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BJ Miller

BJ Miller, MD, is an assistant clinical professor of medicine at the University of California, San Francisco where he practices and teaches palliative medicine. He has been profiled in The[…]

BJ Miller: Health care, medicine in our country is a giant, colossal thing. And it's got a ton of momentum. And medicine has become-- the domain of death is more or less ruled these days by health care. In times past, it's been the church, or the family was the sort of center of all this.
These days, it's mostly medicine. But what's really important in all this is that we people, we humans, we patients, loved ones, we need to kind of take back the subject on some level-- that dying is not just a medical event. It's way bigger than that. It is all-encompassing. It's where everything comes to account-- our psychology, our philosophy, our spirituality, our social world, our intrapersonal lives-- all of it. The medical piece is a little itty bitty piece. It just gets too much attention.
So I'll just think about the emotions for a second. For one thing, to remind ourselves-- for me, the difference between emotion and a thought is you can control your thoughts. You can't really control your emotions. Emotions are much more slippery. They're going to have their way with you. So you ignore them at your own peril.
That's one thing to get across. But I also say that to let us off the hook. The way you're feeling, on some level, isn't your fault. And one of the things I see that happens a lot around this subject-- again, we've talked about how one can be made to feel ashamed to be sick, ashamed to be dying, like we're failing, somehow.
I want to make sure that we all understand, there are certain things that are way beyond our control. And that means-- that may be hard to swallow, but it also means we're off the hook. It's not my fault, the way I feel. I shouldn't have to hate myself or be embarrassed about it. So let's set some ground rules.
And there's this other layer that is particularly vexing, which is how others start treating you. And it's very common, under the banner of sanctity or wanting to protect someone, to-- I watch people, they stop telling jokes. Maybe they think it's sort of sacrilegious to try to be funny around someone who's sick. Or maybe they don't talk about their own joys that they happen to have in their day while their colleague is meanwhile miserable with a fever or something. They don't feel like they should talk about their own joys. Or I don't know, whatever it is-- pick anything.
But one of the things that ends up happening is we end up accidentally making life even harder for each other by keeping the truth of the situation at bay. All right? So these are the ways we die before we have to die. We die before we have to die because no one tells jokes to us anymore because they don't think we're going to want to laugh, or that sounds perverse.
Or maybe our partner stops the intimacy. Physical intimacy might dry up, or sexuality. The idea that a disabled person can be sexual, that's still a novel concept. Just look at most exam rooms in a doctor's office or in a hospital. Most of them are not even wheelchair-accessible.
My mother uses a wheelchair. They used to just assume she wasn't having sex, so they wouldn't offer her a pap smear.
And so one of the things you want to avoid if you plan for your death is you want to-- ideally, we come to our death without piles and piles of regret. So when I'm working with patients, especially upstream of their death, I'm always encouraging them to feel things, enjoy the body they have while they have it, appreciate their body while they have it, because it's someday going to go, and you're going to miss it.
So touch is just profound. It's elemental. It is, even if you think about, I think, the scourge of dementia, for example-- and a lot of us are terrified of this eventuality. We're going to lose our minds. Yeah. And it's hard. And that is a very difficult prospect. And I'm also pretty convinced that there's a life on the far side of our intellect.

And for me, that life is in the senses. As long as I can feel something, I'm interested in being alive. I'm even more interested in that than a thought.