Conversations on Healing

BJ Miller

The Authenticity of Human Connection and Preciousness of Human Life

Author, Science Communicator, and Professor of Neural Science and Psychology

BJ Miller is a longtime hospice and palliative medicine physician. He is the co-founder of Mettle Health, which aims to help patients and their families receive personalized and holistic consultation through navigating the existential issues that come with a serious illness or disability. He has worked in a variety of care settings and his main areas of specialty include working across disciplines to affect broad-based culture change, cultivating a civic model for aging and dying, and furthering the message that suffering, illness, and dying are fundamental and intrinsic aspects of life. Dr. Miller serves as a Medical Advisor for the Partnership for Palliative Care, and is the Honorary Medical Chair to the Dream Foundation, a nonprofit organization that serves terminally ill adults and their families.

In today’s episode, Shay Beider and Dr. Miller discuss the difference between healing versus fixing, and how he found the perseverance to navigate a major accident that resulted in him becoming a triple amputee. BJ also talks about the importance of presence and empathy in life, particularly at the end of life. By allowing things to be as they are, people can live in the moment and experience compassion in the face of suffering. The acceptance of “what is” ultimately allows people to be able to sit with the human experience of pain. In this meaningful conversation, Dr. Miller delves into the importance of embracing the unknown to create connection and fully feel the aesthetic richness of the present moment.

Show Notes:

Introduction (00:02) Welcome to the Conversations on Healing Podcast, where host Shay speaks with renowned healthcare leaders, practitioners, and thought leaders to explore the world of wellness, the incredible powers of self-care and what it truly means to heal today. Join us on this journey to become more whole, healed and connected.

Shay Beider (00:31) Hello, to all of our wonderful listeners. It’s Shay Beider here, and I am so excited and grateful to be able to interview our guest today, Dr. Miller. has been in the public eye, being interviewed by Oprah Winfrey and gaining acclaim for his important Ted Talk on what really matters at the end of life. As a longtime hospice and palliative care physician, has focused his practice to allow his patients to feel whole, seen, and heard through the rawness and authenticity that often accompanies death and dying. After a very serious accident when he was just a sophomore at Princeton University, himself became a triple amputee and found a subtle steeliness inside that really helped him to persevere personally and later allowed him to accompany patients through their healing journey. Today, and I talk about how we each find our way when navigating very hard things, and he also shares his passion for aesthetics and how it can create deeper connectivity in our lives and our relationships. We discuss the importance of finding inner agency and the dynamic balance between fighting and surrendering in life altering situations. So it’s a very rich conversation. I think anyone who finds themselves or a loved one facing serious health challenges will really delight in some of the messages that he offers, which are truly enlightening. So, let’s get the conversation started. So, I’m delighted that you’re able to join us on the Conversations on Healing Podcast and I was sitting like I like to do, kind of in the pocket of where do I want to start with this interview? For whatever reason the word steely kept coming to mind like a steeliness and how that relates to the process of both living and dying, this kind of inner steeliness that can allow us to meet hard things. So I wanted to open our conversation by talking with you a little bit about how you see that relationship between steeliness and getting through difficult challenges in our life.

Miller (03:14): Well, first of all, hi Shay, thank you for having me. It’s funny, as we were having our minute together, I was kind of looking for my steeliness that sort of rudder thing while my brain is flopping all over the place. One thing that I think that steeliness can be cultivated mostly by acknowledging it and feeling into it more than I think you create it. One thing that I got to see coming close to death myself, and watching a lot of other people come close to death and watching that this movement as your body goes from this vital thing to this, where that truce gets broken and the body starts declining and heading for death. I mean that’s the body, but there’s a spirit or other things going on just besides the sort of contours of your body and one thing that’s been really interesting to witness is that steeliness is often just there. It’s almost like a life force, if you let it be. I didn’t know when I was 19 and got injured. I didn’t know myself well enough. I didn’t know what I was feeling but I also remember very clearly that even though I was very close to death, by some measure, I knew on some level inside myself that I was going to be okay, that wasn’t, I didn’t force myself to say that, there was just a feeling in there that I found like subtle, but I found it and paid attention into it. I think it’s that rudder, that steely thing, that life force that is under us all the time, if we can, like I say, feel into it, you have to, it may be subtle, but my sense is it’s there for most of us or all of us or all of the time. Does that comport with your own experience Shay?

Shay (05:22) This is such an interesting conversation because obviously, I can’t know outside of myself, right? Like how others get through hard things, but my anchor personally has always been my spirituality, which was there from infancy. That was something that just came in with my system and for me, that is my rudder. If the whole world is collapsing around me that is the place that my system orients and says it’s okay, no matter what, because from that perspective, this physical dimension that we’re in is temporary anyway. It’s not everlasting it’s inherently transient, which we know inevitably through working with so many people who experience death and that we’re all living and experiencing death and dying every day. So that’s been consistently my rudder because that allows me to have the capacity to see this whatever this life experience is, it’s very temporary.

Miller (06:28) Yeah, that smells right to me. I mean, spirituality that’s a beautiful word for it. I wonder what others might choose and name the same thing, something different, but that force and well, I guess I want to ask you, do you feel that’s particular to you or to one person, or do you believe that sort of underneath everything?

Shay (06:53) My sense again, I don’t in any way want to speak for others cause they have their own experience, but my sense is there’s a raw element of connection inside each one of us that goes back to a deep source that we may know very little about, but that gives us a vitality. It’s like a vitality that helped to birth us into this life and it’s a vitality that sustains us as long as we need to be here. My sense is that core vitality and connection to something so much greater than an individual self is more of a shared experience for all of us, but I don’t want to assume.

