October 27, 2025 âą 63 mins
What if the worst thing that ever happened to you became the very thing that set you free? đ± In this deeply moving episode, Dr. BJ Millerâphysician, amputee, and palliative care visionaryâshares how a near-fatal accident in college transformed his understanding of life, loss, and what it really means to live fully. From his journey through unimaginable pain to founding Mettle Health, BJ reveals how facing mortality can open the door to compassion, creativity, and peace.
If youâve ever feared aging, grief, or change, this conversation will completely shift your perspective.
đ Watch now and discover how to turn lifeâs hardest moments into your greatest teachers.
Timestamps:
00:00 Introduction
00:36 The Accident That Changed Everything
04:17 Processing Grief and Feeling âSeenâ
09:27 Rebuilding Life in His 20s
14:46 From Art History to Medicine
16:24 Discovering Palliative Care
20:27 What Palliative Care Really Means
24:26 Spiritual Dimensions of Caregiving
27:16 What We Get Wrong About Death
29:42 Making All Healthcare Palliative
32:44 Founding Mettle Health
36:56 Advice for Caregivers
41:25 The Power of Grief
43:50 BJâs Midlife Chrysalis
47:49 What People Regret Most Before Death
51:48 Dying as a Creative Act
55:25 Wisdom Bumper Sticker
Learn more about MEA at â https://www.meawisdom.com/
#BJMIller #MidlifeChrysalis #ChipConley #EndOfLifeCare #PalliativeCare #HospiceCare #GriefAndHealing #MidlifeWisdom #CaregivingJourney #FindingMeaning #LifeAndDeath #SpiritualGrowth #EmotionalResilience #MindfulLiving #AuthenticLife
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
We see death in life as opposingforces, that death is this
thing, that this external thing that comes and robs us of life.
That's not accurate. You will die because you are
alive, not just because you had bad luck, you got cancer, bumped
into a bus or something. Your body is programmed to do
so. It is a dialectic.
(00:20):
It's not a duality. And we contain our own
opposition. We contain the up and the down.
It is a package deal and so therefore it's natural,
therefore it's normal. Therefore it's even something to
be celebrated just as life is. We don't look at that as a deep
or or a tragedy. We look at that as sort of life.
(00:42):
That's how it goes. What people really need was
direct care, the safe place to fall apart.
Welcome to the Midlife ChrysalisPodcast with Chip Conley, where
we explore how midlife isn't a crisis, but a chrysalis, a time
of profound transformation that can lead to the most meaningful
chapter of your life. Welcome to the midlife
(01:06):
chrysalis, and today's episode is courageous, inspiring, deep.
It's the kind of conversation wedon't have enough with a human
doctor. BJ Miller, who has a life story
that led to 22 million people watching his Ted Talk.
But it's not about I didn't invite him on because he's, you
(01:31):
know, an Internet sensation. I invited him on because his
journey of living has been informed by his personal
experience of nearly dying and his process of being bedside
with the dying. This is a human who can teach us
a lot about caregiving and grief, even though in his own
(01:52):
way, he expresses some of his challenges with going deep into
grief. And I expressed some of mine as
well. So I, I think you'll find this
to be a, a rich conversation, one that is particularly
valuable for anybody out there who's going through a dark time
(02:12):
or has a family member going through any kind of health issue
or anybody who's a caregiver. I hope you enjoy it.
BJ Miller, thank you for joiningus on The Midlife Chrysalis.
Thanks for having me, Chip. It's really nice to be here.
Thank you. 11,000 volts, 22 million views.
Let's let's explore this as a starting point.
(02:35):
Tell us about your tragic in accident that really quite
obviously changed your life, theeffect of it and the fact that,
you know, if there, if this was the movie Sliding Door with
Gwyneth Paltrow, what would whatwould BJ Miller's life have been
(02:56):
like if that experience had never happened?
I almost shudder to think. I mean, because as a single
event, it's hard to imagine something that's been more
generative. Ultimately, I mean, I want to be
careful. All my comments here about my
injuries, I tend to head towardsthe positive, but I want your
(03:18):
listeners to, I don't want to sort of cheapen it.
And for folks going through similar transitions and tough
moments, you know, lots of pain,lots of trickiness at least came
with this one. But to back to your question,
honestly, my life has been so beautifully ultimately informed
(03:41):
by that experience that it's hard to imagine where I would
have gone, and it's hard to imagine liking my life.
Anymore, tell us what happened. You know, so sophomore year
college, you know, we were, I was 19, sophomore.
