Dr. BJ Miller: How to Die

Summary

Oprah's Super Soul Conversations: Dr. BJ Miller - How to Die

Episode Release Date: November 12, 2018

In this profound episode of Oprah's Super Soul Conversations, host Oprah Winfrey engages in a deeply moving dialogue with Dr. BJ Miller, a renowned palliative care physician and the former senior director of the revolutionary Zen Hospice Project. Their conversation delves into the intricate relationship between life and death, exploring how embracing mortality can lead to a more meaningful and fulfilled existence.

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1. Introduction to Dr. BJ Miller and His Journey

Oprah Winfrey welcomes Dr. BJ Miller, highlighting his unique perspective on life and death both as a doctor and a patient. Dr. Miller shares his life-altering accident at the age of 19, which resulted in the loss of three limbs. This pivotal moment not only reshaped his personal life but also influenced his professional path towards palliative care.

Notable Quote:

"After witnessing the moment of transition Hundreds of times, Dr. B.J. Miller has come to view life and death as mutually inseparable."
[Oprah, 01:00]

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2. The Night of the Accident

Dr. Miller recounts the details of the night he lost his limbs. It was a seemingly mild evening with friends, which took a drastic turn when he accidentally came into contact with high-voltage power lines. The accident left him with severe burns and ultimately led to the amputation of his limbs.

Notable Quote:

"I was the first one up the ladder. And I had a metal watch on, and I got close enough to the power lines and the electricity arc to the watch, and that was that."
[BJ Miller, 02:50]

---

3. Coping with Trauma and Finding Meaning

Dr. Miller discusses his initial struggles post-accident, including the instant desire to escape reality by extubating himself and attempting to regain normalcy despite his severe injuries. However, his upbringing played a crucial role in his resilience. Growing up with a mother who was disabled due to polio, he developed an intrinsic understanding of disability and the inevitability of suffering.

Notable Quote:

"I never really had the 'why me?' Really, really not. And that's not a credit to me. That's mostly credit to my family."
[BJ Miller, 06:20]

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4. Embracing the Present and Letting Go of Comparison

One of the foremost lessons Dr. Miller learned from his ordeal was the importance of living in the present moment. The accident forced him to cease comparing himself to others and to stop the endless striving for more. This shift allowed him to appreciate the present and recalibrate his priorities.

Notable Quote:

"Living in the present moment is the only thing that really matters. It forces you to do that in a way that you can't help but do that."
[BJ Miller, 08:54]

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5. The Zen Hospice Project and Redefining Death

Dr. Miller elaborates on his work with the Zen Hospice Project, where he developed a patient care philosophy centered on compassion, service, and the sacred nature of death. He emphasizes that dying should not be viewed solely as an end but as an integral part of life, transforming the often cold and isolating process into a warm and comforting ritual.

Notable Quote:

"Dying is part of life. So that's the first lesson is, oh, right, dying is part of the deal. And I am still living when I'm dying."
[BJ Miller, 21:09]

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6. Rituals and the Human Experience of Death

Dr. Miller describes the flower petal ceremony practiced at the Zen Hospice Project. Unlike the clinical portrayal of death in hospitals, this ritual focuses on honoring the deceased with beauty and simplicity, allowing families to grieve in a peaceful and meaningful environment.

Notable Quote:

"You see it as a memory. It's this very mundane, amazing feeling. You see it as the shell that it ever was, but you honor it with flowers."
[Oprah Winfrey, 22:56]

---

7. Reimagining the Healthcare System

A significant portion of the conversation addresses the shortcomings of the current healthcare system, which is predominantly disease-centric. Dr. Miller advocates for a paradigm shift towards patient-centered care that honors the human experience of illness and death, reducing unnecessary suffering and improving the quality of life for patients and their families.

Notable Quote:

"The healthcare system needs to switch from this disease-centric focus to focusing on the person, to focusing on what it means to be a human being."
[BJ Miller, 27:57]

---

8. Living Well to Prepare for Dying Well

Dr. Miller emphasizes the importance of living without regret as a pathway to dying well. By making conscious daily decisions that align with one's values and expressing love and gratitude, individuals can minimize regrets and embrace a fulfilling life.

Notable Quote:

"The way we can prepare ourselves to die well is to live well and to live without regret."
[BJ Miller, 29:30]

---

9. The Power of Presence and Forgiveness

In discussing how to comfort the bereaved, Dr. Miller highlights the significance of being present and bearing witness to someone's grief. He also underscores the transformative power of forgiveness as a means to heal and move forward.