Miller (07:40) Yeah. Right. I’m with you and we all get to say for ourselves and feel it for ourselves, but I’m with you. It almost feels like the self or the ego per se, that goes along with this embodied temporary thing that can take up so much space is clue everything else. But for me, what I hear you pointing to for me and my own experience is that thing that’s part of me underneath me, part of me, but is there regardless of what my ego is doing, it’s not pinned to the self in that way. It’s something bigger and that’s why I get to feel part of something bigger. I feel connected that rudder kind of has not a mind of its own, perhaps a mind of its own, but it’s going to, like I say, much of the time, I just need to get out of the way of it. Not gum it up, let it do its thing versus having to recreate it every moment or everyday or build it or something like that.

Shay (08:39) There’s a piece there actually, my daughter and I yesterday were in a car accident and it was somewhat significant. We had to take my daughter to the hospital to make sure she was okay and I think she is going to be okay. Thank goodness, but it was a moment of pause where you recognize the yet again, the preciousness of this lived experience and my inner sense of when I go through hard things, like that is just this core remembrance that again, this is my own choice, but that I want to live my life as much as humanly possible from the depth of that deepest knowing that is actually expansive beyond my egoic self, to the degree that I’m able to hold that as my highest intention, the embodiment of this deepest aspect of kind of core being, and allow that to carry me forward. That obviously is an individual choice, but when I experience hard thing, as I just remind myself that I’m connected to that deep source, that there is a path and a river in life that carries you exactly where it needs to carry you and just be present with whatever is.

Miller (10:09) Yeah, that last part’s really key, at least for me. That part for me, that’s a note of, of minding the comparing and contrasting. If I’m really in the present moment, I watch this with the animals I live with. I live with a dog and two cats. They seem much less burdened by the sense of the past or this worries about the future. I mean here, of course I’m projecting, but that’s the sense of things and that I really admire that’s is very hard for us to do with our human minds. But if we do that, then we’re not pegging ourselves. Our experience in the moment is not pinned to a standard or something we wish was happening versus what is happening. We get to really, once we can let go of those, it should be this, it should that or I want it to be this and versus just whatever the heck it is. If you can go there to me, that’s presence and it doesn’t, you don’t have to command the ship so much. You have to kind of give yourself to it or something like that. It’s not a passive enterprise but it’s also not just dependent on you. It’s not just waiting for you to make the right choice. I watched this happen, play out with patients a lot. Like we get in our own ways all the time, myself included and yet sometimes still our bodies, our minds, our lives find their way to wholeness and healing despite ourselves, some plenty of times, whether it’s numbing out with substances or distractions or whatever else, sometimes I still find my way, even when I’m away, I’m sort of trying not to, or in some destructive mode. Anyway, the point here is I’m with you. I think you and I are speaking of a similar place that I’m so glad to be aware of and I don’t know that I would’ve been aware of if I hadn’t been shaken. David Foster Wallace quotes this in a famous commencement speech he did. And I’m sure it’s not his, but this there’s like, I think he’s referencing a cartoon of two fish. Maybe you’ve seen this two fish in the water and one fish says, to the other, “Hey, how’s the water today?” Or something like that and the other fish goes, “what’s water?” Cause if you’re surrounded by this stuff all the time, you take it for granted. You don’t even know what it is. You don’t know anything but that. Similarly, I think this steeliness, you’re talking about, it’s beautiful to articulate it and I think it’s important, especially if we’re involved in teaching or pointing people to others or involved with healing of others. I think we have to be cognizant of it, but otherwise, it is in a way something you can take for granted again, and it’s there, whether you acknowledge it or not, whether you find the right word or not. I find that extremely reassuring and I don’t find that there’s a lot of promise involved with that. It’s not promising to get me to a better place and I think maybe part of the point is I don’t need it to promise me anything about some future state. I don’t need it to tell me I’m going to go to heaven or I’m going to get this or that reward or whatever it may be that becomes almost immaterial. So anyway, I love that steeliness, it’s a beautiful way to start Shay. That’s a gorgeous thing for me to be aware of on a Friday morning too, I’m looking out my window and it’s all foggy. Anyway, with my little mind spinning around, it’s a beautiful way to start the day.

Shay (13:39) Good. Well, I’m glad that you feel that way. I know one of the areas that we wanted to talk about is about this distinction between healing and fixing. I had shared with you a piece that Rachel Naomi Remen had written about where she really speaks to this point of how healing and fixing are very different. So I want to understand your sense and experience of what differentiates fixing and healing?

Miller (14:10) Well, I think we were starting to get at it in a way, I mean, fixing has this objective, this place that it’s supposed to be, you have a reference point that you’re trying to get to, that you have strayed from, or you’ve been pulled from, or you’re detoured from. That quote that you have pointed me back to with Rachel, I mean if we treat people if we’re trying to fix people, we approach them as broken, essentially. So, there’s some truth to that. I mean, I think we can make the argument that we’re all broken by some measure. There’s something to that too, but in this way if I come as this comes up in medicine all the time, which is really a craft that for the last170 years, in least in the West has really been devoted to fixing. Naming a problem even if it’s a natural phenomenon like illness or death. Call it a problem, go to war with it, try to fix it, cure it, beat it and as someone who’s been saved by that approach. My life was saved after my own electrical burns by this type of medicine, this approach to medicine. So I don’t want to bash it, but it has fallout because there comes a moment where none of us is fixable. We are just trying to live with what this thing called reality or whatever it is, not trying to change it or make it more palatable or more comfortable or less painful or anything that it’s not. So fixing is great when you can fix it. The problem is that becomes our whole goal. Especially in medicine do so, we abandon people when they’re no longer fixable. We say, sorry, there’s nothing more we can do and kind of good luck out there. That’s really rough, and deeply problematic. That abandonment is the thing that gums up the sort of other thing we’re pointing to, which is this healing, this being whole, that’s a place where you’re not abandoned. Abandonment is poaches that enterprise being whole, being seen, being heard, being witnessed is such a gorgeous way to be a healing influence in the world. That requires a lack of judgment. It requires that you’re not trying to make the person something that they’re not, or the moment, something that it’s not so healing to my mind is much larger enterprise is much more vague. It requires an engagement as a physician, I don’t go bestow my healing on people. That’s an internal process as much as an external one. I participate in it as a provider, as a physician, but really as a fellow human being, I participate it in the way that we exchange, we give and receive each other, we see each other cetera. That’s the work for me in palliative care and hospice that’s so much the name of the game. I mean the whole field that I’m devoted to came up, rose up as a discipline because the system had chosen cure as at school, as its objective, and therefore chose to create the world, to treat the world. Like it should be something else. The fall out of that approach is immense and you ask anyone who lives with chronic illness or disability, and you’ll find a kind of a deep suspicion with the medical system. It usually revolves one way or another around this distinction, they were trying to fix me and I’m not fixable. They left and then they dumped me, some version of that story plays out.

