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- [00:00]
Kelly Corrigan
What does a confident smile say to you?
- [00:02]
BJ Miller
And maybe more importantly, what does it say about you?
- [00:05]
Kelly Corrigan
With Smile Generation, it says you're taking care of more than just your teeth. Because confidence doesn't start and stop at a bright smile. It's about your whole body wellness. Smile Generation reimagines oral health as the gateway to long term confidence. Why? Because oral health issues have been linked to heart disease, diabetes and even cognitive conditions. When you care for your smile, you're investing in your future and that confidence. It starts with feeling supported. With Smile Generation trusted providers, you're not just another patient, you're a partner. They prioritize personal, patient focused care that truly listens to you. Plus, with education and preventive care at the core, Smile Generation empowers you to understand the connection between your mouth and and your overall health so you can stop issues before they start. Here's your chance to take the first step. Smile Generation is offering a $59 new patient special that's a comprehensive exam, cleaning and x rays a $290 value. New patients only offer not valid for Tricare or Medicare Advantage may be covered by insurance, subject to plan restrictions. Booked by December 31, 2025. Visit smilegeneration.com wonders for full terms and to book now.
- [01:30]
BJ Miller
Might you be in the market for a zero sugar snack that actually tastes good? Then look no further. Get to know Bavarian Meat's Lilan Yeager Snack Sticks. Unlike most snacks that make you choose healthy or delicious, Bavarian Meat Snack Sticks are both slow smoked and naturally fermented to be delicious. Zero sugar, zero carbs, and packed with nine grams of protein to help you achieve all your daily macro goals. In addition, they are totally portable, so you can put some at your desk and in your bag and in your car and wherever you might find yourself where you have a little pang of hunger but you don't want to eat a bag of pretzels or something that has virtually no nutritional value. Pick up a pack today at your local grocer or stock up@bavarianmeats.com podcast Bavarian meats snack sticks great taste.
- [02:31]
Kelly Corrigan
Zero sugar.
- [02:40]
BJ Miller
Hey, it's Kelly Corrigan, and wondering is pretty much my favorite pastime. Lately I've been wondering about loss because it's everywhere, but also comfort and intimacy and the kinds of things that are possible and in fact, I think only possible when we are face to face with mortality. I believe in the idea of a beautiful death. I saw it happen with my own eyes, and that's what we're talking about today. Kelly Corrigan Wonders is a place for people who aren't afraid to look at ourselves and our weird ways in the hopes that knowing more and feeling more will help us do more and be better. We'll be right back with BJ Miller.
- [03:33]
Unknown
This episode of Kelly Corrigan Wonders is brought to you by Alloy. Women's Health let's face it, midlife can come with some serious curveballs. Sleepless nights, hot flashes out of nowhere, brain fog that makes you forget why you walked into a room. Yeah, I've felt it. And I've kept wondering, is this just how it has to be? Turns out it's not. Menopause is 100% treatable, but get this, Nearly half of women wait more than three years to get help, and 43% say their doctors never even mention menopause hormone therapy. It's no wonder so many of us feel stuck. That's where Alloy comes in. They're changing the game with safe, science backed treatments for hormonal symptoms, skin, hair and even sexual wellness. They now offer GLP1 prescriptions to help manage midlife weight gain too. All delivered right to your door. No office visits, no waiting in line. You'll fill out a quick medical questionnaire, consult with a physician and get a personalized treatment plan shipped directly to you every three months. Automatically join the 95% of women who tried Alloy and saw relief in the first two weeks. Head to myalloi.com wonders tell them all about your symptoms and you'll get a fully customized treatment plan and you'll get $20 off your first order. Today, head to my a l l o y.com wonders and enter code wonders to get $20 off your first order. When the weather starts heating up, I always end up standing in front of my closet thinking I to wear. Not because I don't have clothes, but because nothing feels right for summer. This year I made a smarter move and turned to quints. I grabbed their 100% European linen shorts, super lightweight and actually tailored enough to dress up or down. I also picked up a linen dress I've already worn to a weekend barbecue and a casual work meeting. And I couldn't resist the Italian leather platform sandals. They're classic, comfortable and look way more expensive than they were. The quality seriously rivals high end brands, but Quince skips the retail markup by working directly with top artisans. It's luxury without the price tag. Plus everything is made in safe, ethical and responsible factories using premium fabrics so you know you're getting something that's built to last. Give your summer closet an upgrade With Quince, go to quince.com wonders for free shipping on your order and 365 day returns. That's Q-U-N-C-E.com wonders to get free shipping and 365 day returns. Quince.com wonders.