There's even a adjective, right?Sophomoric.
I was being sophomoric. Do things, whatever.
(04:03):
Silly things. My friends and I, we had just
gotten back from Thanksgiving break and so we were excited to
see each other had been all of four days or whatever.
So but it was a it was a Monday night.
We were doing school work and stuff, but but a couple of my
friends and I decided to go havea a, a beer and go out on the
town for a moment. It wasn't crazy.
(04:25):
We didn't get silly, too silly. It was relatively campaign for
our behavior and we decided to go ahead to the Wawa market,
which in New Jersey in Northeastis sort of like a, you know,
like a 711. So we were going to get a
sandwich and we're just walking through campus and there there's
a commuter train that runs rightup onto the edge of campus.
(04:50):
Those just parts is sitting there, you know, not not on it
was not operating hours or so wethought.
And so we just decided to climb it much like you'd climb a tree
and it did not feel we weren't train surfing or what it didn't
feel like such a big deal. There's a ladder on the back.
We just jumped up on top and I happened to be the first one up.
(05:11):
And when I stood up, this, this train runs by the power, it runs
overhead so that depending on where your listeners live, you
may be familiar. Like in San Francisco, the buses
work like this. Anyway, when I stood up, I had a
metal watch on and I got close enough to the power source at
the electricity arcs to the watch.
(05:32):
And you know, that was it, a bigexplosion and had some very
extensive burns and rushed off and on, you know, touch and go
for many weeks, ultimately landed ultimately obviously
survived, but lost both legs below the knees and, and my left
arm below the elbow. But anyway, in a, in a nutshell,
(05:54):
that's, that's the event itself.But of course, there are so many
more storylines in there, but that's the the details in some
to some degree. We're going to move on to soon
enough to you having an interestin medicine, having an interest
in death and dying. But what was your what was your
(06:17):
grief like during that time? I mean, you were a very healthy
guy with a full life ahead of you.
You were at Princeton, I believe.
And so in some ways, you were a Golden Boy and all of a sudden
three of your limbs had been severely damaged.
You were you potentially were going to die.
If you can look back, if our painful life lessons are the raw
(06:39):
material for our future wisdom, what wisdom do you take from
that experience? It'd.
Be hard to pick one. Pick a few.
You could pick a few. Well, and I, and by the way, I
agree with the premise there. I do think life's harder moments
are these gateways or portals orpoint us to what end up being
(07:01):
the more beautiful moments too. They are related.
So I, I totally agree with that premise.
Saluted But you know, for me, asyou said, I was in the body of
something of a golden child likeyou say, you know, that's my my
older sister would have agreed with you that, you know, I was
(07:21):
the favorite and everything kindof went an easy.
You know, I went to Princeton, you know, I, you know, I worked
hard and all that stuff, but I, from the outward appearance, you
might say I had something of a silver spoon.
And given all the life's blessings, I freshman year, I
rode crew. I was, you know, almost 65 then.
You know, I had a sort of a physical body that a lot of
(07:42):
people might shoot for. I had a brain that worked pretty
well, you know, on and on and on.
And as it goes for all of us, maybe at least many of us, our
experience of being in the worldis shaped by our physicality and
our circumstance, but doesn't always necessarily feel like our
(08:02):
own. I, I spent a fair amount of my
childhood feeling like I was in somebody else's life, or that
maybe I was born at the wrong time.
I just, I felt I had a very common daily experience of
feeling sort of out of place. I was a very sensitive kid, sort
of aired melancholy. I grew up around disability,
which ended up being a really helpful thing.
(08:24):
My mom had polio and post polio and I was used to being around
disability and that was a huge leg up.
But back to your good question, Chip.
I mean, one of the first memories being in the burn unit
at Saint Barnabas Hospital in New Jersey.
You know, you know, it was, it was a, it was a nightmare in, in
(08:44):
what are probably pretty obviousways, lots of pain, etcetera,
scary. And the same time I was
experiencing so much love from my friends, from my family, from
the staff nurses, the burn techs, all this care and
compassion was coming my way too.
(09:05):
And that felt amazing to be heldand loved in a certain way
complicated, of course, you don't.
You wonder if you deserve it andthings like that.
But that experience of, of, of feeling the compassion of others
finally, which in a way I had longed for.
I had felt like in touch with a lot of the world's pain as a
(09:27):
kid, but didn't get any quote UNquote, credit for it.
You wouldn't look at me and think, oh, that kid struggles.
So I, it was an isolating experience.