Shay (17:40) I was reminded last night of this story, which I think weaves very nicely into here. There was a family I worked with maybe20 years ago in the hospital and a 16 year old girl she’d been in a terrible car accident. Her life was forever changed. She’d had atraumatic brain injury. They had to remove about a quarter of her brain. I came to see her. It was probably within the first two weeks after the injury. So she’d gotten through the surgery, but was an entirely different human from the perspective of her parents and grandparents. I remember this one moment where her grandmother came tome and almost with a sense of pleading, kind of grabbed me and said “when are we going to get her back? When is she going to come back?” I knew from the degree of injury, she wasn’t going to come back as they knew her in the past, it was going to be a new relationship with her. It’s very, I feel like I took such a risk in this moment, but something in me said to speak it anyway, but thankfully it worked out okay. It could have been horrible, but something in me, just when she, because she was pleading with me, almost something in me had an instinct to say, in my view, she never left. That’s the piece, that’s like the steeliness, that’s the, like, what’s the part that never leaves, no matter what happens, whether you have a horrible car accident, whether what’s that part and that’s what I wanted so desperately for her grandmother to recognize that she was still there. She was still there. Things had changed. Things had changed massively in her life and in their lives and they would never be the same, but she was still there. That’s the piece where sometimes like we have this desire to fix or bring things back to what was, but very often life doesn’t allow that life says no, something transformed and you’re going to have to roll with the transformation. That can be so painful and hard and scary. So I wonder how you see those transformations where there’s no reversal of?

Miller (20:19) Well first of all may I ask how did the grandmother receive your brilliant comment?

Shay (20:23) Thank God. I got so lucky BJ. I literally got so lucky because it somehow landed in her and she did something exquisite. She received it and then she turned to her granddaughter, who she had actually in many ways been avoiding, cause she was so afraid that she was not her anymore. She turned her and she started telling her how much she loved her and she started touching her. For the really the first time since the injury just being with her connecting and present. So I was like, I mean, literally a part of me just said thank God, because I didn’t know how that one was going to go, but it went in a positive direction.

Miller (21:13) Thank goodness. That’s beautiful and what a gorgeous moment. You’re right on and I’m with you. This irreducible place, that thing that’s underneath all the things that can change this thing, doesn’t change, I’m so grateful. I wish for everybody in a way I don’t wish hardship on anybody, but of course it comes and with, it comes these opportunities to see what’s underneath all the veneer, the shellac, the accoutrement, the accomplishment, the things, the adornment, that’s all beautiful, fine. It’s lovely. Just call it what it is and don’t pretend that that don’t confuse that applique with the thing or the person underneath it. Until you’ve been forced to kind of shed all that applique I suppose you can choose it, but force has away of doing this. Life has a way of doing this. Say, you thought it was going this way, we’re going, this we’re going that way. Without that great big shakedown, this thing I’ve called the “cosmic spanking”, some big old force. It just tells you it is not what you thought it was but the beauty of that moment as you’re describing is that it puts you in touch with what’s underneath all this you’ll feel like you’re in free fall, you’ll feel like who am I? But then you get to answer that question. You get to see the answer to that question. You are whatever you are still here. I just love that moment. I love getting to that irreducible place, that irreducible thing in any of us, all of us, a living thing that nub that doesn’t change. Yes and I would imagine some version of that my little irreducible thing is probably looks a lot like irreducible thing and lot like any who’s ever lived my sense. I don’t know, but that’s my sense.

Shay (23:15) Yeah, I feel that too, but there’s something shared there because I know you’ve had the capacity to sit with so many people who are in a process of dying and in my own experience with that, I feel like some of the qualities that have really served those relationships well are authenticity and rawness. Just being very real in the present moment with what is whatever that is and I’m interested to hear how you sit and practice or just be with an experience of authenticity and rawness when you’re accompanying people through those moments?