- [06:23]
BJ Miller
Hey, this is Kelly Corrigan, and in this series, I'm wondering how change happens for a person or a country or a planet. In today's episode, I'm wondering how end of life is changing. Are we getting better at growing old and letting go? In one particularly powerful year, I lost my dad, my secret weapon in the world, and also my friend Liz. They both consciously stopped treatment, transitioned to hospice, and died exactly as they intended to. No machines, no tubes or pick lines, surrounded by family. Just the kind of death that so many people are being robbed of right now with COVID But in this conversation, we were thinking about managing end of life better in the post Covid world, which is indeed coming in a minute, I'll introduce you to my main guest, a palliative care doc named BJ Miller. He's a triple amputee, which has a lot to do with how he thinks about loss and the body. But I wanted to start with my friend Liz's husband, Andy Lotz. We had a long, unguarded conversation about the final days of Liz's life. We talked for about an hour, actually, and I'll be sharing that conversation in its entirety in a few days when, coincidentally, it will be five years since Liz Lotz died. Liz did everything a person could do. 88 rounds of chemotherapy, a whole bunch of surgeries. But in the end, there was no stopping the ovarian cancer that took over her life. Shortly after her third child was born, I asked Andy to share a little bit of his experience planning and managing a compassionate death for Liz as you as it was going on and on and you were starting to grapple with the idea that maybe she wouldn't survive, that she wouldn't be the corner case that would make it. How did you think about and talk about exactly how she would want it to go down and how you would want it to go down? Or did you?
- [08:34]
Andy Lotz
No. We talked about not wanting to be buried, needing to be cremated, and she didn't. She talked about not wanting to have a bunch of tubes tied to her and be in the hospital. She. Yeah, I know. She wanted to be home.
- [08:57]
BJ Miller
And was that okay with you?
- [09:00]
Andy Lotz
Totally. Yeah.
- [09:02]
BJ Miller
And would the would have been being in the hospital been okay, too? Like, were you, like, of one mind when it came to the best possible way that this could end.
- [09:16]
Andy Lotz
It was a. It was very traumatic for me to call hospice. And then in order to sort of, you know, justify that, I thought as hospice, as palliative instead of. Instead of end of life, thinking that she would go into hospice, kind of like, you know, sit on the bench for a bit, get a breather, take some oxygen, and then get back on the field. And that was probably. So it was. It was very, very difficult to think about her actually dying. So the conversations about her dying with her were very hard to. Hard to have because it was this feeling of acknowledgment of her dying as well as I saw it as a transfer from struggle to failure, you know, that it was a struggle she was in. And struggle's okay. Everybody struggles. It's human. But dying felt like failure. And then crossing that threshold was. Was hard to acknowledge. So it was really hard for me. And when she died, she was in hospice for nine days. And when she died, I was shocked. Like, wait, what? Man? You knew what was going to happen? But I didn't admit it until she died. So it was hard. It was really hard to answer your question, it was really hard for those reasons to actually sit down and say, okay, this is end of life. You know, bright flashing lights.
- [11:02]
BJ Miller
Yeah.
- [11:03]
Andy Lotz
Like saying that it's end of life and still saying, okay, well, how do you want it to go? She and I also, you know, had sort of a roundabout way of talking about important things. She. She and I moved to San Diego together. We were living together. We were head over heels in love with each other. We knew we were going to get married. We never talked about it. And we were at a Padres game once, and some guy proposed to his girlfriend on the jumbotron. And she looked at me and she's like, no.
- [11:41]
BJ Miller
I know we don't talk about this, but just in case.
- [11:43]
Andy Lotz
We've never talked about marriage. We never talked about getting married, whatever. And she looked and I'm like, mm, right. Got it.
- [11:50]
BJ Miller
Note taken.
- [11:52]
Andy Lotz
So maybe it was like, okay. We weren't tremendously communicative about gigantic things. Although, you know, decisions to have children, where to move, professional. We would talk about those things. But I think that this isn't a category all of itself. She was, you know, struggling for a while. And it was right after that Thanksgiving where she said. I think she said, look, I gotta face up to the reality here. As hard as it is to be to recognize is I'm not gonna get back into another clinical trial. We just had 8 liters of fluid drained out of me. That's the end of life.
- [12:38]
BJ Miller
How did you know to call hospice? Did she say call hospice?
- [12:43]
Andy Lotz
No, no. I think one of the times we were getting the fluid drained, I think the hospital people, the nurses, they look at you and they're like, do you have the number for hospice? So when she's like, hey, here's the hospice people. And Liz took the card that was a green light for me. And then towards the end of her life, she would kind of zoom in and out of these hallucinations. She would hear voices. She would think people are coming when they're not coming. And it wasn't all the time. It was just every once in a while. It was really hard. Right? It's acknowledgement of. Of an end. It much more felt like we ran out of options, things to do. We ran out of ways of thinking about it. We ran out of time, we ran out of luck, we ran out of medicine. And it was a failure. And that's not very compassionate to frame it that way, but I have to admit that it's. It was a way that I felt.
- [14:06]
BJ Miller
Do you still feel that way?
- [14:10]
Andy Lotz
You know, there's no way you could say that Liz was a failure. Absolutely not.
