April 2, 2021

Triple Amputee and Doctor BJ Miller On How to Confront Death | Between You & Me

– You don’t get death without life and you don’t get life without death it is a package deal. So I am very interested in depathologizing, and demystifying death as a very natural event. But many people still have a different viewpoint on this. – This week on, Between You & Me, I sit down with author, BJ Miller whose TED talk has 9.3 million views and counting. Miller is a triple amputee and he talks frankly about an accident he had in college that changed the entire direction of his life.

Today he’s a doctor who talks openly about his near-death experience and has written a book about how we should confront our own mortality head on. You had an accident essentially when you were in sophomore year. Can you just tell us a like little bit of what happened to you when you were a sophomore? – Yeah, I road crew freshman year of college and became very close with a few folks in the boat and we were very fast friends. And we had been away for four days for Thanksgiving break so we couldn’t wait to see each other again. And it just so happens that there’s a commuter train that runs right up onto the edge of campus and it didn’t feel like a very daring to do we just jumped on top, there’s a ladder, we scurried up top just to climb it like we would a jungle gym. – Yeah, boisterous boys, like whatever. – We were being boys. – Yeah. – 19 year old boys and so what, it seemed very benign.

We had done dumb, way dumber things we thought. But anyway I jumped up, I had a metal watch on that was close enough to the power source, the electricity arced to the metal watch and that was that. – How many volts went through you? – I think it was 11,000. – 11,000 volts through your body? – I was whisked off to the local hospital.https://onlinechatdatingsites.com/best-interracial-dating-sites/ They did some emergency things where you cut these slits in your skin to let the heat escape. – Right. – Then I was flown by helicopter to the, New Jersey‘s one burn unit at Saint Barnabas Hospital in Livingston and there I lived for three months or so. – So when did the doctors tell you that they were gonna have to amputate? – So there was a series of amputations, but the first one was I think day five or day six. – At any point during this process did you confront this notion of death then, I mean, you know, you were touching your own mortality the whole time– – Yeah. – But did you ever sort of think about, did the sort of idea ever come close to you where you were like, holy (beep) I– – Yeah. – I might die, I could die. – There were nights where my, Dr.

Mansour would tell my parents like he may not make it through the night. – Wow. – And I had just never been aware of that and it hadn’t crossed my mind in part I wonder if it hadn’t crossed my mind because on some level I knew that I was gonna live in this, some visceral kind of physiological way. But it was after the fact pondering what had happened, when I came, that’s when I really started reckoning with death in a way. – You could’ve run as far away from hospitals and from illness and surgeries and death as you possibly could and then you’ve done the entire opposite. Why have you leaned into death? – Me leaning into the subject of suffering, leaning into the subject of mortality, was directly therapeutic for me. It wasn’t an intellectual interest or a recreational thought. It was me getting through my day required me to lean into it and that’s where I developed a habit of leaning into it and that’s where I just saw all this beauty that comes from it and that’s where this whole subject started blossoming in my mind and where it felt like too good to keep to myself.

This is a plane that we should all work on. – I was bringing your book up to my husband last night, we’ve been together for seven years and I sort of said, you know, we don’t have a will, we don’t have a death plan, like I don’t know, and I said to him, he was on the sofa and I looked up at him and said, do you wanna be buried or cremated? He’s like, I love you too. Like, I mean, but, you know, it’s sort of like when is a good, when is a good time to ask those questions and that’s sort of what you’ve done with your book, “A Beginner’s Guide to the End.” so it essentially is like a step-by-step book to answer all manner of questions, everything from that one, buried or cremated, what are the costs that are entailed with that to other more difficult aspects of navigating the insurance world, and insurance system and things like that.

Why write this book? – Dying is hard, but it does not have to be nearly as hard as it has become. As a clinician, and as a patient, as a human being, I watch people go to the end of their life completely unprepared and I watch them and their family suffer in all sorts of ways that are absolutely unnecessary and it’s often just for a lack of basic support of fundamental information. You’re left to go Google your disease, or talk to someone who had a cousin who had this or that, and you kind of cobble together a framework for yourself as you move towards your death. When honestly a lot of the themes that any of us go through no matter what culture, no matter what age, there’s some real basic themes that come to us all. And so the impulse of the book was to make death a little less difficult and life on the way to death a little more meaningful. – Was it to give us back some sense of control as well? – Sure, yeah. – Because I mean death is like the ultimate loss of control, right?

We don’t know what’s gonna happen afterwards. Some people think that they do, but, you know, we, it’s all a bit of an unknown and we don’t have control over death. But was the book designed to kind of give us back some control in a sense? – Both, so yes, the goal here is to not rev up your control freak impulses, I have them too. So we wanna name the things where you actually do have agency, where you do have control.