Miller (24:06) Yeah. Well, it’s a really important I’ve come to just appreciate how much life is sort of is improv. I don’t think we give ourselves enough credit for how creative we are, just how even the most boring of us or the most boring parts of us are still pretty creative. We create our daily experiences all the time and we respond to them. We bob and weave with life. It’s remarkable. So I when I goin when I’m going to be with someone, a patient, whether it’s on zoom nowadays or at the bedside, or it’s done to the process, I don’t need a long process, but I kind of quickly check, take a deep breath, check my self, pull my awareness into my belly. Usually something core, something deep kind of ground myself there, take a deep breath and try it as I exhale. I just try to let go of the “shoulds”. I kind of watch what I hope I’m going to find or hope I’m going to see and just put a nice little bow around that and let it be. But otherwise sort of of try to zero out myself. So I’m not walking in there with a bunch of junk from the earlier that day that didn’t belong to this person or my own neurosis, if I’m doing a good job or blah, blah, blah. I can’t beat that stuff out of myself. I just note it, let it do its thing, but I just try touching it thing underneath this irreducible place underneath all that. I say, zero out, go in there about as neutral as I can be in this way. And therefore ready as I can be this whatever I’m finding incredible sorrow, weird joy. I mean, who knows discombobulation, delirium, depths of sorrow that just powerful. Unless you’re ready to move with some, unless you’re prepared to move with them, you’re going to constantly try to make them behave like you wish they were, or you like something that makes more sense to you but this way you got to get you out of the picture a little bit. It’s not about your image here, but even that, as I say that you don’t, you are there too. You have to honor that you have to watch your own wishes and your hopes, and it’s perfectly okay to have them. In fact, there are very powerful forces. I think it’s just a clear eyed nature of walking into these situations with an awareness that you’re not going to talk yourself out of your ego or your neurosis. You just try to keep them in check and what I love when I latch onto that place with someone, even if it’s a non-verbal place, it’s very often aesthetic place, or it comes through the touch, the senses, once I kind of latch in there with somebody, you can feel it. You can almost feel like you dock with someone and then you can move with them. And that’s just so beautiful. And that’s all the therapy most people need is just feeling that connection. You know it, that’s what fuels you and you can see it in them too, but like we’ve been saying a thread for our conversation. You kind of have to get all the gum and gunk off the things that connect and that’s as much as that’s as much as a process as I just try to get the gunk and go in neutral and see where we go and don’t pretend to know the end of the story.

Shay (27:22) You touched on a couple of ideas there that I want to bring into our conversation around creativity and aesthetics. I know that aesthetics is something that is of interest to you and you’d mentioned to be to me previously about neuro-aesthetics and kind of the blossoming of what’s happening there. I was recently, I had the opportunity to go to the Immersive Van Gogh Experience. I don’t know if you’ve heard about this.

Miller (27:49) I haven’t, I’ve heard about it, yes. I heard wonderful things.

Shay (27:53) It’s really unique and interesting experience. You’re essentially in a space. In my case, we are in two different rooms where they’re projecting all these images from Van Gogh’s body of work on these different walls and spaces and then on one another, cause you become part of the projection as well. So you’re literally immersed in his artwork and it’s changing and moving and you can move and change with it and you can move into a different room. So in the midst of that, I was reflecting on the relationship to that and working with people at end of life, because one of the things I’ve seen so often at end of life is there’s this kind of life review process or storytelling that needs to happen where people kind of go through those moments of their life. I had this sense of, gosh, what if we projected like when someone was dying, what if there was like this projection of images and things from their life around them? How interesting and fun would it be to play with some of these dynamic artistic, like creative elements, more fully to support that process of remembering and releasing, like remembering and releasing. Art is so good at getting us out of the sort of humdrum day to day, where we can go into the sense of mundane and refreshing and reawakening. I think that sense of refreshing and reawakening towards the latter stages of life, where we’re trying to sort of work out in some cases, like what was this all for it. It can bring in like a different lens and light. So I’m curious how you see this capacity for the arts and creativity influencing your work?

Miller (29:48) That’s so beautiful Shay, listening to your description there. I love that image if we could almost externalize their internal experience and consume or surround a person with their life in this way what a beautiful thing that would be. In the word, projection’s a good one, we’re doing it, we’re projecting all the time. So we might as well make that a useful, beautiful force. I would say we can say don’t project your things onto other people, but good luck. I mean that’s what we do speaking of projection. So it’s more like, how do we work with that and make it something beautiful or poignant. I mean the aesthetic thing, let’s just define that for your audience, too. Many of you guys will know this, but that word aesthetic has kind of come to mean just pretty like sweet, something easy, easy on the eyes. Aesthetic dentistry is about making your teeth super white or super straight or something, but the word is way bigger than that. The word simply means the felt world, the world of perception, the world of your senses, there is no need for adjectives. In fact, those get in the way of pretty or ugly or whatever else just to feel the thing, whatever the thing is, don’t need to heap on jut words or judgments. So the world of the aesthetic is a powerful thing as long as we have a body. In my mind, my view of the body is its main purpose is to feel things it’s a sack that moves us around the planet. It houses our self and our experience, but it informs them through the sense we’re feeling things all the time. Why am I interested in having a body? Therefore, why am I sad to lose my body someday? It’s because it feels things it’s this sensory sack of sensors. Anyway, for my money, I think we talked about humans as rational beings. We talk about humans as emotional beings, social beings, spiritual beings. I think we also need to put on that very vaunted list, we are aesthetic beings or maybe rather it’s the aesthetic piece is what’s underneath all of the other things. It’s the sort of fabric of connection. So it’s not, you could make it out to be something like style or taste, but those are just refined versions of it. So anyway, the aesthetic domain, I think is one of the things that’s been lacking in our experience, something we haven’t named, or if we’ve named it, we’ve cheapened it something way more important going on there. I get a sense of the importance of it by working with people who are about to lose their body and are about to lose the experience of feeling anything. So, anyway, I gone on about that. I just think it’s huge. And especially as we’re in this digital space we increasingly run the risk of being detached from our physical experiences, our analog experiences. I think in this way, the aesthetic experience is going to become increasingly more and more poignant, more and more profound and more precious in a sense. So, okay, that’s my little plug for aesthetics and there’s, by the way, along philosophical history around the experience of life through our senses too. So there’s much to say about it. Religious ceremony, ritual are aesthetic in their nature. So what to do with it. So one of the things, the other thing about the aesthetic is it doesn’t and an aesthetic experience. John Dewey was a philosopher and psychologist and wrote about this in the 20th century, Art as Experience it was his little book and in this, he names the aesthetic as anything that intensifies the immediate sense of living. That point of anything that intensifies the immediate sense of living that’s getting at is that it’s not the aesthetic has a power and poignance all on its own just to have the feeling is powerful enough. We can take that feeling and rope meaning around it, or put a story to, of what it signifies. That’s interesting too, I mean humans are meaning making animals and it’s a very useful thing to work with. Other people is to find what’s meaningful for them as a, as something of a roadmap to guide their own behavior and where they point themselves. So I’m all for meaning, but I also know that if you’re really paying attention, I think it’s probably a universal experience to doubt meaning or to realize maybe none of this means anything or to at least wonder, or perhaps just doesn’t mean what we think it means, but one way or another, I think here again, we’re talking about our stories of that comprise us that make us, that we hold onto, that we remember are important, no doubt about it and yet there’s more going on than just our stories. I’ve watched people’s stories free them and I’ve also watched people’s stories cage them because the second you’ve committed to taking these feelings and these experiences have driven them into words in an articulation of beginning, a middle and an end, a narrative. Well, then you’re kind of stuck with the narrative. If that narrative ceases to serve you, or doesn’t quite talk, speak to everything in your experience. Well, then you start becoming at odds with yourself or at odds with reality, that story isn’t big enough for you anymore, or isn’t even accurate. So a lot of time I’m helping people rewrite their stories, find new meaning, but part of that process is to get underneath the story in the first place and just get to the feeling before you heap on language, before you heap on an adjective before you put into a narrative. This is a very important point that the experience itself, the means and the end become the same thing. It doesn’t need to mean anything. It exists irrespective of our notions of meaning. Maybe there’s a higher meaning to it that we just don’t get to know, but the point is, there’s a life waiting for us underneath our stories of meaning too. A lot of people say I lost touch with my purpose or loss touch with meaning, and therefore I should die. I meet people who want to hasten their own death all the time, because they’ve lost their sense of purpose. So I think it’s really important when we come across scary or foreign or uncertain things in life that we look for the meaning, but I also think we should develop a capacity to sit with meaninglessness and to not know not get to know what this signifies to just the power of feeling it in the first place. When I was in the burn unit as a patient, I came clear on this even if it was pain on some level, I was glad to feel anything and that was a very powerful place to be. So I’m sorry, here. I am going on again, but I think this idea of the world through the census, but also this idea that anesthetic experience has its own value, its own power. It doesn’t need to serve a purpose. It’s not a means to an end. Therefore, you don’t need time, you don’t need your intellect. It’s enough to just feel something, therefore, to be connected to something and therefore to be part of something, the end period, that’s enough. If you can make that, if that is adequate for you in this world, you’re going to be fine. If that’s enough for you and shouldn’t it be enough, boy, you’re going to be all right, no matter what life goes your way.