- [14:18]
BJ Miller
I'll say it again. There was nothing about Liz Lotz that was a failure and certainly not her death. My whole beautiful conversation with Andy will be in my podcast feed in just a few days as a way of marking the fifth anniversary of losing Liz. I hope it will be meaningful to those of you who have experienced heartbreaking loss and can relate, but also to those who haven't and maybe aren't sure how you'll deal with it when it comes. Of course, it always helps to talk to an expert, and BJ Miller is just that. Before we dive in, I wanted to share that production support for Kelly Corrigan Wonders comes from the Arthur Vining Davis Foundations supporting inclusive higher education and health care, vibrant spiritual communities, and a clean environment. The Arthur Vining Davis Foundation's investing in our common future. So I had a profound experience the night my father died, and it made me wonder how our feelings about end of life have changed, are changing, might change yet again. I have also volunteered at the Children's Hospital in Oakland, which included some work with their palliative care team, which is this group of angelic women who did what must be the hardest work. So there's a hospice doc who also happens to be a triple amputee. His name is BJ Miller, and he wrote a beginner's Guide to the End with Shoshana Berger. And he gave this unforgettable TED talk that 11 million people, including myself, have learned a lot from. So. Hey, B.J.
- [15:59]
Hi, Kelly. Very nice to meet you.
- [16:02]
So people have been dying for as long as people have been living. And I just wonder, like, was there a time and a place and a culture that handled death so much better than we do now? Great question.
- [16:19]
I don't know. In the hospice and palliative care world, I hear myself and others, we refer to the past, this vague past, as a time where we must have done things better around death. I'm not sure that that's really true, but I think to some degree it is. Somewhere along the way, in the 20th century, we got seduced by our own technology. We really thought death was this thing that we could be that was somehow opposed to life. We were outside of it. We were outside of nature. My gut is, if we went before that, where death was part of the deal, and we weren't necessarily pulling ourselves away from nature or convinced we could invent our way around death, my sense is we did death a little bit better before we did technology, so.
- [17:02]
Well, one thing that seems like it must be true is that we are more mobile. And so I don't live near my dad, but both my parents had way more regular contact with their grandparents, say, when they were growing up than my kids have had with my parents. And so they don't know, like, the sights, sounds, and smells of an older person. And they may feel that they can't handle that. That, like, they would never be able to jump in and do some of the things that I was doing in those final days and weeks of his life. You know, like, I just was totally. I was all up in it. You know, I was cleaning out his earwax. I was getting little, you know, fairy dust out of his eyes. I changed his diapers. And I found that it was heavenly, that it was almost like the greatest achievement of my humanity. I never felt more useful.
- [18:13]
Well, you got my vote there, Kelly. And what you're describing, of course, those are not icky moments. I'm assuming those are incredibly poignant moments. Right? I don't mean to tell you.
- [18:24]
Tell me it was glorious. It was a gift.
- [18:27]
Well, amen, sister. I mean, I'm right with you. And that's, I think, a little bit of a secret because to your point, with all our mobility and all this sense of possibility, and we can be anybody, anywhere and live, that has pulled us away from. From some of these Things that you might not choose in life. But so often it's the things you would never choose for me, amputations for you, perhaps the death of your father. We wouldn't choose these things, but because we can't choose them and we're forced to deal with them, we find new parts of ourselves. We see new things that we would not otherwise see. And I just don't think there's any way around that.
- [19:02]
Thirty years ago, you and some buddies were climbing around on an old rail train and you had, I think 12,000 volts of electricity go through your watch and you became a triple amputee. I wonder how different has that made you?
- [19:22]
It has. I mean, there's, there are a lot of levels to that question. In some ways, my internal dialogue, the way I think and talk to myself, the way I see the world or myself in the world, all those things have changed in detail. But there's also this piece that's completely consistent and the injuries weren't such a left turn in some ways. It just kind of confirmed for me vague, subtle or nuanced hunches I may have had before about myself or the world. So in some ways it was just a confirming experience, more than a life altering one. But so on top of that little enduring nugget, whatever we call it, I have changed a gazillion times. And one of the changes is that I got a. I got hooked on change. I think it's one of the most fascinating things that we humans are so adaptable. We're malleable, our ego, our narrative. We have this incredible power that we can change the words we use for ourselves, we can change our narrative, and then we can change our experiences.
- [20:28]
Well, you know what's so interesting about you and the way that you appear in the world is that you're talking to these patients. And before your accident, you were like this six, five, very striking, Ivy League educated guy who maybe had the appearance of someone who never had a bad day in his life. And now when you enter a room to talk to a patient, to begin the bond that will allow them to have a great death, they can take one look at you and know that you have suffered and that you have had to adjust in, in deep, meaningful ways that probably make them trust you immediately.
- [21:10]
Yeah, if you look at me, you know I've been through something. When I'm talking to patients, they know I've been in the bed. That doesn't often. It's interesting. The details of my story don't necessarily come up all the time, they don't really need to because what's conveyed in an instant without much thought is, okay, this guy has had some curveballs. And I think I feel very fortunate to have an obvious disability this way. I haven't always felt that way. It was hard. I couldn't pass, I couldn't. But that was its power too. Like we said earlier, I would not have chosen it, but because I couldn't have, I worked around it, I worked through it, I worked on my perspective about it rather than trying to change it. Anyway, I get to wear that on my sleeve. I feel for folks who have hidden disabilities and hidden challenges because they don't get the. In some ways they don't get.