Notable Quote:

"The act of forgiveness is really being the kindest thing we can do to ourselves and others. It clears the path to delight in the time you have while you still have it."
[BJ Miller, 37:10]

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10. Philosophical Insights on Death and Afterlife

When pondering the afterlife, Dr. Miller expresses his appreciation for the mystery surrounding death. He believes in the natural cycle of life, where his physical form transforms back into the earth, becoming part of nature's perpetual continuity.

Notable Quote:

"When you put my body in the ground, it's going to decompose and the energy will transfer and I will become that blade of grass. I will become the ground, I will become the tree."
[BJ Miller, 33:29]

---

11. Fulfillment through Love and Connection

Dr. Miller reflects on the essence of love, comparing it to an omnipresent aquifer that's always available if one chooses to tap into it. He emphasizes the importance of loving others and being loved, highlighting the safety and unconditional nature of love received from animals as a model for human relationships.

Notable Quote:

"Love is like an aquifer. It's ever present all the time. It's there for us if we want to."
[BJ Miller, 36:07]

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12. Conclusion: Living and Dying with Intention

The conversation concludes with Dr. Miller reiterating the intertwined nature of life and death. By living with intention, embracing the present, and fostering meaningful connections, individuals can navigate their mortality with grace and fulfillment.

Notable Quote:

"By the end of a life, you won't have stockpiled all that many regrets. Regret's a bitch."
[Dr. BJ Miller, 30:11]

---

Final Thoughts

This episode of Super Soul Conversations offers a transformative perspective on mortality, urging listeners to embrace the finite nature of life to unlock its true essence. Dr. BJ Miller's insights serve as a guide for living authentically, fostering deep connections, and approaching death with peace and acceptance.

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Transcript

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[Oprah Winfrey]

I'm Oprah Winfrey. Welcome to Super Soul Conversations, the podcast. I believe that one of the most valuable gifts you can give yourself is time. Taking time to be more fully present. Your journey to become more inspired and connected to the deeper world around us starts right now. Today, we ask palliative care physician and former senior director of the groundbreaking Zen Hospice Project, BJ Miller, what really matters when we die. After witnessing the moment of transition Hundreds of times, Dr. B.J. miller has come to view life and death as mutually inseparable. He he also has the unique perspective of facing mortality as both a doctor and a patient. After a freak accident caused him to lose three of his limbs when he was a college student. BJ Miller is passionate in this belief. It's time for all of us to rethink, redesign, and reimagine everything we've been taught about death. So let's start when you say your relationship with death began. That was at 19 years old, right? You did a crazy thing.

[BJ Miller]

Yep, Yep.

[Oprah Winfrey]

When you lost your lower legs and arm. Tell me what was going on that night. Had y' all been out? Had you been drinking?

[BJ Miller]

Little bit, but it was actually a pretty mild night as far as we went.

[Oprah Winfrey]

Yeah, because you'd done other crazy things.

[BJ Miller]

We'd done way, I thought, way crazier things. So we had just gotten back from Thanksgiving vacation.

[Oprah Winfrey]

How many of you?

[BJ Miller]

There were three of us hanging out together that night. It was a Sunday night, had a few beers, but really? Mostly decided to go get a sandwich and walk to what's called a Wawa market in New Jersey.

[Oprah Winfrey]

I know Wawa.

[BJ Miller]

Oh, you know, the Wah. So we were walking to the Wah. And it just so happens that our path, there's a commuter train that runs across the path. And it was just sitting there off hours. And, you know, it's a ladder on the back. You just climb it like you would a tree or a jungle gym. We really did not think we were getting into anything particularly nuts, but I happened to be the first one up the ladder. And I had a metal watch on, and I got close enough to the power lines and the electricity arc to the watch, and that was that.

[Oprah Winfrey]

It's like thousands of voltage, 11,000 volts.

[BJ Miller]

Enough to move a commuter train.

[Oprah Winfrey]

Wow. Shot through your body.

[BJ Miller]

Yep.

[Oprah Winfrey]

What does that feel like?

[BJ Miller]

Not good.

[Oprah Winfrey]

Not good.

[BJ Miller]

Not good.

[Oprah Winfrey]

Can you remember the feeling, Katie?

[BJ Miller]

I have to say, I really don't remember the night. My first memory is about four days into the whole ordeal. Actually, my first memory was that night being flown to a burn unit in New Jersey. It was just one burn unit in New Jersey. St. Barnabas.

