#135 - BJ Miller, M.D.: How understanding death leads to a better life

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Nov 2, 2020

BJ Miller, M.D., a hospice and palliative care specialist, shares insights from his unique journey shaped by personal trauma and loss. He discusses how confronting death can actually enrich our lives, emphasizing the importance of reshaping our relationship with mortality. With moving patient stories, he highlights lessons on overcoming fear, the value of authentic connections, and the need for compassionate care in a death-phobic healthcare system. Miller also explores the potential benefits of psychedelics in end-of-life care and advocates for open dialogue about death.

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ANECDOTE

BJ Miller's Accident

BJ Miller describes the accident that led to his triple amputation.
Climbing atop a train, he received an electrical shock resulting in severe burns.

INSIGHT

Anterograde Amnesia in Trauma

Trauma patients often experience anterograde amnesia, forgetting the traumatic event itself.
BJ Miller's first memory post-accident was in the hospital, highlighting this phenomenon.

ANECDOTE

A Painful Realization

BJ Miller recounts a vivid memory of extubating and unstrapping himself in the burn unit.
Seeking to use the bathroom, he yanked out his catheter, leading to a painful realization.

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BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care. We discuss:

BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00];
Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];
Going from art history to medical school: the value of a diverse background in medicine [28:15];
How BJ’s new body liberated him [40:00];
How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];
Discovering his path of palliative care—distinct from hospice—in medicine [55:30];
Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];
The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];
The major design flaws of a “death phobic” healthcare system [1:14:15];
Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];
The story of Randy Sloan—a case study of playing life out [1:33:45];
Physician-assisted dying: Legality and considerations [1:39:45];
The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and
More.

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