- [22:05]
Oh. I always felt so sorry for people with like depression, which is non obvious when there I was at 36, bald from chemo, and everyone was letting me go first and showing me such patience.
- [22:17]
Yeah, well, so I grew up with a mother who had polio and uses a wheelchair. And so I'd been around disability, you know, so I. My idea of a normal life, of a normal body that a lot of us absorb was already expanded. I was already. I was already. I had pre baked in this idea that human beings are not just their limbs or not just their bodies, you know, so that was in my gut, you know, that was in my bones in some very important way. But besides that too, I mean, I think I was. And I was kind of. I would qualify, I think, as a sensitive kid, a little melancholy often. And in my mind I just looked around and we moved around a lot. And so happily for me, I got to see a lot of different parts of the country. But as we moved around, you just had to open your eyes to see people struggling. Miseries everywhere, loss everywhere. There's a lost goldfish loss, a tree, a leaf falling from a tree, a person in the gutter. I mean, the range is just. It's in our eyeballs all the time. I was, I saw that, I felt that. And I suppose in a word, I was aware that we were all confused creatures trying to find our way and that we were all vulnerable. And I just got. I was always flummoxed by the fact that the degree to which people went to hide that, to pretend otherwise when it was just so clearly not. We were so clearly vulnerable creatures.
- [23:52]
Yeah. And the ways specifically that we are vulnerable, that we feel vulnerable, are the most interesting things about us. Like, if we're gonna go around and keep that all boarded up, it's gonna be pretty dull, you know, that's a boring. That's a boring day.
- [24:12]
Exactly. Right. Yeah. And just inaccurate. Just bull. You know, Just not. Not right. False. So I. That was in that. That was my setup. So for me, I didn't have to spend a lot of time in the. Why me? It was pretty quickly, why not me? You know, finally, here I am, this white suburban kid, and I was aware of all this misery, but wasn't having much of it directly on me. And now finally, I almost felt like, okay, now it's. You know, now it's my turn. It felt like there was some justice in it.
- [24:44]
You know, it's interesting. I really felt like I had led a charm life. And when I got diagnosed, I did think, oh, here it is. Like, here's the rain, you know, into every life some rain shall follow. I had been waiting for it, and if this was it, so be it. But I do want to draw a distinction. For me, I was always so grateful, as if, you know, you just get one thing, one hard thing dealt to you per lifetime. But at the time, I remember thinking like, this is so much easier because this has a beginning and a middle and an end. And I will return to. To my normal self, and I will. My hair will grow back, and I. And I won't come back to this infusion center. But your situation is permanent.
- [25:29]
Do you mean by that, Kelly, an experience that kind of comes and goes versus one that lingers, like in lost limbs or something like that?
- [25:35]
Yes. Yeah, exactly.
- [25:37]
One of the fascinating lessons is that I can't change it, is that it's permanent, because I know this is the deal. I'm not. There's no piece of me that's biding my time, waiting for it to end, and then I'll go do X, Y, or Z. You know what I mean? And that's such a trip that. That happens all the time. A lot of us, I find ourselves. We suspend ourselves, like, okay, let me let this pass, and then I'll do. Then I'll go tell that person I love them. Or then we just defer and defer and defer, and that's really hazardous, as we know when time is precious. You know, it's really, really hazardous. So this, my experience, this is another thing that feels lucky, is I don't. There's no compulsion to defer. I can't defer. I would be very obviously deferring my life. And that seems, like, inherently problematic.
- [26:24]
The other thing that's permanent, that's sort of embarrassing, but I'll tell you is that after My dad died, and after my friend Liz died, I did have this feeling like I had worked hard to process the emotions. I had cried a thousand tears. I had eulogized both of them to the very best of my ability. I had loved them with my whole heart. And after six months of living without them and carrying all that pain, I did have this super childish feeling like, okay, I did everything. And now I would like to be rewarded with the return of my special people.
- [27:07]
I'm sorry to laugh. That's very hard. That's a hard thing. But I'm laughing at this very human thing that we all do and the performance aspect of some of this stuff and how we grade ourselves and what we expect the rewards to be. All that sort of this leverage we assert on ourselves. If I do X, Y and Z, then this will happen. Of course, all that strategic thinking ultimately runs afoul. And whatever we're doing, the outcome, on some level, has to be inconsequential. On some level, you got to get into it while you're in it. And I just think this comes up for me with the book and in clinic, too. A fair amount of people I've worked with or some folks who've read the book have said, you know, I did all the things I got clear. I made my advanced directive like you said, I did a good job. I did good. And you know what? Bj, Damn it, I still. This still sucks. I'm still sad, or I just need to hug them. I say, yeah, I mean, we never promised make this easy. Maybe by doing these things, you can you find a way a little more. More easily, or maybe things are a little less difficult and maybe you have a little more access to meaning. But nowhere in here is a promise that if you do these things, somehow you get to circumvent the pain. But ultimately, if you try to lead a life without pain, without sorrow, without sadness, if you're trying to lead a life without needing anything from anybody, you're essentially signing up for half a life. There's just no two ways about it. Pain, sadness, dependency, those are parts of a full life. It may be difficult, but if you want to have a full life, you need those, too.