Focus some of that impulse to control your life there and we also name the things that you can’t control and where the skill set you need to develop is how to let go of the impulse for control, so it’s a little bit of both. – That impulse as well, when you reference it in the book, there’s a short chapter on, physician-assisted death, and you know that’s an element where I think society we want to try and have some control and some people sort of say that they should be able to go out on their own terms and if– – Yeah. – They wanna leave and they feel like it’s their time that a physician should be able to help them do that. Why was it important for you to put that in the book? – It’s rolling through state houses. I think we’re up to maybe eight or nine states now who have, Aid In Dying, laws on the books, so that’s one reason to address it because people are thinking about it. But it also has as a tip of a spear it brings up this whole idea of, I would encourage anyone, and myself included, to really ponder how interested am I in control and how much grace do I find in letting go of control.

And it’s more meant to prompt us thinking about what works for us as individuals. And on the far extreme, yes, I know people who really want to have that power to exercise their will one last time and to name the moment of their death. And I begrudge them nothing for that. I understand that impulse on some level. – According to the CDC the suicide rate in this country is the highest it’s been since World War II.

You know your experience as a physician has been in the palliative care realm. What have you seen, or you know, how do you navigate it when suicide ideation and suicide comes up in the palliative care sphere when a patient does bring up the notion of suicide? – Yeah, you’re talking to a fellow who lost his sister to suicide and I have a lot of feelings and thoughts about it. If patient’s come to me as a physician and request my help ending their life, hastening their death is the way we talk about it in the field.

When I hear someone wants to hasten their death I’m trained to really investigate what they mean by that. Because it turns out someone may say, hey doc, help me die I can’t live like this anymore. And when you start to get to know them make sure they feel safe and they start talking and it turns out maybe, maybe in fact what they can’t live with is this pain that they have from their tumor and it’s just been under treated. So the first thing I do is treat what you can. So maybe what’s pushing them to the edge is untreated pain, treat their pain.

Maybe it is, it’s very often that they’re running out of resources. It is very expensive to be sick in this country and very, it’s expensive to die in this country. So I watch people who have said, who wanted to hasten their death because they’re trying to protect their family. They don’t wanna be a burden, that’s a very common comment, I don’t wanna be a burden so let me just get off the planet.

Very often when families hear that their loved one is, doesn’t wanna burden them of course they say, no, mom, dad, whatever, I love you so much. You took care of me let me take care of you, I want to, you’re no burden, et cetera. So sometimes you can just sort of clarify what’s actually behind that impulse. – Throughout the book it’s like a manual for dying and it’s not just aimed at the person who may have the illness and is sort of grappling with it, but it’s for the family and friends– – Yeah. – Outside that person as well and I really appreciated the sort of caregiver notes that you have throughout. People are then becoming caregivers at a rate in which we haven’t seen before.

We don’t seem to treat caregiving with the respect it maybe deserves in this country. What do you think about that? – Part of the fallout by sort of ignoring this mortality thing, ignoring our vulnerabilities as critters walking the planet, well we ignore all that goes with it. So we don’t honor caregiving because we don’t honor what it means to be sick and all that goes into it.

And to your point the flip side of progress of all this technological progress is, you know, we’re able to live with things that would’ve killed us 20 years ago. – Sure. – And so we’re living now, we’re gonna, most of us, 80 to 90% of us are gonna die from chronic illness. This dream of oh I was healthy playing tennis and dropped dead of a heart attack, that is a very rare and for some folks that would be considered a very lucky end that is not gonna be the way for most of us. – What advice do you have for millennial caregivers? I mean there’s sort of, there’s a lot of it baked in the book, but do you have any specific advice for people who are juggling caregiving, people at both ends of the spectrum, you know, perhaps an infant so you’re kind of trying to give maybe one way– – The sandwich generation. – Yeah, the sandwich generation exactly. What advise do you have for that sandwich generation? – The first piece of advice guys is you ain’t alone.

These numbers are huge and growing. It’s just that people are doing this on the side or under the table and it’s just not seen. They don’t talk about it at work for whatever reason. So one thing is you are not alone. Second of all is I think what we all have to realize is the loop between caregiving and care receiving, that everyone involved in that picture is gonna be, there’s suffering and there’s beauty for everybody in that mix.

And that it’s a team sport and that injuries don’t just happen to me they happen to my loved ones too. By virtue of me being injured my family was affected et cetera. So making the link as a caregiver, feeling relevant in the mix. I’ve watched caregivers come to clinic and here we are in a hospital, a whole building, this huge thing designed for a patient in some ways, but there’s no place for caregivers. There’s no language, there’s no award for caregivers, we don’t, there’s no language for it.

So it’s not, it’s not honored as it should be and poor caregivers that have to suffer kind of silently feeling like oh, well I know I’m hurtin’ right now, but I’m not hurting as much as my dad, he’s the patient, so it’s not about me it’s about the patient. So what ends up happening is caregivers keep pushing their own needs to the side in this beautiful selfless kind of way, but I guess that’s my point. We’ve gotta drop the notion of selfless versus selfish, caregiving versus care receiving, it’s a reciprocal loop and you’re all affected and everyone needs space around it. – Thank you for watching, Between You & Me.

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