Shay (37:35) I want to deepen my understanding about something in my own life, I’m able to have a relatively high degree of capacity to sit with the unknown and to just kind of be in that place of the unknown. It’s for a very specific reason, in my case, which is for whatever reason. I have ideas around it, but I have this deep inner experience of trust of the universe in which we live. Like I trust it so completely. My inner sense, like my just core inner knowing tells me this is loving and intelligent and it’s all going to be okay. Even when it seems like it’s not okay. So I feel like I’ve always had a tremendous advantage almost in those moments of total unknowingness because something in me feels that depth of connection and a kind of inner sense of security or safety, even in just horrible, not knowing, but I wonder because I definitely don’t want to assume that anyone else lives or walks in these moments in the same way, because I know they don’t. I know we each have different understandings and perspectives. So I wonder for you, how do you sit with the unknown?

Miller (39:12) Maybe not so different from how you do. I do sense too, that there is a loving beneficent connection going on there’s that is somehow inherently good. But even as I say that, all our words, my words will feel so inadequate because every time I pick a word I’m excluding other things and the place you’re talking about, I don’t know that for myself, that there is a way to get there with words. But I do sense for myself too, that there is that it is a loving, enormous force that connects everything. I do believe that we are all okay. Even if we don’t get to see how or what it’s going to look like. I see this like end of life, as a phrase in our work end of life care. Well, it’s an important misnomer end of your life, end of my life, end of this life, but not end of life. We humans are really powerful. We can do all sorts of things, but we’re not even when our species is long gone, there’s still going to be life going on. There’s all sorts of life going on. In death, there’s life going on, you see it, you just can’t avoid this stuff. So anyway, so yes, I believe, I think I sense a place of what you like you described too. I get to trust it in part, because I also know the alternative is kind of silly, I can choose to not trust it, I suppose. In this way I can choose to trust it. I can give myself to it wholly, but it’s sort of like, we can’t separate ourselves from this life stuff. If we tried every time we’ve pulled ourselves out of it and feel isolated or feel different then or something else we are, as long as you’re around you can’t avoid life. It’s in you, so yes, I trust it. So I said with the unknown all the frigging time, I mean it’s a friend of mine now. For me it was such a relief to kind of welcome the unknown and welcome mystery because that took the pressure off that I needed to have all the answers that I needed to know everything. As a doctor, sometimes people want you to know everything often they do. I have to just find a general way to tell them, I don’t know, I don’t know everything, I don’t know. This is the sweet moment that happens clinically where I’ll come across something that I don’t know and then you say it kind of gets at our curing versus our fixing versus healing moment. I don’t know either. I’m not sure what happens after, I don’t know, I don’t know, but let’s find out together or let’s see. Or isn’t it fascinating. You turn those moments of uncertainty, which can take you to fear, of course, if you can pull it towards curiosity, just interest, if you can just be interested in it. It’s such a different energy to meet the world with. So I’ve watched that play out in myself. I used to be embarrassed by all that I didn’t know, or I would try to posture or something like this or cover it up but I’ve now I realize this not knowing places where so much of the connection happens because no one knows. I mean, the smartest person who’s listening to our podcast will tell you of course that there’s all sorts of things they don’t know and it’s not, that’s not a laziness. That’s not a lack of trying. That’s an honesty before the universe being larger than we can fathom. Even though it’s in us all the time, it’s right under our noses, it’s in our noses, it’s everywhere. So anyway, so I have just rallied up. I have just saddled up to the unknown. I’ve just made a friend of the unknown and I’m sure that can bite me too, just because I believe there’s beauty that I can’t fathom. I’m sure there’s terror that I can’t fathom either pain I can barely imagine, even though I’ve had tons of this stuff. So I don’t mean this to be a Pollyannish kind of trust. It’s more like I’m okay, even when I’m in horrible agony. I’m okay even when I’m in bliss, I’m okay, no matter what’s going on with those sensors. So anyway, back to your question, the unknown is just an incredibly obvious place to start when you start tuning into it and it’s a very rich place. It’s where our imaginations get to go. It’s where curiosity goes cetera. So I love finding my way to honestly not knowing willful ignorance, willfully not knowing when you actually do is a different problem. We can talk about that too and that happens a lot, perhaps these days in particular. So that’s almost its own kind of sin. That’s a real problem, but honestly, no matter how hard you start, honestly, being aware of the place where you don’t get to know, and therefore you don’t need to know. That’s a very beautiful restful place. I enjoy that and especially working with people, coming up to get the end of their lives, you were walking towards an abyss so you better find your way to being interested in mystery. I’m interested in not knowing if you’re going to do this work.