- [29:06]
Let's take a short break and we'll be right back.
- [29:15]
Kelly Corrigan
Acceptance is important. Acceptance makes doors open. Acceptance everywhere is a dream. You know who's really big on acceptance? Discover. You see, Discover is accepted at 99% of places that take credit cards nationwide. That's a whole lot of places and a whole lot of acceptance, which is great for Discover, but even better for you, based on the February 2025 Nielsen report. Learn more at discover.com credit card you know that moment.
- [29:48]
Unknown
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- [31:02]
BJ Miller
Hi, welcome back. I'm in conversation with BJ Miller, a wise and compassionate man who knows a lot about end of life. So that really takes us to how end of life is changing within the context that we're living. So here's like the megatrends view of America is we've never had access to so much information in our lives, and half of it's inaccurate. So there's that sort of problematic fact. There's this enormous generation of baby boomers that are aging that are going to need to find a way out of this life, which we hope will be as graceful and painless as is possible. There's a whole set of policy changes, like gay marriage changes, who can be in the room, and then there's all the work around assisted suicide to say that in nine states right now, we can ask a doctor to help us depart. So how do you think about the context in which end of life is evolving?
- [32:10]
Right on. I mean, so for some of the listeners who don't know this, we've got a huge bulge. We've got the Silver tsunami coming. Some of it's like 70 million baby boomers, huge numbers of people aging and dying, living with disability, living with illness. So we're all coming out of the closet now. You know, this idea of ignoring death that that's not going to be possible much longer, if it ever was. So I'm excited for that. I think that means we're about to all be reacquainted with a fuller view of nature, especially human nature. And I think that's nothing but good. So our dragging our feet around health care overhaul and policy changes, social services being cut, et cetera, we're heading for a reckoning, Kelly. You know, hospice and palliative care are wonderful and it can do a lot of good work, but we're never going to be able to train enough hospice and palliative care physicians or nurses, social workers, chaplains to tend to all the folks who would benefit from such service. We're nowhere near being able to meet current demand, let alone this bulge coming our way. The big flummox for medicine is we're talk talking about diagnoses, illnesses, traumas, things that the medical system can't fix. By definition, an illness that can't be cured is a failure in the medical system. That's how the medical system sees it. Death is a failure. Okay. This is a huge problem. So the medical system's gotta, gotta really rethink its approach to life and death.
- [33:40]
Is there anything that you're seeing or hearing in your field that gives you hope that we are reconsidering everything, that we are recasting the problem not as death, but as how we die?
- [33:56]
Yes. I mean, the field of palliative care is all about. It's very explicitly about tending to the things that you can't change. We treat suffering, we don't treat illness. So in so many ways, the rise of palliative care speaks to the medical system's understanding that it has an issue here.
- [34:14]
And we should say here there's a difference between palliative care and hospice. So palliative care is treating the things you cannot change. Hospice is a subspecialty inside palliative care that helps people die with dignity.
- [34:29]
Yes. Thank you for this, Kelly. So, yes, hospice is devoted towards around the time of death. But palliative care writ large has nothing to do with death per se. Some of the patients I've seen in clinic, I've known for 12 years.
- [34:39]
Hospice was started by a British woman. Yes.
- [34:42]
So in the 1960s, Cicely Saunders came up first as a nurse. Then she injured her back lifting a patient. I believe the story is, then she became a social worker where she didn't have to do so much physical exertion. And in her role as a social worker, she was working with A lot of folks who were at the end of life. And she was watching how the health care system just basically, you know, once, once you were no longer fixable, you know, good luck out there. Sorry, there's nothing more we can do. There was just no care for folks who weren't fixable. And she got the advice that she needed to become a doctor if she really wanted to have power to change things. Then she went back to medical school, became an md. She was like a one person interdisciplinary team by the time she was done with all her trainings. It came to the US in the mid-70s, and for whatever reason, by how it crossed the Atlantic, it landed here as a countercultural movement, almost in some ways as an anti medical, anti conventional medical approach to care. It was sort of nurse and volunteer driven, oftentimes politically outside the norm. In the 80s, it grew up and it became the hospice, Medicare benefit.
- [35:54]
And then this huge thing happened, which was this advance directive to do not resuscitate. Like do not break through walls to keep me alive at all costs. Emotional, physical, financial.
- [36:11]
The medical system in our country, and it makes some sense, is designed as a default to sustain life at any cost. It doesn't bother itself with whether this person would want to be kept alive, with whether that even if they can be kept alive and what constitutes alive to that individual in the medical system, that means basically a pulse. And because there's not a lot of time to ferret out what someone wants, if someone comes into an ER unconscious and undeath's door, you don't have time to think that through these things. So as a system's default, it just means everything's gonna resuscitate. All effort to resuscitate you, shock your heart, breathing machines, you name it. If you don't say that you want otherwise, that's what you can expect. That's the default in the system.
