Kate Bowler (4:25)

Wow, that sounds like it was a very long season of recovery.

Dr. BJ Miller (4:32)

Yeah.

Kate Bowler (4:33)

And I've heard you say that you adopted the attitude of like fake it till you make it and that. I'd love to hear more about that.

Dr. BJ Miller (4:42)

Yeah, I mean, it's sort of like a lot of things went right as has to happen. I had a lot of support, I got great medical care, I had beautiful friendships and people really rose to the occasion and rallied. And my family, my parents, I've never heard of this. I don't know if this ever happens, but somehow my parents, who at that time were living in Chicago, they moved into the hospital in New Jersey. I was in the burning it for about three months or so. Anyway, the point is I had pounds of support and I really was sort of trying to recreate a life and figure out who I was and who I was and Allah. And there was a lot of pain as you can imagine, your body is not so much your friend at times. But I could see land, you know, thanks to my family and friends, I could. I was out into sea, but I could see land. Like, they held the shore for me. The way it felt was they loved me. They held the other end of the bridge. They loved me and touched me and looked at me and didn't condescend. They cared for me while I filled in the blanks myself, while I came to love myself again on some level where I came to accept my new lot. That was. The faking it part was like, okay, guys, I have faith in you, and you seem to still care about me, so I'm gonna. I'll care, too, to honor what you're doing, to honor life in general. I'll care, too, and I'm gonna try. And eventually, I filled in enough gaps that I could stand up and walk around and walked across the bridge back to land, and here I am.

Kate Bowler (6:19)

That makes sense that people set the horizon for us sometimes, and then sometimes even just them being there. I study prosperity churches forever, and they had their own version of fake it till you make it. It's our obligation to always be chipper and sort of enact what you hope to achieve. But what you're describing is a much richer version where people' love in us can reconstitute our own expectations of what our life could be again.

Dr. BJ Miller (6:47)

Yeah. Because frankly, I'm not. I don't know about you, but I think. I think life is generally way more amazing than I'm able to treat it. You know, I don't often. You know, it's hard to feel up to the bigness that it is.

Kate Bowler (6:59)

Yeah.

Dr. BJ Miller (7:00)

So I watch myself and others sort of reduce it to make it manageable, knowable, et cetera. But here I was sort of cast into a way bigger field that took a while to catch up with.

Kate Bowler (7:11)

Yeah.

Dr. BJ Miller (7:13)

In so many ways. It was, of course, an enormous eye opener. And to your point, strangers do this too. You know, hold that bridge, hold that horizon, and remind us how amazing life is until I can. Until I myself can get back up there and actually believe it, too.

Kate Bowler (7:30)

Yeah. Yeah, that's right. I think the part I find exhausting is when Americans, she said lovingly, have this deep desire to believe that we are all limitless. And I. It sounds like you, from a very early age, became more comfortable with limitation than maybe other people.

Dr. BJ Miller (7:54)

I think that's true by force. You know, in some ways, I. The trajectory was heading for a relative limitlessness. I was a Hyper educated, white man, you know, able bodied, all that stuff. I mean, I had the running start, you know, but I think from an early age, I think if you just pay attention. And I certainly owe so much to my mother who lives with polio. And so I've been around disability forever.

Kate Bowler (8:20)

Yeah.

Dr. BJ Miller (8:20)

So I've been thinking about limitations in ways that would probably be different from my peers as a kid. I mean, I can't begin to unpack how helpful my family has been to me in terms of the example they've set. My mom in particular, my dad, how he treats my mom, et cetera, et cetera.

Kate Bowler (8:36)

Yeah.

Dr. BJ Miller (8:37)

But this idea that people like, oh, if you can dream it, it will happen. You can do anything. And positivism and, and especially in California. Geez, are we in the Bay Area? Oh, my Lord. You know, like, if you acknowledge a limitation, you're just like a party pooper. You almost feel like you're going to be run out of town.