Shay (44:20) I remember reading about how in certain indigenous cultures, they don’t like to name things on purpose because in the naming, it kind of creates almost this a sense of limitation or defining it in a way that doesn’t allow the fullness of the freshness of seeing that in every like new moment, right? Cause what is that now? What is that now? How do I perceive that now relationally, my experience to this, whatever it is. How is that freshly awakened in each present moment? There’s something around the capacity to hold that inner vividness about every moment in life, every experience in life to the degree that we can, that I feel like invigorates that inner felt sense of life is delicious. It’s like when you hold it with those fresh eyes and you don’t limit what you see and experience, with a sense of I know that I know what that is, but instead you look at it from the other angle of like there’s a sense of awe and wonder and curiosity and maybe I’ve never seen that in quite this way before. I know in my own life I try to really make that a practice, every time I look at the sky, cause I know that every sky I look at will never be repeated. That every single one is a unique sky. It will never be exactly the same and so every time I look at the sky, which is several times, each day I intentionally create that inner process of this will never come again. This is unique and to allow that.

Miller (46:22) Therefore, soak it up.

Shay (46:24) Soak it in. Yes, exactly. That something about that reinvigoration of awe and wonder that enhances, I feel like the preciousness of life. So I wonder what that raises for you?

Miller (46:39) I mean, I think you’re right on and I think it’s so important to really, I think in Buddhist traditions, they call this beginner’s mind in the secular world. They say funny things like don’t assume you’ll make ass out of you and me. These kinds of things are all pointed to similar big, which is just show up. This is a new, this is every moment it’s a novel moment. If you bring your conditions and your stories and your la la la and your words, you’re going to miss so much of the power of the moment of the uniqueness of the moment. So I think it’s one of the way what’s so intoxicating to be around young people and children who aren’t so tempted because every experience is actually novel. They’re not tempted to say, oh, I know this one. I’ve seen, I’ve been around this one before. That’s why I think such intoxicating being around a child’s kind of energy, but we should be able to discover that ourselves. As I get older, I can watch myself get a little scarred down and feel like I’ve seen it all. I talk like I have this is one of the hazards of getting older you got to accumulate all these stories and all these words. I think you also have to learn how to put them on the shelf and let go of them. Sometimes for me, that’s throwing myself into new situations that I’m not forced that I’m not tempted to think I’ve seen it before or whatever, but anyway, finding yourself to those fresh, that fresh point of view, those fresh eyes, so powerful and so beautiful. If we’re really working it, we can, that should be very accessible. Cause as you say, the truth of it is every moment is unique. There’s never been another shade. There’ll never be another shade just like you. I mean, no. I will say also maybe to tangent for a moment, Shay is I think it’s also true. I think one of the human, the great human powers or capacities is that we get to name. I learned this by studying art and art history we get perspective as a thing we can play with, we get to frame things. So I almost think of us like we have like a telescopic lens, we zoom in and out. We can zoom out and see, change the context and see us all as one thing, part of one thing or you can zoom in and see the particulars. Those are true too. So yes, every situation’s unique, every person’s unique and also within some frames, we’re all the same and both need to be true. I think what works for me and other people I work with is if you get that facile relationship to your lens of how you frame things, how you zoom in and out, depending if you want to feel connected to everything or do you want to feel really particular and move, I get to this almost this there’s like a inspiration expert there’s a rhythm, there’s a moving in and out with people in this way. I think that’s really where so much the action is. Does that make sense to you too, Shay?

Shay (49:44) My experience has shown me is that there is that level of just deep interconnection where we are all part of something. I don’t know exactly what that something is but that has that deep oneness inherent in it. Simultaneously maybe my favorite thing about the human experience is that each human is only one. That like my uncle who passed away, who I love so much, he’ll never be recreated again. There was just one him, it’s also the intimacy right of close relationships is you come to know those particularities about a person that only the people who know them so well, so intimately get the privilege of knowing those sweet little nuances and then those are when you love someone deeply those are so they’re treasures, it’s so endearing and to me, I love that part of life. I love that I remember that the way my grandmother held a handkerchief and like that for me bears tremendous, meaning it reflected so much of the essence of who she was, who she uniquely was. Yet then you can just, like you said, you can scale back and suddenly there’s this whole other lens in which we’re like the ocean, all these drops of water that then converge into something large and totally dynamically interconnected.