- [36:54]
And interestingly, every person I know over 70 years old, all the people I love over 70 years old, have grabbed me by the shoulders and said, do not let them keep me alive. I have pills in my dresser drawer, put a pillow over my face. Like, they just do not want these extreme measures taken, quote, unquote, on their behalf.
- [37:22]
And if you interview most doctors, it's very telling. Most doctors would be dnr. They'll tell you, hey, heck no. Do not resuscitate me. Heck no. So it's very telling that we have a system propped up by the people who know who work that system and know what it means. The ones left to Promote this idea of propping up a body at all costs, which very few people want.
- [37:42]
You know, when you think about how things change, sometimes it's these small policy issues. Like, at some point it was put on the books that the recommendation was, once every five years, a doctor should have a conversation with the patient for about an hour about how they would like their lives to end. And people went crazy. It became this, like, death panel idea. But in terms of policy changes, there are nine states that have assisted suicide. And I just wonder, do you think that will bethat will accrue more and more states that operate that way? Because, boy, does my mother want that to come to Pennsylvania.
- [38:20]
I do think it'll likely become the law of the land in most states, if I had to guess, eventually. Since 1997, history of the aid and dying laws goes back to Oregon in the mid-90s, and there was a supreme court case that basically kicked it back to the states, and Oregon went ahead with its death with dignity law in 1997.
- [38:41]
Also somewhere in there is Jack kevorkian, which was the first time I ever heard of euthanasia. And he was giving people lethal medication with their blessing. And he put the whole idea on the map.
- [38:54]
The whole kevorkian story is kind of scary and kind of fascinating. He was in many ways the wrong messenger. But about a conversation that needed to happen. He popularized the subject, but the subject was important, and the laws are importantly different than how he was handling it.
- [39:10]
You know, I'm friendly with Tony bosas at nyu, who's doing all that work with psilocybin for dying patients. So what are your thoughts on psilocybin and what is it even so?
- [39:24]
Psilocybin is the chemical responsible for hallucinations from magic mushrooms. There's a resurgence of interest in psychedelics, including psilocybin, for therapeutic purposes. A lot of people in this country don't know. There was a very rich research history in the 1950s and 60s around the use of hallucinogens in folks for depression, for addiction, for end of life anxieties, all sorts of things. And it was incredibly promising, this resurgence in this old idea that hallucinogens can really break patterns of thought and behavior in people in ways that other chemicals don't seem to be able to and help people find meaning and feel connected to the universe and to let go of the ego. There's something about ego dissolution in this and sort of helping it gently helping you fall apart so you can see what you are beyond your ego. It's beautiful. Fascinating, powerful stuff. There are studies going on and people having these experiences. They're not just taking mushrooms and going out into the woods. It's a much more controlled idea with a psychotherapist guiding you through the trip, the end of the experience. There's a very serious period of integration where you work with that therapist to integrate what you saw and learned on your trip and to put it back into your daily life. And people who do this just once seem to have a lasting impact that goes on for months. Just one dose of this stuff, from a medical point of view, it's the closest thing we've had to a miracle in my lifetime. I mean, it's a huge, huge deal. These drugs aren't harmless. Just witnessed sort of some of the fallout in 1960s and 70s. I mean, decontextualized without support, improperly dosed, these drugs can hurt you. So but within these controlled studies, like we're talking about now, zero adverse events. I mean, it's incredible.
- [41:20]
Have you done mushrooms?
- [41:21]
I have. Oh yeah. Oh, for sure, for sure. I really love this. And part of it, back to my own injuries, I have come to love. I couched it as change, but I also love sort of discombobulation, coming apart, reforming, coming apart, reforming. I just feel this happening all the time, small and small and big ways and psilocybin and other experiences like that. Mind altering moments like that have helped me exercise that skill really of falling apart and putting myself back together again. I think it's an invaluable experience.
- [41:56]
So it's so interesting that you keep using these phrases. Come apart, put back together, come apart, put back together. Liz, my friend who died, did this, did psilocybin at the end of her life with a therapist. And afterwards I was asking her all about it and she said, I guess what I came to is that in a way I'm not dying. Because in a literal sense, like genetically, I've already passed myself on to my kids, but also in these other funny, trivial ways, like my favorite foods and our favorite sports team and my values and the books I've loved and the things that make me laugh and what kind of music makes me dance. Like all of that has been and will continue to be redistributed through Andy and through, through our kids. And that means that maybe I'm not going anywhere after all.
- [42:48]
This is immortality, you know, for those of us who really want to, who really are afraid of death. You can see how this segue makes so it's so potent. There is a fact to immortality. The fact that I can observe and see what you just described, you know, it's not what we might have imagined immortality to be. Like I look like myself going forward in some other future state. No, but there's obviously something much more important about me than my physical bits. You know, there's this emotional residues that we leave all over the place. You get to touch into this version of immortality, and this version of immortality is real and accessible and observable and what a relief.