[Oprah Winfrey]

What was burned.

[BJ Miller]

So with electricity, you burn from the inside out. It enters your body and then tries to get out, and it tends to incinerate where it enters and where it exits. So it entered my arm and then blew down my feet. And as your leg tapers, all that current slows and the energy gathers, and at some point, your flesh just can't take it. So you burn from the inside out.

[Oprah Winfrey]

Whoa.

[BJ Miller]

Sad to say, but I don't remember that night, really, except for when they were loading me into the helicopter. I remember being too tall. I was like, six, almost six, five. I remember they were trying to fumble with my feet of where to put me in this helicopter thing. I vaguely remember that. But then my first memory is about four or five days into it.

[Oprah Winfrey]

What do you remember?

[BJ Miller]

This is a. And I kind of like this story, Oprah, because it's just a strange feeling. So you know that feeling when you wake up from a dream and it was not a good dream, and there's a moment where you realize, you look around, you say, ah.

[Oprah Winfrey]

Ah. That was a dream.

[BJ Miller]

All right. That was just a dream. Okay. I'm okay. Everything's cool. You know, it takes a little minute. You can kind of feel it happening.

[Oprah Winfrey]

Yeah.

[BJ Miller]

So I woke up in the burn unit and had that sensation. I said, oh, man. Oh, cool. That was just a dream. It was a horrible dream. Everything's cool. Everything was so clearly not cool. I'm in a burn unit icu. I'm intubated. I've got lines in my jugular. But somehow I still managed to look at this whole scene and think of it as a dream. So I extubated myself, took the ventilator out, pulled the necklines out because I had the feeling I needed to go to the bathroom. So I did all this stuff, get out of the bed. At that point, I still had the feet. They hadn't been amputated surgically yet. That was the next day. So I get out of bed, stand on my crispy little feet, start heading towards the door to go to the bathroom, still completely clueless. And then the catheter line ran out of slack and that. So the way a Foley catheter works is a little ball that's in your bladder, and that keeps it secure, but when you pull on it, it doesn't go anywhere. So.

[Listener]

Mm.

[BJ Miller]

So that I fell to the floor. And in a second, the same reverse happened. I realized, oh, this was all real. This was real. And in that millisecond, it became extremely clear what had happened.

[Oprah Winfrey]

Whoa.

[BJ Miller]

Yeah, it was.

[Oprah Winfrey]

Whoa.

[BJ Miller]

It was intense.

[Oprah Winfrey]

Were you filled in that moment with what, regret? Horror? Why did this happen to me? Oh, no.

[BJ Miller]

You know, one of the great things about. I never really had the why me? Really, really not. And that's not a credit to me. That's mostly credit to my family. My mom. I grew up with a mother who was disabled. She had polio, and she has post polio syndrome, so a real progressive illness where she's progressively disabled. And so much of my childhood was spent with her navigating the planet from a wheelchair. And I was so very, in my bones, sensitized to disability as an idea, as a construct, as a concept. And I just knew it happened to good people. So there was no part of me that was surprised that this had happened to me. And in a way, I feel so fortunate because I got to sidestep. I watched some of my peers in similar situation have to go through a couple years of, like, you know, hating themselves, practically hating their lives.

[Oprah Winfrey]

Yes. Yeah. I've talked to lots of people who went through that.

[BJ Miller]

Yeah.

[Oprah Winfrey]

You did not go through that.

[BJ Miller]

Oh, really?

[Oprah Winfrey]

Yeah. At what point were you able to look back and see, actually, the beauty this accident brought into your life? Takes a long time to get there.

[BJ Miller]

It takes a while to get there. Like, there were moments even in the hospital where you're like, you can't believe you're alive, and you can't believe all this effort going to help you survive, and all the human innovation around you, helping you live, and the devotion. I mean, there were plenty of joyful moments, even in the burn unit. Actually, I cried the day I had to leave the burn unit. It had become my home. So your frame of reference gets really strange and everything's altered. But beauty wasn't out of reach immediately. But until I could really feel it in my bones in a daily way. And that took a couple years, and that was sort of a slow awakening.

[Oprah Winfrey]

So how did this accident help you get in touch with the true meaning of your life?

[BJ Miller]

So I think the first thing it did at that age, here, I'm at Princeton, you know, I was caught up in. You take these tests to get here, and you go there to get there. And it was just sort of this future orientation.

[Oprah Winfrey]

You're just comparing yourself to what everyone else is doing.