Miller (51:25) Yes and all of the, everything just led it out. Everything in between is true. It’s like not one state is more true than the other. This is where life is just so dang fascinating if you’re paying attention. I saw a quote somewhere someone said they can gauge someone’s intelligence by how easily bored they are. I think he was saying that super smart people get bored easily. That’s so funny, I’m sitting, gosh, I almost felt like it was a typo cause in my mind it’s like really smart people really made screw smartness, really in touch people or engage people. You never get bored because like we’re talking, there’s just so much happening in a strip mall anyway, whatever, pick your environment. There’s just so much going on in the way we’re talking and how to relate with it. So anyway, yes, this is what you’re describing these two states and everything in between are happening all the time. This is what brings in our agency as human beings. This is why it’s not so passive our experiences. We get to move our lens and we have choice in what we’re choosing to see or pick out of any one picture. I think it has a lot to do with what we’re describing here is this ability to move our lens and to frame things, very particular, very generalizable and everything in between.

Shay (52:40) There’s an idea that you and I had touched on briefly before that I want to kind of bring into our dialogue today, which is this sort of interplay between surrender and fighting when we’re faced with real adversity or illness. I’m interested to hear more about your understanding between that interplay between those two things.

Miller (53:06) Well, here’s a good example of where it’s all of the above. Like we’re saying you move in and out of these states, there is a time for fighting, there is a time for surrendering and every time I hear myself or people asking me whether it’s sort of like as though it’s got to be one or the other, do I just surrender to this life thing ordo I fight my disease? It’s so importantly to have a version, the conversation we’re having, when we find a way without being tedious, to encourage people to own the words, don’t let the words own you and you get to be more than one thing and you are more than one thing. Souse that. So here again, the capacity when I’m working with patients and families, what I’m really trying to do is develop that capacity that they get to do both and they get to be everything. I watch people plays out a lot of times on the emotional plane they’re yo-yoing between being kind of ecstatic and happy to be alive. Then moments later terrified and miserable that they have to die at some point soon. Yo-yo through these states super depressed, incredibly invigorated and inspired and it’s discombobulated and invariably one way and another, my job of people is to reflect with them in a certain way so that they get to feel all of the above. They don’t have to choose, am I happy? Am I sad? Am I fighting? Or am I surrendering? More that you’re doing all of the above and you get to move in and out, as you say, this is where your agency is. That’s how I talk about it one way or another with people and that’s what I’m trying to do with people is in a sense, make everything okay. Give them access to everything that’s going on in them and get shame out of the way that other things that shut them down or tell them that parts of their experience aren’t right or aren’t valid. Trying to get rid of all that stuff and open it all up. So they have access to all of it. I feel like emotional health is being somewhere in the middle where you have access to joy, you have access to sorrow and everything. That’s a different version of strength in some peoples who just need to be positive all the time. That to me is that’s not my way. I’ll just leave it at that. So back to question surrender and fight both. You get to do both and you get to move in and out. This is where your agency is and you’re not one or the other, both and both and both. It becomes this sort of sweet, this shift that happens as you’re fighting an illness. As it becomes clear that that illness is really going to have its way and then you move into surrender. That individualized experience gets down to how they move within those polls for themselves. When they choose their points of surrender, where do they yield? Where do they stubbornly hang on. None of it’s bad. None of it’s good. It all is whatever they got to do. I think that’s my answer to your question. It’s all of the above and helping people own all of the above and be okay with all the above and own that lens, their hand on the lens, zooming out, zooming out, zooming in, zooming out does that register with you?

Shay (56:26) It does. I feel like there’s such a relationship between what you’re describing here, this kind of tension almost between surrendering and fighting and our direct experience of suffering because in my own life, also in the lives of others that I’ve served or supported, I can see those moments of hard cling, hard cling where we hold, we want it so bad and we just don’t want to let go and then in my own experience, and there’s this huge ripple of suffering that can be created from that because sometimes we just have to let go there’s like a necessary component to certain kind of determinants in life. Again, we don’t always get to decide everything. It’s painful. So a lot of what I see around that is you can become skillful at navigating, your own suffering because the more recognition, ultimately, I feel like that we can each individually gain around sometimes it’s okay to let go, and you just let that happen. There are those other moments where you got to fight with everything in the core of your being to just stay on course. So, yeah, I mean, I love that it’s not an easy answer. Like this is not an easy answer. Cause sometimes it’s going to be one and sometimes it’s going to be the other and again, it’s also going to be an interplay of everything in between.

Miller (58:19) I’m not against suffering. I mean I’m not really, as I come, I’ve spent sometime around Buddhism and I was raised Episcopalian and I’m not terrifically interested in enlightenment that’s a funny thing to say. Cause I’m still suffering. There’s something there’s a time for friction and yes, sometimes I am creating my own suffering, no doubt about it, but sometimes I find it pretty useful to really check myself to burn off something, to really kind of feel stubborn for a moment and just sort of demand myself as a certain way, even though I know it’s not going to last very long, I’m not looking for a frictionless experience at life. In other words, I’m not sure what that would look like. That may be exactly a way of signing up for numbness. I’m not sure you get to feel anything in a frictionless experience. Again, I want to feel stuff while I can. So I’m not really, we certainly create our own suffering. There’s no two ways about it. But I still find some of that stuff pretty useful. One of the ways I know I’m alive and then you can make the argument, well then are you really suffering if you’re kind of into it? Well, I don’t know. We could kind of quibble, we could certainly quibble, but this to say that suffering death, I’ve the more I look over my training, of course there’s been moments where I’ve been tempted to inherit this idea that suffering is enemy, but then I’m like we’re talking the more I realize, no that’s a way to kind of limit your experiences in life. If you wanted to avoid suffering, it’s also a way to be sort of, you won’t have much in common with other people. There’s something really, and there’s, it’s also like personalities, like who would we be if we didn’t work without our neurosis? I mean, they’re fascinating it to make us so anyway, I’m much more interested in just loving reality. In my view, reality, my experience reality includes things like friction and suffering.

