I you're, sharing the the the chief with that person and that I've seen the b the real sab yeah. A friend of mine, said once when our mother pass- and I was saying I didn't know what to say she said just just being here: you're you're being there you're being present you're, not knowing what to say, because you right language is inadequate. So what believe happens when we die. You have any theories on that thought. So I do here. One is like I told your love mystery. I love not now and then such a creature,
space some people can apply their own ideas to it, and I watched people do us which apply all sorts of ideas to, but I do think for me like empirically it it's just we its. I dont need to no more than a few when you put my body in the ground, it's going to decompose and I want the entered he will transfer and I will become that blade of grass. I will become the ground, I would become the tree, that's the kind of, more town in their registers with me, and that's observable, that's just true: do you find people who are dying if they have some kind of faith? Is it easier for them? It very often is a great service to people in the end and absolutely without a doubt, but if their cracks in their fate
Those cracks can open and widen, and I've seen some one who would have consider himself devout the whole lives at the very end, lose that faith and its extra hard, its extra fierce reared, its extra terrifying. So I think the lesson is continents with your faith, with your belief, holding true to your belief, whatever it is modern and there being a absolute truth per se, its you're continents, with Yes, absolutely make sense. What do you think is one of the big decisions or choice, Is you made to fulfil your destiny? I think it was two things one was. Coming to see myself a little bit rule a little bit to remove from just me, as is not just my body
an open idea that my life, my body, was just raw material stuff for discernment. Not so much judgment, just differences that I had Play with and seeing my life as raw material to play with make stuff with that really is help me a ton, a ton and then more, this less a sort of the generic nature of suffering. We have variations on themes, seeing the theme Then the variations as the key, therefore seeing what unites us, therefore sing seeing variations on themes, seeing the theme rather than the variations as the key. Therefore, seeing what unites us, therefore, seeing what we have in common keeping my folk and seeing that all people suffer on some level. When do you think your life force is most fulfil when I'm loving somebody
and their receiving. It then remain. They need to receive it from a really feel that, and I do think one of the core things about love. I think we all talk about the desire to be loved. I think, those who have animals in our life. We are taught by the UN, conditional love, we receive from them right gorgeous doubt about it. But honestly, I think the bigger lesson is hurrah, looking first, a safe. Place to love, he has very safe, loving my dog maisie he's not gonna bite me for loving her harder to love, human being, sometimes correct, and I think we all share the safe zones to love as much more than being loved. You fill the presence of love when
an assassin. So my my mind: love it's like an aquifer, its ever present all the time. It's therefore, if we want to, we just gotta, get our act and geared to feel it and it's like let it come through us it's, but it's everywhere, I would say it's omnipresent and the purpose of forgiveness is forgiveness is my favorite muscle in the human body. It really is so potent back to forgiveness is really being you know, This is the kind of thing we can do to ourselves and others, and it's the way,
to move on clears the path delight in the time you have white still have it. So none of it as your question of what the active forgiveness is, it is a loving thing to do. I know that much was my joy to talk to you today. I was my joy open so much I'm over Winfrey and you ve been listening to supersede conversations the pod cast. You can follow super soul on Instagram, Twitter and Facebook if you haven't yet go to apple pie, catches and subscribe rate and review. This pledge guess join me next week for another super, so conversation. Thank you for listening.
Transcript generated on 2020-01-15.