[BJ Miller]

Exactly. You got it. And it's a kind of a prison if you're not careful. And I was in that prison, like so many of us. And the first thing that this did for me was just make it impossible to compare myself to anyone else for a little while. Like, I couldn't be seduced into thinking I should be doing more or otherwise getting through the day. Going to the bathroom was hard enough. You know, whatever the simplest things, it sort of recalibrated me. And that was the first gift, was to at least to cease the endless striving, the endless comparing and contrasting myself to others.

[Oprah Winfrey]

Yeah. And it forced you to do what Eckhart Tolle says, you know, in all of his books, basically, that living in the present moment is the only thing that really matters. It forces you to do that in a way that you can't help but do that.

[BJ Miller]

Yeah. Yeah, exactly. And that's sort of related. That's the second great lesson was that being present, I mean, that was just. That's all you have. You don't. There's no promise of a future. The past is the past. I mean, it's just empirically true. But now I could feel that truth. And it was not a recreational thought. It was a therapeutic thought.

[Oprah Winfrey]

So now, do you look back at that accident and can you say that in some ways it was a gift to you?

[BJ Miller]

Yeah. I mean, you know, at some point, you know, the lessons pile up.

[Oprah Winfrey]

Yeah.

[BJ Miller]

The beautiful moments, the exchanges with others, the shared vulnerabilities, they stack up pretty quickly. And before you know it, if you're honest, the good that's come from it is so potent that I can't regret it. I can't. I would be fooling myself if I regretted this situation. Of course, you can't take it back either. I mean, there are other ways to learn these lessons. You don't gotta. You don't need to go through that kind of ordeal.

[Oprah Winfrey]

Did it take you time to figure that out? That you are the same person without your limbs and how. And no matter how many limbs you lose, you're still you?

[BJ Miller]

Yeah. You know, I have to say this is again, credit to my mom. It didn't take me too long to get there because in some way, Oprah.

[Oprah Winfrey]

Watching her all those years, watching her.

[BJ Miller]

All those years and also being a sort of, you know, I was kind of a hypersensitive kid, maybe because of my experience with my mom, watching the planet respond to her. I don't know why, but I was a little on the melancholy bent. And in a way, if I were totally honest, I remember the feeling of, well, now I look like I feel now. My body fits me in a way because I didn't have any ownership of my own ordeal, ownership of my suffering. Everyone thought that I had a silver spoon in my mouth. I was given this education. I had so much access, I could own nothing. I looked okay. I was a decent athlete. So in a way, I couldn't complain about anything. And yet I had a real misery in me as a human being trying to reconcile themselves on the planet. And now, finally, I looked a little bit more the part. And in a way, it was a little bit welcome. I don't mean that in a melodramatic way, but I did feel my identity quickly shifted, relatively quickly to accommodate this, because it felt. Felt sort of right.

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[Oprah Winfrey]

I have never in all of my multi thousands of interviews heard someone be candid about what it means to be privileged. Really, because you go through the world. And you're so totally privileged. I often wonder and ask my friends who, you know, are of privilege, how do you raise kids?

[BJ Miller]

Yeah.

[Oprah Winfrey]

With kindness, with grace, and their own sense of ambition. When you've actually had everything. And that is its own cross to bear, too. But those of us who grew up poor and just trying to get a meal, you know, don't think of it that way.

[BJ Miller]

Yeah, of course not. And it's. I don't mean to make too much of it, but it's a kind of a quiet suffering that you really can't share with others because you sound ungrateful.

[Oprah Winfrey]

Yeah.

[BJ Miller]

But for my money, and this is what helped me understand all this, I think being a human being is just plain hard. And if I think about some of the people I know, some of the most miserable people I know are of great privilege. I think the human conundrum of having an imagination, being able to imagine a world that you don't have, one way or another to have this sense of power to know the questions, but not enough power to know the answers. I mean, however you describe it, being a human being, I think, is a very difficult proposition, period.

[Oprah Winfrey]

And figuring out why you're here and what that all means. Yeah, yeah.

[BJ Miller]

And it does help to have something to push against. Whether it's an injury or perhaps poverty, not that I can describe that, but something to rail against, to motivate you, to mobilize your energies, to push against, fight for. To fight for. In a way, I think death gives us that nice bookend as something to shove against this fulcrum, this pole to bounce off of.

[Oprah Winfrey]

Oh, for sure. If we didn't have death, nobody would ever get anything done.

[BJ Miller]

No, ma' am.

[Oprah Winfrey]

There wouldn't be a damn thing ever accomplished.

