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

Nov 2, 2020 1h 54m 26 insights
<div>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.</div> <div> </div> <div>We discuss:</div> <div> <ul> <li>BJ's accident leading to the loss of his limbs and his experience inside a burn unit [3:00];</li> <li>Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];</li> <li>Going from art history to medical school: the value of a diverse background in medicine [28:15];</li> <li>How BJ's new body liberated him [40:00];</li> <li>How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];</li> <li>Discovering his path of palliative care—distinct from hospice—in medicine [55:30];</li> <li>Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];</li> <li>The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];</li> <li>The major design flaws of a "death phobic" healthcare system [1:14:15];</li> <li>Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];</li> <li>The story of Randy Sloan—a case study of playing life out [1:33:45];</li> <li>Physician-assisted dying: Legality and considerations [1:39:45];</li> <li>The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and</li> <li>More.</li> </ul> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/bjmiller">https://peterattiamd.com/bjmiller</a> <br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p> </div>
Actionable Insights

1. Embrace “Both-And” Thinking

Reject false dichotomies, such as ’either life or death,’ and instead embrace ‘both-and’ thinking, allowing you to both strive for a longer, better life and accept the reality of death.

2. Confront Mortality Early

Dare to look at death earlier in life, rather than waiting until it’s too late, to avoid dying more miserably than necessary and to make better life decisions.

3. Appreciate Life’s Preciousness

Recognize that the finite nature of life is what makes it precious, and confronting mortality can help you truly appreciate what you have.

4. Invest Beyond Yourself

To achieve a form of ’living forever,’ invest yourself in the world beyond your individual self, so that what you love and contribute continues even after your own death.

5. Act on Important Matters Now

Recognize that the time to make crucial investments in your relationships, purpose, and legacy is while you are alive, as final moments are often not conducive to deep conversations or grand gestures.

6. Live Without Wasting Time

Realize that if ‘failure is guaranteed’ (i.e., death is inevitable), the only true loss is wasting your time; therefore, take life seriously, say what you need to say, and do what you want to do without fear of failure.

7. Clarify Fear of Death

Reflect on whether your fear related to mortality is about the process of dying (which can often be managed with medical support) or being dead (which requires a different kind of contemplation and life response).

8. Adopt Palliative Care Mindset

When faced with unfixable or unchangeable life events, adopt a ‘palliative care mindset’ by focusing on the ’now what,’ exploring how you see yourself, the words you use, and how to find therapeutic meaning beyond just the physical.

9. Seek Palliative Care Early

Understand that palliative care focuses on improving quality of life during serious illness, regardless of life expectancy, and is not exclusive to end-of-life; seek it early for support with emotional, physical, and spiritual well-being.

10. Let Go of Unfulfilled Wishes

While some final wishes can be fulfilled, it’s often more important to practice letting go of the many things you won’t get to do, by shifting your perspective to find peace with what is, rather than clinging to what isn’t possible.

11. Choose Feeling Over Numbness

Recognize that feeling something, even pain, is generally preferable to feeling nothing; avoid emotional numbness, as it can be a way of dying before actual death, which is a greater tragedy.

12. Reframe Fear and Failure

Cultivate a different relationship with fear, seeing ‘falling’ or failure as a skill or an opportunity for growth, rather than something to be avoided, which can be liberating.

13. Cultivate Self-Acceptance

Actively cultivate a mindset of self-acceptance for your current circumstances and body, as this can significantly reduce regret and second-guessing, fostering peace with ‘what is.’

14. Embrace Life-Altering Changes

When facing life-altering injuries or disabilities, don’t aim to ‘get back’ to your old self or ‘overcome’ it; instead, allow yourself to be changed by the experience and integrate it as a part of your ongoing life.

15. Transform Disadvantage into Advantage

Seek ways to turn your personal challenges or perceived disadvantages into an advantage, especially in your professional life, by using them to foster empathy and connection with others.

16. Adopt “Why Not Me?” Mindset

Instead of questioning ‘why me?’ during suffering, consider adopting a ‘why not me?’ mindset, which can reduce feelings of self-pity and guilt, especially if you’ve had a privileged life.

17. Allow Yourself to Grieve

Don’t suppress your emotions or try to be ’tough’ in the face of significant loss; allow yourself to cry and grieve, as it can be a magical and relieving experience that releases physical pain.

18. Avoid a Sacrificial Life

Make a conscious promise to yourself to avoid getting stuck in a job or life path that leads to misery, even if you’ve invested heavily in it, recognizing that life is short, important, and beautiful.

19. Study Humanities for Healing Professions

For those entering healing professions, study humanities or find ways to explore questions of meaning and identity, understanding why life is amazing, horrifying, and difficult to let go of, to avoid becoming a ‘zombie’ clinician.

20. Study What You Love

When choosing a field of study, ensure you genuinely love the subject matter, rather than just pursuing it as a means to an end, to cultivate a deeper passion and intellectual curiosity.

21. Explore Psychedelics for Death Anxiety

For those with end-of-life anxiety or fear of death, explore the potential of guided psychedelic sessions (e.g., psilocybin, MDMA, ketamine) under proper conditions, as research suggests they can significantly reduce fear and foster a sense of connection and meaning.

22. Engage Beyond Medical Solutions

Look beyond solely medical solutions for issues of suffering and death; engage with multidisciplinary approaches, community efforts, and personal responsibility to address these universal human experiences.

23. Advocate for Person-Centered Healthcare

Advocate for a healthcare system that focuses on the person living with disease, not just the disease itself, by integrating the pursuit of quality of life (palliative care’s mission) into all aspects of healthcare.

24. Integrate Palliative Care into Medical Training

For medical professionals and educators, advocate for integrating palliative care principles throughout medical school curricula, recognizing that all patients suffer and die, making these conversations fundamental to all of medicine.

25. Find Common Ground in Mortality

In a polarized world, use the universal experiences of suffering and mortality as a way to find common ground with others, fostering connection and shared understanding across all demographics.

26. Subscribe for In-Depth Content

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