Shay (01:00:31) It does. It does. I haven’t met anyone who’s living a life with no suffering whatsoever. I don’t find in my own experience, that’s what I’m seeking because probably my greatest growth opportunities have all come through great suffering.

Miller (01:00:48) Yeah, mine too. I think there’s an important thing to say here. I think there’s suffering that is just is that just, it’s an elemental human experience. I mean I make sense of it by realizing that we, as human beings are creative, we have imagination. So we could always picture experience that’s easier or better than the one we have on some level. Therefore, we kind of set ourselves always to be at odds with reality and therefore to suffer a little bit, there’s a creative edge there. I think it’s also important. I don’t want to, I don’t want to conclude that. Oh, suffering’s unavoidable, therefore it’s all right, fine. Even attractive at times, I want to be very careful. I believe everything we just said, and I think there are limits. I think we humans often are just a little too casual in the way we perpetuate suffering or even generate it or create it or project it onto others or cause it, in others that language I’ve inherited sort of necessary versus unnecessary suffering that there’s some suffering, you can’t change. It’s bigger than you. So you better learn your job is to learn something from it, find a way to love it. But there’s also our own sort of culpability and agency in this. If we’re not careful, we’ll just cause suffering. We’ll become the source of pain for ourselves and more importantly, perhaps, or just as importantly, others. That’s really problematic even though you and I both agree that we’ve learned so much from suffering can’t imagine learning without it. It’s not an invitation to this, therefore will caused this stuff and created in others. Absolutely not. So there’s really, there’s a line in there to really pay very close attention to we casually spray pain all over the world and it is so, so incredibly sad and disappointing and disheartening and like we’re saying, so I’m sorry. I’m just going to make one more point in that it’s like, and it’s also true. One of the things that’s been hardest thing for me in my constitution to come to terms with is no matter what I do, I am going to cause suffering in this world. I can try to put bubble wraparound myself and anyone I put come into contact with, but that would isolate us, which is its own form of suffering. I mean, I will cause pain no matter what I do and that is one of the hardest lessons to come to terms with in its life and yet it’s true. So we’re saying many things at once here, including like you’re going to cause pain, you’re going to feel suffering and you’re going to cause it, no matter what you do and be, please be very, very careful and learn how to not accident or casually or gratuitously cause this stuff for yourself and for others. It’s a really important point. Otherwise become sadistic truly. I mean, it can get pretty foul, if you’re not careful.

Shay (01:03:59) You made that point beautifully and I’m glad you spoke to the distinction cause there’s a reception of the inevitable sufferings that you cannot control and how to move with that gracefully. That is quite different from our own capacity to inflict suffering on others. To me, that’s the area where we have to, as you spoke to pay the greatest depth of attention so that we don’t do that to the highest degree possible, like you said, we’re still going to do some of it anyway, but to the highest degree possible.

Miller (01:04:33) Right on.

Shay (01:04:35) Well, as we start to bring our conversation to a close, although I feel like I would love to talk to you more cause this has been so much fun, but as we bring it towards a close I want to talk to you cause I love to ask all our guests about how they understand what healing is. I had touched on this briefly with you before and there were a couple of words that you had presented to me, which were empathy and compassion and so I’d love to deepen my understanding of how you perceive what it means to heal.

Miller (01:05:16) Well, I buy into the basic root of that word of wholeness, of being intact and that is not a bodily thing per se. I found my way to being healed, to feeling whole again, even like being dismembered as an amputee. I don’t mean be whole in some physical sense have all your body parts, but be whole by being intact as a person and aligned and in touch with the world around you and in you. Being right with yourself, right with reality and realizing the two are the same, that’s wholeness, that’s healing. I think something in there. To get there, I think some of the most powerful tools we have to work with ourselves and each other are relatively straightforward. Like bearing witness, seeing each other, hearing each other, seeing ourselves, hearing ourselves excluding nothing, not cherry picking. Well, I like Shay when she’s nice to me or I like Shay when she wears this or that. No, no, I like Shay period. I love Shay period and not picking and choosing that’s to me is where the action is. That’s really powerful. So dropping the judgment, seeing, being with, feeling that witnessing is really key to do that. Well I really think the empathy, the empathic roots is another, probably another aesthetic thing actually is empathy is when we feel each other, this material sensation that I feel your pain, you feel mine or I feel your choice. You feel mine that we are literally connected. I’m not just sympathizing to you, I’m feeling you. That is a amazingly cool thing. This idea that we are individuals automatons, not at all. We are super connected anyway. So empathy is this connected place underneath everything that an empathy can be a real hazard. There’s an occupational hazard in the healing professions, the helping professions, where you’re feeling. If I see 30 patients today, I’m feeling not only my pain and I’m feeling logarithmic, exponential amounts of pain and suffering all day long. So empathy can be in this, no wonder we scar down. So finding a way to feel in the first place and then orient towards a compassion, putting it out, back out in the world in a loving, beautiful way. That’s really, really powerfully important and that’s a key second step there feeling the pain, feeling the sensations great, but that can be overwhelming and that can scar you down. That can make you miserable. I mean, you got to find a wayan alchemy to move that, to feel all that and then respond with, I feel you. I love you. It’s okay. That that’s really, really key. So dropping the judgment, bearing witness, being, present, feeling the feelings and nudging them towards that benevolent beneficent thing called compassion. That’s if there’s a recipe for healing, there’s somewhere in there.

Shay (01:08:32) So glad I asked you that question. I love your answer. Well, it’s been an absolute honor having you on the podcast BJ, and I feel like I learned a tremendous amount through this opportunity to speak with you today. So thank you.

Miller (01:08:50) Thank you Shay, such a pleasure.

Conclusion (01:08:55) We hope you enjoyed this episode of the Conversations on Healing Podcast. If you haven’t yet, please go to Apple podcast, Spotify or your preferred podcast platform and subscribe, rate, and review this podcast. It helps so you won’t miss an episode. See you next time.