[BJ Miller]

No. Why would you get out of bed. I'll do it tomorrow.

[Oprah Winfrey]

Tomorrow. If we didn't have death pushing against us, nobody would ever do anything.

[BJ Miller]

No.

[Oprah Winfrey]

Yeah.

[BJ Miller]

And now I find myself giving talks more often. And one of the things I love to ask the audience, because I think we absorb this idea that death is bad. Death is inherently negative. It's nothing but losing control. It's all negatively framed. But when I ask this question to most audiences, I say, you know, if you could push a button and live forever, would you push that button? I mean, it's a silly question. Depends on the conditions, but still, you get the point. And I'd say I've asked that question maybe 30 times and of thousands of people by now, and maybe 10% of people say they'd Push that button. So that tells me a lot. So death isn't necessarily this ogre that we all don't want anything. Actually, at some point, we kind of welcome it. So I just use that to kind of help us reframe the whole idea that death is inherently horrible. I don't think it is. And most of us. I don't know how you'd answer that question. I know. I wouldn't push that button.

[Oprah Winfrey]

No, I wouldn't push it either. I'd ask for, could you give me a little more time?

[BJ Miller]

Bargain for a little time.

[Oprah Winfrey]

A little time. But no, wouldn't push the button. Yeah, me neither. Because then I'd never get anything done. What's the point? What's the point?

[BJ Miller]

Right?

[Oprah Winfrey]

It's the yin and the yang. Yep, absolutely. So for people who are listening, who have, you know, something traumatic happen to them that changes what was normal. Because I think most people, so many people want it to be like it used to be.

[BJ Miller]

Yeah.

[Oprah Winfrey]

And I want to be, quote, normal. I want to be like those people.

[BJ Miller]

Yep.

[Oprah Winfrey]

Yeah. Well.

[BJ Miller]

And it's a funny thing as we grow up, too, you spend so much time as a young age trying to be like everybody else, and at some point that you shift, you want to be like just nobody else, or at least just like you. But I have to say, to be really clear, Oprah, I mean, it took me a few years to make good, to feel what we're saying right now. I could say these words pretty quickly. I knew the ideas, but to feel it in my bones and to stop comparing myself to the old self, the old body, that took, honestly, a few years before I stopped doing that.

[Oprah Winfrey]

What did it take? Actually practicing what you were saying? Putting into practice on a daily basis.

[BJ Miller]

Yes.

[Oprah Winfrey]

What you intellectually understood.

[BJ Miller]

Yes. And I was. Early on, I had this ruthless sort of. It was just a trick. Sort of like I was looking for silver linings wherever I could find them. And, like, one of my early silver linings was I used to, like, you know, when I'd walk in an ocean, I would be afraid I was gonna step on a stingray or something. So one of my early silver linings just to pull myself forward was, oh, well, now I don't have to worry about stepping on a stingray. Okay, great. I mean, it was silly.

[Oprah Winfrey]

It was, you gotta start somewhere.

[BJ Miller]

You gotta start somewhere.

[Oprah Winfrey]

Yeah.

[BJ Miller]

And you start collecting these little silver linings. And that's how you start reframing the whole thing for yourself and making perspective with it and studying art and learning how to See, and this human talent of how to look at something not so much what you see, but how you see, that helped a ton. But, yeah, it was putting into daily practice what we're talking about.

[Oprah Winfrey]

So art. Studying art changed the way you saw yourself, your condition, and the world.

[BJ Miller]

Yeah.

[Oprah Winfrey]

After graduating with a degree in art history, BJ decided to pursue a medical degree, but not in the field many would expect. Working with amputees, BJ found himself drawn to palliative care, which focuses on providing relief from chronic pain or for those near death. So how do you get from art history to palliative care?

[BJ Miller]

Okay, so studying art, that got me really focused on how does the end the human condition, what it meant to be a human being. That became the subject matter for me, which was obviously therapeutic for me to think about. It made me help me find a new confidence, feel like I had a place in this world. I didn't know what I was going to do for a living. I really had no idea. But I knew I wanted to be of service. I knew I wanted to have fun. I knew I wanted to feel like I had a creative existence. That's all I knew. So then with that was, well, medicine would be a great way. I mean, I could imagine if a doctor looking like me came into my room when I was sitting in the bed, boy, that would have been potent. So that was the impulse. I didn't take any undergraduate.

[Oprah Winfrey]

Doctor, you've been through some things.