My, my pain was isolating in a way, and MIT my, my outward
appearance was misleading in a way.
So now I I remember the feeling or the thought being like oh
(09:47):
now, now I look like I've alwaysfelt or something like that.
Did you articulate it that at that age or, Or is this
something you've observed over time?
Observed over time. I don't know if I would have had
this language. I know I wouldn't have had this
language per SE, but it wouldn'thave been far.
I would have been a little bit more confused by my own thoughts
on this than I am now. But I do remember that thought
(10:11):
very plainly. I remember coming out of the
first surgery, there were multiple surgeries.
Remember the first surgery and they just removed the legs.
And I remember being wheeled outof the OR and seeing my mom.
And again, she had polio. And I just remember the first
thought, the first thing that came to mind was say, oh, mom,
look, now we have even more in common.
(10:31):
You know, it was just sort of like, because I knew already
that bad things happen to good people or, you know, that life
didn't reside in our toes. And so I armed with that as a
young person, I think, I feel, Ifeel like I got to sidestep a
lot of the self loathing that might have come my way
(10:53):
otherwise. And I was relative relatively
quick to see this as a point of potential connection versus
dislocation or something like that.
All kinds of social science thatI know you're familiar with,
which shows that when you compare the, the, the happiness
set point of a lottery winner versus a paraplegic after, you
(11:17):
know, a, a down or an up, depending upon the
circumstances, people sort of end up back at their set point.
How did this happened when you were 19, I think?
And so how did, how did your 20s, what was your 20s like both
in terms of the physical rehabilitation, the, the sense
(11:38):
of your identity as well as yourcareer path?
Because really, what we're goingto spend most of our time on
today is the career path you've chosen, which I don't know if
you would have chosen if this experience hadn't happened.
Yeah. And probably wouldn't have
medicine was not on my radar. It's not like I always wanted to
be a doctor or came from a line of doctors that wasn't really on
(11:59):
my radar. But I'm I'm not sure what was
really. I was very much in the liberal
arts bent. I was just going to learn how to
learn and be interested in life.I had that good fortune to be
able to take that time. So it's not like I was heading
this way and then all of a sudden I had to go that way.
That's the, it's not honestly that kind of a story.
So, but you know, another cue I got very quickly from my mom and
(12:24):
other people would work in the disability rights movement sort
of advocacy work. I knew a couple of things and
like, I, I knew not to take the bait that this all of a sudden I
was special because that's sort of one of the sweet ways that
people end up exempting you fromlife.
You, they, it's a way to kind ofsweetly remove people from life
(12:45):
often, especially around disability that we're in special
as a lot of connotations. I'll, I'll take out, I'll
receive that comment. Oh, you know that I'm special as
long as everyone else agrees that they're special too, you
know, so that's sort of the deal.
That time I knew not to take that bait.
That was just going to lead me down a path of blandness.
(13:05):
I also knew to not take the bait, that this was something to
overcome or put behind me as a story and maybe for for my
friends and outlookers to kind of digest and then move on.
But for me, this was going to bea daily experience.
And so it wasn't about overcoming it.
It became about, OK, here's someraw material to work with in in
(13:29):
my life and to play with. And yes, very challenging stuff,
but that kind of gets back to how my 20s went.
So again, with these sort of topline thoughts, they were the
organizing thoughts. And again, I just want to note
for anyone out there wondering and also looking at their own
experiences, this took months and years to kind of really play
(13:52):
out and figure out there was pounds and pounds of physical
pain and emotional pain and feeling out of sorts and guilty
for surviving and guilty for allthe care I had received from my,
from peers, etcetera. So it's complicated.
But with that caveat, back to your question, you know, as I
kind of came out of that rock bottom in a way, I've come to
(14:17):
love rock bottoms in a way because the view, it's all, I
mean, it's just like, I know you're like, you can't go much
lower. Of course, we always can.
That was more I could lose. But you know, I was pretty far
down. I was on my knees, let's say,
you know, And the view from there, once you kind of, you
know, transition to accepting itor something like that, or just
(14:41):
being real about it, that view, that vantage point, it's not a
place many of us would wish to be and myself included.
But if you find yourself there, you have less to lose.
Yeah. And that I feel it was a very
empowering notion for me. And I was also armed with now
this, this very common appreciation for life that comes
(15:03):
when with grief, when you lose something is when you is very
often right when you really appreciate it.
So yeah, I'd lost plenty, but I still had plenty.