Kate Bowler (8:53)

Yeah.

Dr. BJ Miller (8:53)

Like, this is the land of dreams.

Kate Bowler (8:55)

How dare you not send me your good vibes only. How dare you?

Dr. BJ Miller (8:59)

Yeah, yeah. And I think because aids unrealistic, and that's a huge problem. But b, like, I not only accept the idea of limitations, but I'm enamored with them. I understand in a very base level the relationship between a limitation and creativity. Like that is what humans are really, really good at. We're not amazing creatures of nature. You throw you or me out in the woods for a week, we're kind of toast. My cat would do way better than us. Right. By some measure. But we, because of our limitations, we find workarounds, we get creat, we adapt like no other species that's walked this earth and that is completely related to our limitations. So I'm enamored with them. I'm almost grateful for my limitations.

Kate Bowler (9:50)

Yeah. You know, I really appreciated the way that so much of this is born from your insider's perspective. Hearing you talk about your experience as a patient, I just loved even just what the word patient conjured up for you. You're like asking people to remember that, like when you're in the bed, you have to be patient with your own limitations. You have to live in a world that is bounded for you in ways you might not have picked. And it seems like when you come into the room, you bring a kind of 360 view to that, maybe for your own patients.

Dr. BJ Miller (10:26)

I really do think I feel very lucky in so many ways. We can open that up. I don't want to be Pollyannish. At all in any of this. But I will say, where it relates to my profession, I do feel very fortunate to have had the experiences as a patient. And, you know, I have taught a fair amount in the school of medicine and school of nursing here at ucsf. And, you know, I find myself with these slightly sadistic fantasies that anyone who's gonna do clinical work somehow ends up having something horrible go wrong that lands them in the bed, essentially, because it's such an incredible education and it provides insights that you're gonna be hard pressed to get from a book. And disability is so dang obvious. I just get to walk in a room and immediately everyone knows I've been through something. I've been a patient. Somehow my life didn't go as I had hoped or planned. And that just immediately, practically instantaneously, gets me to, I think, a better place with patients, perhaps maybe a more trusting place.

Kate Bowler (11:30)

When I first got sick and I wanted treatment, I immediately thought that when someone said palliative care, they meant that they were giving up treatment for me.

Dr. BJ Miller (11:39)

Right, right.

Kate Bowler (11:40)

But I mean, it's not. Would you mind just telling us a bit about some of the misconceptions of palliative care?

Dr. BJ Miller (11:46)

Palliative care, I mean, the word palliate just simply means to ease or to cloak. That's it. I mean, it's basically multiple disciplines getting together on behalf of, you know, lessening suffering and optimizing feeling good, you know, feeling as well as possible. That's the goal of palliative care, period. Irrespective. You could have one hour to live, you could have a century to live. It doesn't matter. So to be so super clear with your listeners, you do not need to be dying anytime soon to benefit from palliative care. You just need to be struggling. And it's pretty darn easy to struggle with illness and struggle with the healthcare system. So there's no shame in it.

Kate Bowler (12:26)

Palliative care can be almost more of a way of life. Like even just accepting the idea that we're limited. And that was hard for me to come to. But I was kind of blown away when you described it in musical terms and you talked about the crescendo and just being able to follow the song through till its end. That's kind of the heart of it for me. Whenever I hear you give a talk. It's just that you've come to accept limitation in this really generative way.

Dr. BJ Miller (12:57)

Gosh, that's a wonderful takeaway. And that message does really make sense to me. Then you're in an engaged point of view, you're off your heels. Heels. You're leaning into your life. You're working with your limitations. You're working with reality. You're working with a fuller view of reality. Reality is pretty amazing and hard, but amazing. And to sort of divvy it up and say this part of life is, no, I want to. That's not for me. I'm going to just. I'm going to have all positives, no negatives. Honestly, I'd almost rather we just banned adjectives altogether. You know, just. Just deal with whatever is good, bad, black, white, rich, poor. So much har. Gets done by our labels. We tell ourselves that we are one thing. We're saying all the things that we're not. And the truth is, I would have never. Interestingly, I don't know about how you feel, Kate, with your dance with illness, but I have to believe I would have learned some of these lessons otherwise. But, you know, I have come to love my life. And loving my life means loving every ounce of it. I don't get to hand pick and quilt it together. I have to love all of it. That's the charge. And that I've learned really directly related to my injuries. I don't know how else to say it.