[BJ Miller]

Yeah. And that helps, right? I mean, the patients. And still to this day, with my patients, I can get to trust much more quickly than some of my colleagues, because one look, you know, I was in the bed, and that helps a lot.

[Oprah Winfrey]

I think that's powerful. You know, I've been in that bed.

[BJ Miller]

Yeah, it helps. I don't have to prove anything that way.

[Oprah Winfrey]

Through his work at the Zen Hospice Project, BJ Miller spent six years developing a patient care philosophy based on the spiritual values of compassion and service. And rooted in a belief that death is both sacred and unknowable. BJ has since expanded on those ideals by creating the center for Dying and Living. It's a nonprofit website he created to be a vital source of information on quality of life, death, and everything in between. So what has being around the dying taught you about living?

[BJ Miller]

That's a great question, Oprah. One great lesson is dying people are still living. You know, it's like to realize it, see it as part of life, and to separate dying from being dead. Dying is these final moments of a life, and therefore a very Potent, essential, really concentrated. Part of life. But it's part of life. So that's the first lesson is, oh, right, dying is part of the deal. And I am still living when I'm dying. That's a really important lesson. You start realizing that what makes anything precious except that it ends. So dying is what creates preciousness, what gives us the impulse to make meaning, because it proves death, proves life. I heard that statement once, and that makes sense to me. You know, you're alive because you're going to die someday. That's what proves you're alive. So another big thrust of this, Oprah, is what you learn is time is short, so the decisions you make are of consequence, delaying things that you love or want or seek, not calling Grandma, whatever it is, you have no promise of tomorrow. So live your life today. I mean, that's probably the singular best lesson about dying, is to teach living for me, anyway.

[Oprah Winfrey]

And so I love this ritual you all created at the Zen Hospice Project because anytime we've seen in a movie, which is how most people have seen people die, most people have not actually witnessed it themselves. It's cold and isolating and removed and everything, but warm and comforting.

[BJ Miller]

Yeah.

[Oprah Winfrey]

And you all have created a ritual of.

[BJ Miller]

It's a flower petal ceremony. When someone dies and the mortuary guys come to pick up the body and are taking the person's remains out of the house for the last time. Everyone gathers around and they just sprinkle it with flower petals. And some people may sing a song or recite a story that they heard from the person or some shared memory or just silence. But the most beautiful part is just the flower petals. Seeing this body, this clearly done, there's no life left in that body. You see it as a memory. It's this very mundane, amazing feeling. You see it as the shell that it ever was, but you honor it with flowers, and you watch the body roll out the house, and that's the final image for the families. Contrast that with a typical hospital death in the ICU with tubes and machines and all this vulgarity and grotesqueness, which is essential to some degree and important, but it can often scar families unnecessarily. The final images can be so barbaric, they have to. And that sets you up for a very different grieving process than do flower petals.

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[Oprah Winfrey]

Where the body becomes the shell. Can you sense when the person it the spirit goes and there is some kind of lingering in the air, there's something that remains. Is that the person's spirit? Is it their soul? What is that?

[BJ Miller]

So you know, I've been around people who are just about to die, people and bodies that have just died and there is this lingering sense. It's true. There's a feeling. It's a palpable. Yeah, there's a lingering and I don't know if that's in my mind or if that's in the air, or if that's spirit. One thing I've gotten, really, one thing that minders helped me with was to not need to know. I didn't need to have control of everything. I didn't need to know the answers anymore. I mean, I love not knowing. The answer is unimportant. It's just a sacred and gorgeous moment. And you can feel this.

[Oprah Winfrey]

It just is.

[BJ Miller]

It just is. It just is. But I must say too, I've been around folks who I'll be sitting there talking with their family and we're having a conversation and the person dies in the middle of conversation. And it's seamless. It's almost gorgeously like the word mundane. It's almost. It's just they were here, then they're gone. And there's a moment where it's just so matter of fact, as you say, it just is. That's its sort of charm, it's its beauty. And then we start heaping meaning upon it. But in that moment, it's such a profound, stunning moment to see the body finally as a shell and devoid of that person. And in that moment of transition around the body, you're really in touch with the continuum of life. That life is proceeding, that individuals go on, but life goes on.

[Oprah Winfrey]

What do you want us to know about what and how we should be thinking about designing our life and our death? Because you think or feel that they're inseparable, right?

[BJ Miller]

I believe they are, yeah. So some of this stuff is just mother nature at work.

[Oprah Winfrey]

Yeah.