And so I was really primed to appreciate what I had and a
little bit freed up to worry about comparing or contrasting
myself with my peers. So in a way, it freed me to some
(15:27):
degree. And I, I let it.
I cultivated that freedom. So in my 20s, you would have
found me. You know, much of my 20s are
spent in the San Francisco area.You would have found a very free
spirit. I got into like, looking weird.
I got, my hair was all over the place.
I wore strange clothing. I just was like, you know, I
just looked around and I saw allthis everyone trying so hard to
(15:47):
kind of live within this very narrow range of what constituted
normal. And I was given a little chance
to free myself from that. And I took it, you know, so I
just kind of got, I was very open.
Anyone wanted in my life, they're welcome to it.
And I just, and it actually became a little problematic.
I didn't think I went a little too far with some of that but
you would have found a very openfree spirited person.
(16:11):
Maybe a little Moody too as I still working out all the pain.
And you were and you were dating, you know, as a 20,
someone in their 20s would be doing and yeah, and getting
used, getting used to dating andcareer wise, what was going on
during that time? So shortly after I went back to
college and I graduated with a degree in art history.
Then we can talk about that, butour art, that was a great move.
(16:34):
I learned a lot about perspective making and and
treating life as raw material toto work with, even play with.
So, but that was awesome, but itdidn't set me up for work.
So graduation was sort of a Cliff.
I didn't really know what I was going to do.
But given all that we just said,I knew I did.
I wanted to use these experiences.
And so medicine lit up as a way to do that.
(16:54):
You know, I just thought about if I had, if if a doctor walked
into my room looking like me, how how helpful that would have
been without even a word, Sarah,just seeing my person and
knowing that I had been in the bed and it was that kind of
trust and making good on the this outlandish experience that
that medicine seemed to offer me.
So I went back and did the pre meds after college.
(17:17):
So that took a couple years and then into Med school.
And the deal with myself, Chip was simple.
Like, you know, I also knew thatlife was way too precious to be
sacrificing to something that you didn't really care about.
So I've made a deal with myself medicine.
If I, if I either, if it's too hard or I just don't like it,
I'll, I'll get out, but might aswell get on this horse.
And by now failure had ceased tobe the worst case scenario.
(17:40):
Failing was like, ah, OK, fall down.
OK. No, it was.
It was just more about day-to-day experience and
therefore I became much more used to it.
I've got very good at falling. When did you start focusing on
palliative care? Deep into Med school, so often
medical schools at UCSF, I figured I, well, I, you know,
this is not so much of A love ofscience, but a love of humanity.
(18:00):
And, and I was trying to go intomedicine as a way, as an excuse
to, to put myself in front of other people who are trying to
figure themselves out. So I figured, oh, well, I should
do rehab medicine, work with other folks who are freshly
disabled. And that's even the highest,
best use of me. And so all through Med school, I
just assumed that's what I was going to do until deep into
fourth year Med school and I finally did a rotation and
(18:22):
rehabilitation medicine, it's called physical medicine and
rehabilitation is the full name of the specialty.
And I did not like it. I mean, it was very mechanical.
It was, you know, it was, it made me, it honed my interest.
I realized what I was really interested was not so much the
physicality, but the emotional, spiritual, existential questions
(18:44):
like what do people do when theybump up against things they
can't control? That I, it helped me get clear
on that was my issue less about the angle of a joint or
something like that. So I dropped out of the
residency match and was going todrop out of medicine.
I didn't know what else I would do in it.
But my Dean talked me into, I was, you know, 1 semester away
(19:06):
from graduate. I was going to graduate, but
then my Dean talked me into doing a year of residency, the
internship just as a, as a better stopping place.
You can get back into it if it easier if you've done your
internship. So that's what I did, and then
during my internship I stumbled on an elective and palliative
care and fell immediately in love with it.
(19:29):
And was that was there an experience of being at the
bedside of someone who was dyingwhile interning that had an
effect on you? Yes, there are several
experiences. So I was at the Medical College
of Wisconsin for my internship. My parents at that point were
living in Milwaukee, so I thought I had left home at an
early age. And so I went back to be with
them for that year and just do the internship, get it done.
(19:51):
And it just so happens that the Medical College of Wisconsin has
one of the oldest palliative care programs.
A fellow named David Weissman did beautiful work, established
sort of a pioneer in the field. And so he just happened.
He and his crew happened to be there.
And so I I got to work with a very seasoned practitioner and
just watching him at the bedsideand being part of his team.
