A palliative care specialist at UCSF Medical Center and director of the Zen Hospice Project in San Francisco, BJ Miller connects art, spirituality and medicine in end-of-life care, and has a grant from the Fetzer Foundation to integrate spirituality with the health of mind and body in medical education.
In his sophomore year as an undergraduate at Princeton, an accidental encounter with 11,000 volts of electricity nearly killed him and resulted in the loss of his legs below the knee and his left forearm.
Miller says he has no regrets, not even for the injury. “Too much good stuff has come out of it,” he says. “I was not headed toward a career in medicine before the accident, and I don’t think I’d be as good a palliative-care physician if I hadn’t had that experience. Every day I feel I have a head start when I meet patients and their families, because they know I’ve been in that bed. That can take us to a much more trusting place more quickly.” He walks, hikes, and bikes on carbon-fiber prosthetics that look like supple metallic bones.
When he discovered palliative care, he knew he had found his calling. “You’re encouraged to use your suffering as a motivator and teacher. That was the right fit.” “That’s the most potent medicine, just coming from a place of love and kindness. Medicine traditionally thrives on a hierarchy that I’m happily flattening. I equate the doctor and patient because I am a patient. Sometimes there’s nothing fixable and nothing left to do except bear witness and lend a shoulder, even if it’s handing someone a tissue and not running away when things get rough.”
“After my accident, I came to regard death and suffering as normal. They’re part of the package deal that is being a human being.” After graduating from Princeton in 1993, Miller says he wanted to “use these experiences as a disabled person, and as a former patient, because I knew they were very rich things to work from,” leading him to pursue his medical degree from the University of California.
“Palliative care is many disciplines gathering around a patient and their family with the mission of mitigating suffering and helping foster quality of life,” says Miller. “It is much, much larger than the dying moment. Our job is insisting on dying as a human event beyond a medical one.”
Miller says there’s an immense trust and faith implied by entering into people’s lives at the most fraught and precious moments. “We on the provider side are charged with holding peoples’ vulnerabilities,” he says, adding that interconnectedness is implicit in this work. “You’re invited to feel people’s pain and suffering all the time, so it’s a great benefit and a hazard of the job. Feeling yourself in somebody else is profound.”
Many of the staff of the Zen Hospice Project, including Miller, do not identify as Buddhist. He says they define spirituality as “seeing truth in impermanence and responding to that truth by the cultivation of presence, a delight in interdependence, and an embrace of mystery. People don’t have to pretend to be something they’re not; everything that is in anyone is welcome.”
Miller says his understanding of death and dying has deepened through his work. “I have come to appreciate grief as a very sweet, loving process—hard, for sure, but not something to rush through. It’s where your relationship with what you just lost sets up in perpetuity."
“So if you lose someone, if you grieve them well, you might find yourself ten years down the road still having a very active relationship in your heart with that person or thing that you lost. And that’s pretty gorgeous.”
Probably the best introduction to BJ Miller is to watch his TED Talk, "What Really Matters At the End of Life."
Pico Iyer wrote of his experience doing so in 2015:
“Having heard more than 200 talks at three TED conferences in the past two years, I can truly say that none has stayed with me more piercingly and offered more wisdom and clarity and depth, all delivered with rare humanity and calm, than the address I was privileged to hear from BJ Miller. With each passing sentence, I felt I was being ushered into a grounded, lucid, compassionate and possibly life-changing perspective on dying, living and all that sits at the center of our existence. Many TED talks have offered me exhilarating glimpses into possibility and the new—but this one was the perfect note on which to end a rich and idea-filled conference, coming right after His Holiness the Dalai Lama and teaching us unforgettably about reality and all the changeless truths that guide and steady us in a world of change.”