Kate Bowler (14:12)

Yeah, I think what's hard, though, for me, like, when I allow my mind to just do that, reach right where it can, try to love all the scope of it. I think what's so hard, though, is I just keep bumping up against the fear. I think it's hard for me because I, you know, I'm so grateful for everything I've discovered. Once I realized that I was on the losing team, you know, I've come to really embrace that. But whenever I want to embrace it, I keep bumping up against being afraid. Afraid.

Dr. BJ Miller (14:41)

Afraid of anything in particular, I guess.

Kate Bowler (14:44)

Just like, if I don't live long enough, then I will have not, you know, been a mom for long enough or been a daughter for long enough for a wife. Like, I guess a lot of it is just focused on the people I love and. I don't know.

Dr. BJ Miller (14:58)

Yeah.

Kate Bowler (14:59)

Yeah. That part, like, incompleteness, I guess, scares me sometimes.

Dr. BJ Miller (15:04)

Well, and I don't pretend to have advice for you, but do you think to whatever degree your life might be incomplete in the end, do you think there is such a thing as a complete life? Is there a line in there?

Kate Bowler (15:17)

Yeah. Because I guess one of the things I really appreciated about reading your work and listening to you is it makes even the shorter songs Feel a bit fuller, you know? Like, if you can work with the end in mind, like, you can live with more richness. I guess it just feels like richness for me sometimes. Like, we can't know if we've given enough to the world, I guess. If that makes sense.

Dr. BJ Miller (15:46)

Yeah. What would be. What would. What the heck would be Enough.

Kate Bowler (15:49)

Yeah.

Dr. BJ Miller (15:50)

I mean, when would it be enough? And how long is a long life?

Kate Bowler (15:53)

Yeah, yeah, yeah, yeah. I have a different view of that now. And I feel like. I wish I knew that math. I wish you could. Anyone could just, like, give me that math. You'd be like, all right, 44. That's it. You just have to hit 44, and you'd be awesome. You'd have done it.

Dr. BJ Miller (16:09)

No such luck. Life's way more mysterious, isn't it? It is way more demanding.

Kate Bowler (16:15)

I used to have this totally lame desire to have an app that would, like, go off. So I'm always at these academic conferences, and there's, like, 2,000 receptions, and I'm always at a reception, and someone's like, oh, hey, we should go down the hall to this reception. And then you're at this other reception, and truly, it's lame. And you're really wishing you were at the other one and long. I decided, wouldn't it be awesome if you had an app that went off when you were at peak fun, and then you could relax and really enjoy what you're doing? And when I read your stuff, I thought, oh, man, how do you learn to be more attuned to peak life so that you're not the person who lives with regret? And I think part of it is giving up. Maybe on the framework of regret.

Dr. BJ Miller (16:59)

Well, I've really surprised myself at how prone to regret I've become of late. And I don't. And I don't really understand why. And so I'm wondering what it's trying to tell me. And I do. I do have, like, a bratty piece of me that just doesn't understand that I can't be everywhere at once. Like, I honestly don't get it. Maybe I'm a narcissist. I don't know. Maybe I think I could do anything and everything.

Kate Bowler (17:22)

Oh, I totally think that about myself. I love this.

Dr. BJ Miller (17:26)

Yeah. When I feel, like, offended that I can't. Like, there's a piece of me that wants to, like, pout.

Kate Bowler (17:31)

Yeah.