(20:14):
And how he talked to people and how he handled this event,
whether it was someone dying from heart failure or whatever
it was cancer. It didn't so much matter the
details of what was as what was challenging them or taking their
lives. Soon it was just that they were
bumping into what it means to bemortal and what it means to
(20:35):
lose. And the way he and I came to
realize the field handles that, we don't look at that as a
detour or a tragedy. We look at that as sort of life.
That's how it goes. It changes the affect at the
bedside. You're no longer looking at a
patient to see whether you can fix them.
It's less transactional, more transformational.
(20:56):
Very that's really well put, Chip.
Exactly. It's about accompanying, you
know, that fix it mentality can be powerful when you've got
something that is fixable. But the, the way that healthcare
has devoted itself or the, the directions it's taken in recent
decades kind of leaves you feeling like if you're not
fixable, then you're kind of in the way.
(21:17):
There's not really, there's sortof like, and oftentimes even
worse medicine accidentally makes you feel like that's your
fault. So there's, there's a lot to say
and critique of that approach. But just to say sitting with
someone, being with someone and not trying to change where they
are, rather trying to be with who they are and accompany them
and see them, that was very, very powerful to me, beautiful
(21:40):
to me. So that was a real initial hook.
And so from that point, focusingon palliative care, wait, first
of all, just so those who don't know, how do you define
palliative care? Yeah.
Thanks, Chip. It's a great question, really
poorly understood field. So it grew out of Hospice.
So Hospice is sort of a subset of palliative care.
(22:02):
It's the same training this, this, the field is officially
called Hospice and Palliative medicine since its inception in
2006. It's one of the newest
specialties out there, but it's one of the sort of the oldest
mentalities of of approach to care.
It's it's sort of ancient beforewe were so seduced with curing
people. So it grew out of Hospice in the
(22:22):
80s and 90s. It's a similar kind of approach
to quality of life. And so a basic sort of wrap
around term for palliative care might be something like multiple
or multidisciplinary pursuit of quality of life in the treatment
of suffering. So we treat suffering, not
disease. We treat people, not disease.
(22:42):
So your art history gave you a little bit of a dose of
understanding the human condition in life and in death.
So and what do you do with that?Like, so how do you, how do you
become, what do you do with, I know at, at some point you ended
up at the, I think the San Francisco Zen Center is in
(23:05):
Hospice, But what, what, what was the path that you took as a
doctor in working with the dying?
And, and then, you know, obviously later in your career
or, you know, more recently, thelast 5-10 years, you've become
pretty famous about this. So what, what, what, what
happened along the way? We.
Can talk for a long time. I mean, I think in general I
(23:29):
went the sort of, well, just thesort of the mechanics of it.
So I went back, finished my internal medicine residency,
then did a fellowship in Hospiceand pad of care, the sub
specialty training. And then I came back to San
Francisco and joined the facultyat UCSF and went down the path
of sort of rigorous academic medicine and trying to learn as
(23:52):
much as I could at that time. Much of my training as it goes
in the field, especially for the, the, the medical piece of
the puzzle, a lot of it was about symptom management, you
know, pain management, nausea, etcetera.
So helping people physically feel as well as possible.
And that was fine. I, I, I enjoyed that.
(24:12):
Having spent a lot of time with pain, I know it's no fun.
And so it was it was wonderful to be learning how to help
people hurt less. But all along the way, given the
reasons that you just pointed toin our conversation here, I'd
those were talking about someone's pain or nausea was a
way to gain their trust so that we could get into what it like
(24:35):
the issues of identity, a word you use a bit back a bit ago.
It's great. That's and how they're groping
with the person they thought they were and the person they
are now. That's the meaty stuff I
couldn't wait to get to. And but all those earlier years
was really about learning the the trade and so much of that
about with that was about the prescription pad and the
(24:56):
physiologic. But I think I did well as a as a
young pad of care doctor compared to my peers because I
had AI had been a patient. I knew so much of what I was
guiding people through. And I also had really wrestled
with this questions around identity and grief and loss and
gain and how they come together.Those are more sort of those
(25:18):
were on the side or sort of on the margins of what we learned
in our training. Those became sort of
increasingly front and Center for me.
I'm going to pause there before I go on so long and there's so
much more to say about that. But does that kind of make
sense? Can you picture that Chip?
Yeah, it does. I'm curious if at any point
along the way up, up to you're 54 years old now, have you ever
(25:40):
imagined going to divinity school?