- [43:30]
So, you know, when I look back on my father's death, when it was happening, I was so flooded with gratitude for the hospice nurses that I actually wanted to be one. I mean, I can't, like, tell you an atom from a molecule, so I am not suited for that. The test you would have to take, but the spirit of the work. I just felt like I had never been around someone so important as the women who were helping us escort our guy out of the world. And I wanted more people to be able to have that ending. So can you talk about how accessible this kind of hospice care is right now and how we're going to make it more accessible so that more people can die?
- [44:19]
Well, as we started to say earlier, hospice and palliative care are amazing fields, but they can't possibly grow fast enough to tend to all the need. So one of the things that we need to be doing here as a culture, and this is why I'm so grateful for what you're doing, Kelly, in this podcast and talking about these things, we shouldn't be leaving all these issues to the medical system to take care of. The hospital's become our church. It's overloaded. We need to take some of these issues on ourselves as people, as family members, as loved ones, as friends. And there is so much that can be done. I mean, it's the idea of loving someone, bearing witness, not judging them, daring to touch them, even if they smell funny. These are some basic things. You know, we can all do that. The medical pieces and medications layer on top of that. But there's a lot more that we as a society can do, including shifting how we see death so we don't accidentally embarrass or shame each other for dying. That's. That's the current state. Like, oh, he lost his. He lost the battle. Like, not only does he have to die, he's a loser on top of it. You know, we can really shift this kind of language and how we set ourselves up.
- [45:31]
I mean, the other piece of this that's fascinating and deeply hopeful is that this is the greatest fact of our shared humanity. This is what we all have in common.
- [45:46]
It's this thing that links us all. Rich or poor, black or white, young, old. This is where we actually have so much in common. And these days, where we're so dang divided and so pulled apart and so aware of what we don't share, it affects 100% of us. No one can escape it. On this plane, we are actually equal. It's not just a made up construct. And so going there, not only could we imagine a better death for ourselves and people we love, but just as you've experienced, Kelly, you come out of this, you come out of that experience really understanding how linked we are as people. And you feel it in your bones and the importance of kindness and just witnessing each other and seeing each other warts and all that stuff. It's so, so beautiful. In terms of a civic mission. The idea of us are working on a better ending for everybody, for ourselves. It's hard to imagine a single ending effort that would have more lasting impact on society.
- [46:44]
So is telehealth like, does that have potential? Is that a real thing?
- [46:49]
It is real. It's not going away. It is powerful. I think it's really, really important that we benefit from that technology and use it wisely and that we understand and that we are aware that zooming with each other is amazing and cool. But as useful as it is, it's not the same thing as being in each other's presence where we would smell each other's breath and feel each other's eyes lock and contact. Those little things are hugely potent. So yes, telehealth's here to stay. My partner and I are just now starting an online palliative care company called Metalhealth. M e t t l e metalhealth.com where we're doing sort of palliative care coaching and counseling online, whether by phone or on video chat like this. So I believe in it. It's a piece of the puzzle. It's not going to miraculously make everything better, but it's a piece of the puzzle.
- [47:42]
Sometimes I feel like the answer is tactical. In other words, if we could just teach each other, like, what are the questions to ask? So when my dad was dying, I have two older brothers and my mom, and all of us were losing this very precious person. And I felt like the trick to it all going so beautifully was all of us asking each other the right questions, like, what do you need right now? Or how's this going for you or is there anything really important that you have to have before this ends? So do you have a set of questions that you can't recommend highly enough to help people in these final days?
- [48:24]
You just said that so beautifully where, you know, just, it's not exotic stuff. Turn to turn to each other, say, hey, how you doing? We missing a note here. Any little thing bothering you? I think checking in with each other and really asking about those smaller, subtler parts of ourselves that nonetheless really need some attention, it's easy to blow past them. I find one of the things, especially when trying to make very important medical decisions, to ask folks, you know, hey, if you could zoom ahead and look back on this period, what do you want? How do you want to have handled it? You know, what would you regret? And it can clarify for folks how they want to. How they will have. Want to have handled it. You know, as you and I both know so often, it's the quote unquote little things that make these huge, huge differences. So you gotta, gotta give a safe space, space to unearth those. Avoiding regret is about as powerful for me, perhaps more powerful than pursuing joy. So I find them, I use them both.
- [49:32]
Have you lost someone that you thought you couldn't live without?
- [49:36]
Well, I lost my sister to suicide when she was 32 and I was 28. That was 20 years ago. That was a doozia. Besides, Lisa would be my dog, VT. It was my service dog when I got out of the hospital. And I was reliant on him in ways I had not been relying on any human being. It was hard for me to imagine living without him. So those are the two creatures that come to mind when you ask that.
- [50:04]
Oh, bj, I'm so sorry. What a terrible loss. Have you figured out a way to think about her that works for you or is it still turning over in your mind actively, still, still chewing?