Dr. BJ Miller (17:32)

And it's an old piece of me, and sometimes it kind of pops out and gets a little bit more than others. And I've been in a Zone lately where it's just. I'm just filled with regret. I start my day and end my day with feelings of regret. I don't know what to do with it. But it does point me back to something I was going to say about fear, which is, I think, part of the message of this way of rolling all experience into a life, a full life, in other words. I think that must mean having the full spectrum of emotions, including fear. And so at least a technique that's worked with me with fear and with some of my patients is like, yeah, no, you get to be afraid. The goal here isn't to stamp out those pesky, untidy emotions. No, no, no. It's a much bigger charge. Like existential fears are to be listened to, are to be heeded. Feels like a reminder in us saying, hey, hey, you're not going to live forever. Hey, hey, take it seriously, man.

Kate Bowler (18:31)

Yeah, yeah.

Dr. BJ Miller (18:32)

Use your time. Hey, appreciate it right now. And, and that is related to find meaning. It's out there. Make it, create it, relate, pal, while you can. Do it while you can. It's a regret avoidance kind of muscle in us. And so, in other words, there's something vital about existential fear versus like fear of snakes or fear of heights. Well, you just avoid snakes and don't go up on heights. This is a fear to be respected. It's a fear that I think that demands and gets. It's easier the closer we look at it, the more we work with it rather than try to run from it.

Kate Bowler (19:08)

Yeah, it's a regret, avoidant fear. What a smart thing to say because I don't want to be one of those bucket listy people who are like, nothing is important if I haven't seen the pyramids. And then you see other people who want to treat life like it's this really awful, all you can eat buffet. Like maybe like the Denny's kind where you're just like, no, no, no, you're just like consuming forever. I do really love the idea that it does make you make different decisions when you live with the end in mind.

Dr. BJ Miller (19:41)

Yeah. And I think in a positive way, on balance, I get why a lot of us try to run away from all this stuff. If we could actually run away from all these pesky thoughts and our mortality. If I give it, or possible I might go for it. I might advocate for that. I guess I'm just here to say it's not possible.

Kate Bowler (20:00)

Therefore you're like, I've done a survey. Everyone dies. Given the results of the survey, I'VE come back to you. To death.

Dr. BJ Miller (20:08)

I've changed my mind. And it turns out. Right, no, exactly. I think that's a really important piece here. It's not like I love death or love limitations just so. Because I've got some weird dark streak. It's just. No, I love them because they exist. And my charge is try to love what exists, including myself. So that feels like an important asterisk in this.

Kate Bowler (20:30)

Yeah. You have this new book, a Beginner's Guide to the End. And when I read it, it felt like a real how to guide. Like, it reminded me when I was reading what to Expect when youn're Expecting when I was Pregnant. It has this very similar, like, practical, no secrets, you know, kind of approach. A list of almost things to be prepared for. And so who is this book for?

Dr. BJ Miller (20:56)

Yeah, it is. It is meant to be extremely practical, but. But supportive, too. We hope. We hope we got the tone right. One of the challenges with all this stuff, with a how to guide with any sort of constructive preparation work around dying, if you're not carefully. I've watched myself do this with people accidentally. You know, we talk about the aspirations, about the opportunities along the way, about what can still be and how to reframe hope and la la, la. All really important. But if you follow some of the logic out, you might feel a sort of pressure to get it right. And the on earth I or Shoshana, my co author, ever would want to do is set people up to feel like they're failing at dying. You know, the second we say, here's a way to deal with it so you're not quite so miserable, and if someone doesn't do all those things and they're a little bit more miserable than they want to be, and then they're going, oh, crap, now I fail to die. I can't even die well. You know, like, that would be horrible. So I hope to God that we got that tone right. Yeah, but that's a really important distinction. The very first line of the book is, there's nothing wrong with you for dying. Yeah, preparation, planning is important, but there's a real big metamessage. It's don't be ashamed of your nature. Don't be ashamed to die. Don't do that to yourself. You got enough pain to deal with.