And I say that not that you would necessarily want to go do
that and all the regimen of it, but it feels as if there's a
clerical element to this, this there's a science and an art and
clearly a spirituality. So maybe touch on that a little
bit about just what is it like to be a doctor, being in service
(26:05):
and caregiving to those at the end of their life from a more
spiritual or religious perspective, Has it deepened
your sense of the mystery? Absolutely it has.
So yes, yes, yes. So so as you mentioned, I went
from, I stayed at UCSF all throughout my clinical work, but
then I took a job at Zen Hospiceproject in part because of what
(26:27):
you're pointing to. Yeah, the medical piece is
helpful. And medicine has become sort of
the arbit arbiter of death. It's sort of it's become the
church, it's become the family, it's become many things.
The ER is not just for medical issues.
So anyway, but the sense was just as you're pointing to that
(26:48):
this was sort of a, the, the stuff that's really meaty here
is not the stuff of medical science and much more the stuff
of spirituality, philosophy, aesthetics.
So I, I was looking for ways to augment my understanding.
So working at Zen Hospice was very helpful to work in a place
(27:09):
with the spiritual basis of care.
But again and, and again and again, I just have come back to
my own experience being a patient, being a human being,
someone who cares and wants to be cared for.
That is the best teacher I have.It's my daily teacher.
And that's that's been profound.And to your question, you know,
(27:31):
if I found myself kind of marching down a particular
belief system, I most certainly would pursue training or
clerical work in that, you know,if it were Christianity, if it
were whatever Buddhism, but I never found myself lighting up
with anyone path. So otherwise, I, I think I
(27:53):
really would, to your point, andwhen I was a kid trying very
hard to be a Christian, there was a lot I loved about the
message of love and forgiveness.And at one point I did think
about pursuing the cloth. Anyway, back to my later
experiences. Yes, I felt very much pulled in
the spiritual direction, but notin an organized way, more in a
(28:16):
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What do we get wrong about deathin the United States?
(29:00):
Let me count. Let me count the ways.
Well, there's, yeah, it's a longlist.
I mean, one is, I think all trouble at root.
I think the biggest problem is that we've tried to wrestle
dying away from living that thatwe see death and life as
opposing forces, that death is this thing, that this external
(29:23):
thing that comes and robs us of life.
That's all our language, you know, the sort of succumbing to
illness or you know, this sort of it's all the sort of language
of giving up or giving into thisthing that's going to that robs
us of our life. It's inherently tragic.
That's not accurate. And you just spend the need to
(29:47):
spend a little time with your with yourself, really paying
attention to the world at all tosee how or just better yet walk
in the woods that you know, if we're parts of nature, you just
there is no separating life and death and nature there.
They are one in the same. They are part and parcel.
So I back to your question, I think that is the fundamental
(30:07):
error that we make. And there's all the rest of it
is sort of fallout from that misplaced notion that we can
forestall death, keep it at Bay.I think a really stop here
saying I think a really important note.
Then I find myself thinking about it a lot for myself and
(30:28):
the people I care for, which is you will die because you are
alive, not just because you had bad luck, you got cancer, bumped
into a bus or something. If nothing, if you have a
Christine, if you're in bubble wrap, you will still die.
Your body is programmed to do so.
It is a dialectic. It's not a duality.
And we contain our own opposition.
(30:49):
We contain the up and the down. It is a package deal.
And so therefore it's natural. Therefore it's normal.
Therefore it's even something tobe celebrated just as life is.
So older cultures have gotten this, you know, go to Varanasi
in India, go to, you know, I've been there.
A lot of cultures have been around the planet for a little
(31:10):
bit longer than the US per SE, have gotten this memo.
And you can feel it. You were an advisor to a
President of the United States and you could have one wish
about a public policy or change in the culture regarding
caregiving and or death, and you're welcome to have more than
(31:32):
one wish. What would that be?
Well, let's see here, that's a fun one.
Let's, I mean, excuse me, let's start with healthcare because
it's still too huge to ignore and it has such potential.
I'm alive because of modern medicine.
It's it can be so beautiful, butour systems have really gummed
(31:55):
it up or the man made stuff, theconstructs that the policies,
etcetera. So I would take healthcare down
to its studs and reimagine it asinherently palliative in nature.
It's more like. All healthcare should be pout of
care. By that we mean, do I care about
your quality of life? Do I care how this illness or
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this event is affecting you and your family?
Of course I do, you know, just, it's just putting care in the
sort of groundwork of, of the healthcare.
So all healthcare would be trained in palliative care.