- [50:23]
I think, you know, it took me years, 20 years in now. And it's if unlike any other loss in my life. And I think for most of us who are left behind, it relates to this idea of what do you do with someone who loved you and you loved. Who chose to leave. You know that we always presume that death is this thing that no one wants and you know, but that's just not true. People choose it and that's a doozy. So I am, for me personally in my relationship to my older sister, to my sister, my one sibling that's still unfurling for me. It was a black box out of which no light came for years, I could barely have a thought about her. I couldn't approach it more and more through learning more about grief and letting myself feel hard feelings. I've been able to pry open that box a little bit and get in there and feel her again. And that's through the magic of grief. Actually letting myself grieve is what allowed me some access to her again. And then otherwise, professionally, for me, it's a big lesson, this idea that there comes a time where people actually choose death, and that's informed my work in a lot of ways. Just appreciating that death isn't the enemy and understanding how it can be a relief and how it's not necessarily pathological to yearn for one's own death.
- [51:52]
You know, one of my huge takeaways from when my father was dying was that every person in our little family was doing it the very best way they knew how. You know, I was, like, up in there, close. My mom went to church a ton. My brother Booker tried to keep us all fed and light and tried to crack a joke every now and then. My brother GT found this incredible way to involve all the kids that my dad had coached over the years and had all these kids send in notes to him that we would read to him by his bedside. And everybody's way of doing it was the right way for them. And I think that is so important to let people do it the way they want to do it, which could be, like, not talking about it that much, not hugging that much. It could be cracking a joke at a weird time. Like, all of it is so understandable to me. It was at the time. And it's even more so in retrospect.
- [52:50]
Well, there you go. You just gave me chills. That's my favorite. There's a permissiveness that comes with death if you let it, one of the upshots. And that permissiveness pushes back on the judgment that otherwise hems us in so much of the time. Sure, that judgment kind of keeps us on the straight and narrow in some good ways, but it also makes us really alienated from parts of ourselves and all sorts of things. So that has been the grand lesson for our family. We used to, early on, try to spend Thanksgiving holidays with other families and stuff, and we just found we couldn't, you know, we just couldn't get into it. We couldn't kind of get the smile going in the ways that people needed. And so we just find some screw it, and we just give ourselves, because she died December 1st. And so Thanksgiving was the last time we were all together. And that time of year, we just let ourselves. We just get together, the three of us, and basically scrape the barrel, you know, we let our moods go anywhere they need to go. We may not get dressed. We may smear cranberries on our foreheads instead of eating them. What? Doesn't matter. It doesn't really. Nothing. None of those details matter except that we're together. And that is a powerful and beautiful place. We're very grateful to have landed there, and Lisa helped us see that. The power of that.
- [54:10]
To me, it seems like there are moments of intimacy that are available in the air around loss, that are just otherwise totally inaccessible.
- [54:21]
These hard experiences can blow open those doors, and I feel like an intimacy junkie, if anything, you know, and it doesn't need to be. Intimacy is such a beautiful thing. I feel it with a stranger in the public when I hold the door open for them or they me. And there's a little bit of eye contact that's maybe a millisecond, but it's intimate, you know? I love it. I just love. I can't get enough of it.
- [54:46]
Okay, so before I let you go, there's this beautiful poem by a woman named Ellen Bass that feels like the right way to end here. It's called the Thing is. The thing is to love life. To love it even when you have no stomach for it. And everything you've held dear crumbles like burnt paper in your hands, your throat filled with the silt of it. When grief sits with you, it's tropical heat thickening the air, heavy as water, more fit for gills than lungs. When grief weights you down like your own flesh, only more of it. An obesity of grief. And you think, how can a body withstand this? Then you hold life like a face between your palms. A plain face, no charming smile, no violet eyes. And you say, yes, I will take you. I will love you again.
- [55:45]
Unknown
Oh, man.
- [55:48]
BJ Miller
I'm not gonna try to up that.
- [55:50]
Pj, I can't thank you enough for your time and your work and your insight. You're a real gift, and I have loved every minute.
- [55:59]
It's such a pleasure, Kelly. I hope we get to do some. Some more of it sometime. Thank you very much.
- [56:05]
I shed a lot of tears and took a lot of notes during these two conversations. Here are my takeaways. 1. Death is not the opposite of life. Death is an integral part of life. It's the last song in the musical. 2. We Are Plastic creatures built to adapt. There's lots to be learned from coming apart and real reforming yourself over and over. 3. If you value intimacy, allowing your brokenness to be seen is a good first move because game knows game. 4. Thanks to the Silver Tsunami, the national conversation around death is about to radically change. 5. Deferring is hazardous. 6. Beware the if then thing. If I am good, then I will live. We have to decide that the outcome is inconsequential to the experience. Number seven, if you're trying to live a life without needing anyone, you're essentially signing up for half a life. Number eight, a well supported psilocybin or ketamine trip can be a miracle. And number nine, human beings are not just their bodies, not even close. I want to thank BJ Miller, Susan George, my partner in crime on Kelly Corrigan Wonders, Ben Bernstein and Dean Kateri on Sound, the Arthur Vining Davis Foundations for Production Support and of course I want to thank Andy. Ladies lots. I invite you to listen to the whole conversation with Andy. The episode will be called Love, Loss and Remembering and it's dedicated to my friend Liz. Lots of.