Kate Bowler (22:14)

Yeah. And it was also nice in its scope because it's for people who are sick or people who are elderly and also just for those who love them.

Dr. BJ Miller (22:24)

Yeah. It is meant. So Shawn and I were writing this thing this beast. We were trying to figure out your question, who the heck is really gonna read? Who's the audience? And what we decided to try to do was to write to the patient, the person who's actually just got a diagnosis or somewhere on the spectrum of life either coming to an end or being challenged to our bones. So it's meant to be practical, and the information is geared to the patient and the tone is geared to the pat, as a rule. But the secondary audience is the caregiver. And our thesis is probably that more caregivers will read the book than patients. Although it seems important to respect the patient and speak directly to him or her. It's one of the things that happens. I don't know if you've had this experience, Kate. It's amazing how people find ways to see through the actual patient, especially if they're in a. I don't know if you've ever noticed this. I notice it all the time with people in wheelchairs. Like my mom uses a wheelchair. I'll be with her. People will talk to me, not her people. Talk to my dad, not her. People will see right through here. So for so many reasons, we didn't want to actually make that mistake and assume that the patient wasn't reading this. No, they're our primary audience.

Kate Bowler (23:37)

Yeah. I'm just thinking about what you said about minimizing fear, and it made me wonder what kind of advice you might have or we might be able to come up with for people who want to be a little more comfortable with their losses.

Dr. BJ Miller (23:53)

For me, what has been very, very helpful is when I start pondering loss, pondering grief, pondering coping, is reminding myself that the loss hurts because we care, because we love. They are absolutely directly correlated. And so that has allowed me to. When I feel loss, when I feel grief, I've gotten much better at reminding myself, hey, man, that's love talking. And that's good. Just casts a totally different climate around the suite of sensations that go along with all this. And that reminder has proven, at least for me and some of my patients, has been very, very helpful.

Kate Bowler (24:38)

Yeah. Like making a little bubble around it that says, this is beautiful. That's why it matters.

Dr. BJ Miller (24:44)

That's why it matters. And that's why it hurts that it's going. That's why, you know, that's. It's completely directly related.

Kate Bowler (24:51)

Yeah.

Dr. BJ Miller (24:51)

It's not a silver lining or a fringe benefit. No, no, no. This is a wonder. Like a one to one correlation, direct relationship.

Kate Bowler (24:58)

Yeah. Between things you love and grief. And maybe even Just that image you gave at the beginning of the bridge. It feels good to be anchored by both people. And it feels good also just to see our lives as bridges where we know the beginning and we're all kind of hoping we're just near the middle, but, like, it's good just to see the other side, to see the destination and just get that sense of horizon that comes with seeing the scope of our lives.

Dr. BJ Miller (25:25)

Yeah. It is grounding.

Kate Bowler (25:28)

Yeah.

Dr. BJ Miller (25:29)

I think. Yeah. And in some way, we know where we're headed.

Kate Bowler (25:32)

Yeah. Makes us great at parties. People love it when we bring it up. Man, I'm so glad you're in this club with me. It really makes you really happy.

Dr. BJ Miller (25:44)

Well, it's getting bigger, our little club, sweetheart. There's gonna be a lot, a lot of people begging to come to this party. There's some truth to that. I mean, you know, our stories are gonna become less and less exotic, you know, just by the demographics. And that's kind of a fascinating notion.

Kate Bowler (26:03)

Well, my deep hope is that we all become a little more comfortable with the scripts, the social scripts around suffering. And maybe in the meantime, I'll take racquetball up just to piss my father in law. Hey, thanks so much for talking with me today. This was such a treat.

Dr. BJ Miller (26:20)

Thanks, Kate.