[BJ Miller]

But then there's this human element of it. How we design the health care system, how we design hospitals, because a lot of the suffering you'll witness around serious illness or dying is unnecessary. It's the waiting two weeks to get a call from your doctor about a test result. When the test result was run, within a half an hour, it's your car getting towed because the hospital didn't build enough parking spaces while you're in seeing your mother in her deathbed. And the health care system, most importantly the 20th century, was designed around diseases. The idea was life's wonderful, then you get a disease and it sucks. Then if you can fix the disease, you can get your back self up to wonderful. That was kind of the thinking. But it turns out that illness, suffering, death are way more persistent than that. They're going to come no matter what we do. So the healthcare system right now is in this. And so the system needs to switch from this disease centric to focus on the disease, to focusing on the person, to focusing on what it means to be a human being. You know, dying doesn't have to be the gnarly bed hotbed of suffering that I think a lot of us imagine. And some of our anxieties are unnecessary. And many of the people that I help care for, by the time that they actually die, they're really ready to go. They're done. They're done. And that's okay. The hard part is very much for the family living on with it.

[Oprah Winfrey]

And so that's why fighting death should not always be the goal.

[BJ Miller]

Not necessarily. I won't talk people out of it, if that's the way a lot of people want to go down swinging. You know, that's the phrase. And I'll help them do that. It's not mine to mandate a certain way of dying. I think most of us crave a certain peace, and that peace is accessible. And I guess, to answer your question most succinctly, my money, the way we can prepare ourselves to die well is to live well and to live without regret. And that means checking yourself pretty much on a daily level, on a daily basis, am I doing what I care about? Am I doing what I love? Have I told the people I care about that I love them? Et cetera. These are fundamental things. You check yourself on a daily basis, and by the end of a life, you won't have stockpiled all that many regrets. Regret's a bitch.

[Oprah Winfrey]

Regret's a bitch.

[BJ Miller]

It's really hard. Loss is hard. You start putting regret and guilt and other things on top of that. It doesn't need to be that hard.

[Oprah Winfrey]

Have you been with people who, in their final moments, are living that space of regret?

[BJ Miller]

Yeah.

[Oprah Winfrey]

Yeah.

[BJ Miller]

Yep.

[Oprah Winfrey]

Gotta be the saddest thing.

[BJ Miller]

It is sad, but, you know, it's also important.

[Oprah Winfrey]

What do they regret? Cause, you know, there's this phrase that nobody's gonna regret not spending more time in the office. Nobody's gonna regret. You know, it's true. What your spreadsheet look like.

[BJ Miller]

It's kind of true.

[Oprah Winfrey]

What do they regret?

[BJ Miller]

So I love these vicarious deathbed moments that I get to have. And there's some real truth to that, like, why did I spend so much time with this job I hated? Why did I spend so much time married to that person I didn't really respect or, you know, whatever? And there's some real truth to that. And it all invariably has to do with time and how you spend how you value your time. But you Know what's also kind of true here is when you watch the power of just accompanying someone and bearing witness, some of that regret just gets to go away. Because regret too is also unavoidable. I wouldn't make all the exact same decisions now that I've made in my past.

[Oprah Winfrey]

Right.

[BJ Miller]

The salve is being seen. The salve is being felt and heard and witnessed. That helps the regret fade so nicely. So, yeah, I've seen those vicarious, those deathbed regrets, but I've also also watched them just fall by the wayside pretty sweetly.

[Oprah Winfrey]

Being seen and heard by whomever in that moment, by family, by family, by.

[BJ Miller]

Volunteers, by nurses, by people in the moment who are daring to sit with someone who's in agony, who may smell funny, who's not themselves. You know, the whole thing. Dying isn't necessarily so pretty, which is extra potent when someone can sit with you and be with you in that state. It's an amazing thing to offer someone. That presence is an amazing thing to give and it heals a lot of wounds quickly.

[Oprah Winfrey]

Wow. What do you say to someone who's lost their beloved? What are the words? How do you comfort? How can you be a comfort?

[BJ Miller]

I think there are many opinions on that very question. For my money, there aren't really bonafide guaranteed words. You know, I've used the I'm so sorry and people will come back. What are you sorry about? I'm like, oh, well, you know, I'm not really sorry, you know. Anyway, the point is, language is deeply imperfect.

[Oprah Winfrey]

Yeah.

[BJ Miller]

But to answer your question, one of the things that I think is so potent is in that moment of sharing grief with someone, is witnessing them sit in that hot stew with someone for a moment. Like we're talking about that. Bearing witness.