And then on top of that, you'd add these beautiful ways to
forestall illness or treat illness or suffer less, but
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would all be in the name of supporting the human and human
condition as natural beings. So that would be 1.
I think we'd have a very different country if that were
the case within a generation. We probably also, we probably
appreciate midlife more. I think 1 of there are many
reasons why midlife is not appreciated in the US and called
the midlife crisis. But one of the many reasons is
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because it's the doorway to the second-half of your life and the
fact that you're going to die and and people just don't want
to think about that. Right, which is don't want to
think about it. So there's some same way saying
like they don't want to think about their life, they don't
want to think about life. Like, you know, this is where
the problem of separating these these things.
So and then you find yourself atodds with reality and boy,
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there's your grand ticket to suffering right there.
So right, I'm, I'm completely with you, Chip.
That's really well said. So you know, there.
So there's, there's a beat as towhat else we might change.
Well, I would tell to talk to the culture makers in the world
and find ways to get real about aging as well as sort of
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celebrate it, usher in aging in a different way, which I know
means a lot for you, which is your work too.
So that could be up to the culture makers to some degree.
From a policy point of view, we've got to crack the code on,
on how do we, how do we support caregiving in this country that
period. So I think those are my top
(34:03):
three moves that would change the country I think, pretty
quickly. Tell tell us about mental health
spelled METTLE because in many ways you're trying.
You're creating a role model fora company dedicated to
caregiving and in So explain, explain what it is you're you're
(34:24):
now an entrepreneur, my friend. Who knew?
Who knew? I know it's nuts.
I mean, this is the playful thing with identity.
Once you get to note that you'renot your job, you're not any one
thing, it's can be a little devastating, but also frees you
up to kind of play with it. So yeah, I've been a doctor,
I've been a patient, I've been an author, I'm a speaker now I'm
an entrepreneur. What, you know, who knows what
(34:46):
else is going to come? But.
But anyway, yeah, back to your good question.
So Metal. So my business partner, Sonia
Dolan and I, we had been workingtogether for a few years, worked
on a lot of the sort of public engagement, trying to talk to
people, get folks paying attention just like you're doing
here, to the realities of life. We were heading down a different
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path. We were going to start at a
library of resources to help people not fall into the rabbit
holes of Googling their diagnosis and help information
float a little bit differently. But then the pandemic hit and so
Sonia and I decided that what people really needed was direct
care. They needed a safe place phrase
that we've come to love. It's a safe place to fall apart
(35:29):
essentially, with this big existential crisis.
So and that allowed me to devotea, a practice to the things that
that I knew I cared about most. I got to let go the prescription
pad. We pulled metal out of the
medical model. So I'm no longer practicing
medicine technically. And in this practice, we could
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focus highly on the existential,spiritual, social nature of all
this stuff. So it allowed me to put my chip
down on the things that I had knew were my prime loves.
But I was doing these other things, symptom management,
other things, just to to get to that other stuff.
So anyway, we started mental health early in the pandemic
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2020. I hung our shingle and at that
time, telehealth was on the risetoo.
So we could just, we just started Zooming with people one
hour at a time, just talk to anyone, just about anything and
allowed us also to welcome caregivers into the equation.
You didn't have to be a patient.So therefore you can be anything
and talk to us. And so off we went.
And so that's how that's how mental health got started.
(36:35):
And so it is a consulting service or a retainer.
People, people really look to you to provide the combination
of medical, spiritual, psychological help at a later
stage of life. Really any stage of life, cause
a good question is when you start dying.
And it's not about death so much.
(36:56):
It's about as much as it is about transitions.
I know catchment you play with too, you know, It's really the
details of. How old you are?
Or whether you're dying or losing something, it's become
less important. It's just like life ain't what
you thought it was. You're now scared or freaked out
or lost, and you got to go. You need somewhere to turn,
(37:19):
someone to talk to. So it is all those things.
We do help people navigate healthcare.
All our counselors are former clinicians, so we know
healthcare. We can help you navigate
healthcare. We can help you reconfigure your
identity, we can help you fall apart and then help put you back
together again just by being an honest reflective device with
you. So it goes many directions.
(37:40):
And I would say maybe 60% of ourclients are caregivers or family
members. They're not the ones who are
technically dealing with the illness themselves.
So and then a subset of still offolks who are going through an
existential crisis, they're struggling to find meaning in
their life, but there's no tragedies befallen, they're just
kind of languishing. And then another even smaller
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subset are clinicians themselvesare often times calling us
because they're burned out or need help with a patient of
theirs, etcetera. So we see an array of things of
people. What are your prescriptive tips
for caregivers? I mean what what can you word to
wisdom do you have for people who are have been forced into
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the caregiving profession because of family or friends as
opposed to doing people who are doing it as profession?