Kate Bowler (26:34)

It always drives me a little crazy every time someone says the best is yet to come. Because I want it to feel okay again to say lovingly. Sometimes it isn't. Sometimes we lose things. Sometimes we have crescendoed. Sometimes we have finished singing the song of our amazing racquetball career. Sometimes we've finished humming the tune of our parenthood, either because we didn't have that baby or they've grown. Maybe you're playing the closing notes of a parent's life, or a friend or a child. I want it to feel okay again for us to sing, knowing that someday the last note will be sung. I have a lot to sing about. I may never be an amazing racquetball player. Sorry, dad. But I can make different choices if I'm allowed to work backwards, asking myself how I might spend my time, best efforts, gifts and resources, knowing that I am limited. There's this beautiful story in Atul Gawande's book Being Mortal, about a study where people were asked who they wanted to spend time with. So they asked little kids and teenagers and adults and then the elderly. And they found it went like this. Little kids wanted to spend time with their family, and teenagers wanted to spend time with their friends. And by the time you asked the guy in his 30s. He wanted to meet Bono. But then the closer people grew to death, the more they wanted to spend time with their closest friends and family. Again, the horizon shrunk back to that beautiful, precious inner circle. I get that we make different evaluations about what to do with our time when we live with an awareness of the end. And what a gift to be able to see that with such clarity. So let's sing our songs about our beautiful, ridiculous lives. We will peek and crescendo and approach the finale, hoping for a pretty damn good finish.

Dr. BJ Miller (28:54)

When my dad was diagnosed with als, I took up birding as a hobby. It had been one of his and I had resisted his efforts early in life to get me into it. I took it up because it gave us something to talk about while he was sick, other than talking about that he was sick would one day die. I confess I birded a lot after his death. It made me feel connected to him as well as giving me space to grieve.

Megan (29:22)

In September 2015, my baby son was born sleeping and his death hit me with such a sense of shock and trauma and grief that I had never really experienced before. I was knocked sideways and I wasn't really sure how to recover from that. A little while later I wanted to somehow move my focus from something that I couldn't do to something that I could. I wanted life. So I started a choir up at my kids school. We had 30 kids coming along and together we sang and it was a joy. It is something that I wouldn't have had the time or the energy or the motivation to do if I hadn't experienced such a serious loss. Whilst I would not wish to go through that again, and I'm thankful for where this brought me, I wrote poetry after my grandfather died. It helped me better capture the little details about him that I was afraid of forgetting. I find that I often lose those small details in longer form. Writing so poetry was a nice challenge that kept Papa breathing on the page.

Kate Bowler (30:33)

So many thanks goes to our amazing partners who make this all possible. The John Templeton foundation, the Issachar Fund, the Lilly Endowment, North Carolina Public Radio, WUNC Faith and Leadership, an online learning resource, and Duke Divinity School. Not to mention my team, Beverly Abel, Jessica Ritchie, and Be the Change Revolutions. I'd love to know what you think. Leave a review on Apple Podcasts and find me online at Kate C. Bowler this is Everything Happens with Me Kate Bowler On August 9, 2014, a police officer shot and killed Michael Brown in Ferguson, Missouri, setting off 400 days of uprising. That's what the what they didn't see was the family, the grief, and the young man behind the headlines. Now his mother, Leslie McSpadden, tells her story of love, loss and the fight for justice. I'm still Mike's Mom. Once you're a mother, you never forget how to mother. From lemonada Media and Campaign Zero. Still My Baby is coming out May 27th. Tired of the same old political shouting matches and talking points? Looking for thoughtful conversations that go beyond the headlines and help you understand issues that matter? I'm Sarah. And I'm Beth. Together we host Pantsuit Politics, a podcast where we bring grace, nuance, and perspective to the news. Because democracy deserves more than hot takes. Join us as we approach politics and current events with curiosity, empathy, and a commitment to understanding the bigger picture. If you want to stay informed without the anxiety, we're the show for you. New episodes drop on Tuesdays and Fridays. Subscribe to Pantsuit Politics wherever you get your podcast.