[Oprah Winfrey]

Sit in that uncomfortable space.

[BJ Miller]

Yeah.

[Oprah Winfrey]

That awkward space.

[BJ Miller]

Yes. And let.

[Oprah Winfrey]

Or you don't know what to say.

[BJ Miller]

Where you don't know what to say. And that's. You're sharing the chafe with that person and that I've seen to be the real salve.

[Oprah Winfrey]

Yeah. A friend of mine said once when her mother passed and I was saying I didn't know what to say, she said, just being here, you're being there, you're being present, you're not knowing what to say because you're right, language is inadequate.

[BJ Miller]

Yeah.

[Oprah Winfrey]

So what do you believe happens when we die? Do you have any theories on that? Thoughts?

[BJ Miller]

So I do. Yeah. One is, like I told you, I love mystery. I love not knowing. And that's such a creative space so people can apply their own ideas to it. And I watch people do all sorts, apply all sorts of ideas to it. But I do think, for me, like, empirically, it's just we. It's. I don't need to know more than when you put my body in the ground, it's going to decompose and the energy will transfer and I will become that blade of grass. I will become the ground, I will become the tree. That's the kind of immortality that registers with me. And that's observable. That's just true.

[Oprah Winfrey]

Do you find people who are dying if they have some kind of faith, Is it easier for them?

[BJ Miller]

It very often is a great salve to people in the end, absolutely, without a doubt. But if there are cracks in their faith, those cracks can open and widen. And I've seen someone who would have considered themselves devout their whole lives and at the very end, lose that faith and it's extra hard, it's extra fierce, it's extra terrifying. So I think the lesson is consonance with your faith, with your belief, holding true to your belief, whatever it is, rather than there being a absolute truth, per se. It's your consonants with it. Does that make sense?

[Oprah Winfrey]

Yes, absolutely makes sense. What do you think is one of the big decisions or choices you made to fulfill your destiny?

[BJ Miller]

I think it was two things. One was coming to see myself a little bit of remove from. From just me as not just my body. And that opened the idea that my life, my body, was just raw material stuff for discernment. Not so much judgment, just differences that I had to play with. And just seeing my life as raw material to play with, to make stuff with, that really has helped me a ton. A ton. And then seeing this, seeing a sort of the generic nature of suffering. We have variations on themes. Mine is particularly dramatic, but it's not more or less than yours or anybody else. It's just interestingly different. But seeing variations on themes, seeing the theme rather than the variations is the key. Therefore, seeing what unites us, therefore seeing what we have in common, keeping my focus.

[Oprah Winfrey]

And seeing that all people suffer on some level. Yeah, yeah. When do you think your life force is most fulfilled?

[Listener]

Mm.

[BJ Miller]

When I'm loving somebody and they're receiving it. You know what I mean? They need to receive it for me to really feel that. And I do think one of the cool things about love, I think we all talk about the desire to be loved. I think a lot of us who have animals in our life, we all talk about the unconditional love we receive from them. Gorgeous. No doubt about it. But honestly, I think the bigger lesson is that we're all looking for a safe place to love. It's very safe. Loving my dog Maisie, she's not gonna bite me for loving her. It's harder to love human beings sometimes.

[Oprah Winfrey]

Correct.

[BJ Miller]

And I think we all crave the safe zone to love as much or more than being loved.

[Oprah Winfrey]

And you feel the presence of love when finish that sentence.

[BJ Miller]

So in my mind, love, it's like an aquifer. It's ever present all the time. It's there for us if we want to. We just gotta get our act in gear to feel it and let it come through us, you know. But it's everywhere. I would say it's omnipresent.

[Oprah Winfrey]

And the purpose of forgiveness is.

[BJ Miller]

Forgiveness is my favorite muscle in the human body. Really. It really is. It's so potent. The act of forgiveness is really being, you know, is the kindest thing we can do to ourselves and others. And it's the way to move on. It clears the path to delight in the time you have while you still have it. So I don't know if that answered your question of what the act of forgiveness is. It is a loving thing to do. I know that much.

[Oprah Winfrey]

It was my joy to talk to you today.

[BJ Miller]

It was my joy. Oprah, thank you so much.

[Oprah Winfrey]

Thank you. I'm Oprah Winfrey and you've been listening to Super Soul Conversations, the podcast. You can follow Super Soul on Instagram, Twitter and Facebook. If you haven't yet, go to Apple Podcasts and subscribe rate and review this podcast. Join me next week for another Super Soul Conversation. Thank you for listening.

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