Yeah, and I think the advice actually ends up being much the
same for depending no matter what landed you in a caregiving
role, personal professional, whether you sought it or it
befell you or its duty driving you or obligation or you're just
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stuck. I think, you know, I think a, a
root notion, much like, you know, reacquainting living and
dying, I think we're trying to reacquaint sort of self and
other and the healthcare as I was trained and the world I grew
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up in caring for my mom, etcetera.
The messaging sort of suggested that you want to be a good
caregiver, then you need to minimize your own needs.
You know, you need to shrink yourself so you can grow for
another over here. And that's sort of the math that
is and that it is a selfless act, this kind of stuff.
(39:32):
I mean, you know, you see everyone gets to see it how that
how whatever feels right. But I think that way I got to
see it and it's sort of to a sort of logical tragic
conclusion in healthcare where you where everyone's burning
out. I mean, you're just you don't
sleep, you don't eat, you're notsupposed to have any hot, you
know, you become a machine of output, of care as an output.
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And that is really importantly wrong.
This gets that sort of self-carefor caregiving.
But even this, the phrase self-care is problematic.
It implies that you know, you know that self and other are
somehow so different that you have to note that it's important
to take care of yourself in order to care for another.
(40:19):
It is that sort of a conceit. Because of this sort of one way
notion of caregiving, we suffer in this way.
What I saw play out in among some individuals who got there,
how however they did, and what Isaw play out in more into the
sort of Buddhism tenets of care was that care was much better
(40:42):
conceived of as a loop. This circle of care that me,
let's just say you're my patientchipped.
Well, OK, I will. Sure I will care for you.
I will care, but I'm really caring with you.
I'm jumping in. I'm sitting next to you, not
above you, human to human and worked, trying to see how we can
kind of make something a little less hard together.
(41:03):
And so I'm partnering with you. I'm not caring at you and in so
doing, I get to be accompanied too in my humanity.
I get to be receive your attention.
And this sort of care care caregiving when it's going well
is really as much care receivingas it is giving.
It's a it's really a loop of reciprocity.
That's when it works really well.
(41:25):
Now, as I say that, I just real quick, I know I'm saying a lot
of words here, Chip, but I mean to say, I know that might sound
to any caregivers out there listening to it might sound,
well, that sounds great. But you know what, I've got 8
zillion to do things to get mom to the appointment or whatever
it is. And yeah, how the hell am I
going to take care of myself andall this mix and, and I get it.
This is, it's sometimes feels impossible, but it much of the
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impossibility is, is really because of the world we've
created around caregiving. We don't support it.
You are not encouraged to take care of yourself.
You're supposed to somehow find this time and not sacrifice
work, not sacrifice your own family's needs, etcetera.
It's it's an impossible set up. Caring is not impossible.
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Caregiving in modern life has started to feel impossible.
But that is an invented thing. That's a made-up situation.
I guess it is a we've always, we've had caregiving since the
start of time. So what advice and wisdom do you
have around grief? Oh, just just that I, I've
become such a fan of it. I, I've just been really.
(42:33):
And I, it took me a while, you know, I didn't really let myself
grieve in a, in a, in a thoughtful way when I lost my
limbs, I lost my sister some years later and didn't really
let myself grieve there, not consciously.
I kind of bought into grief was the kind of a, you know, that
(42:54):
was a root to sort of sad sack and, you know, and something
weak or something not good, not valuable.
I, I have to admit that it was deep into my 30s before I really
started letting myself see otherwise.
And it was my patients who were teaching me this, you know, even
though I'd had a good reason to grieve, I just really hadn't
(43:15):
taken it up. I hadn't and I was suffering
because of it. I was at odds with parts of my
experience, like, you know, my sister died.
I could I because I was unwilling to consciously grieve
or lean into my grief. I walled her off, I couldn't
even summon my memory of her so I just kept losing more and so I
find. This actually, BJ, did you do
the same for your own injuries? I mean, did you, did you ever
(43:38):
have a chance to grieve back then or has it been something
that you have ever been able to,to truly no.
No, no, I've revisited it. I have.
You know, grief is mysterious and that odd and just makes me,
makes, makes a person feel weird.
(44:00):
It's a, it's a, it's a wild force.
And I think that's a really goodFrench word, a wild force.
It is nature. It is a natural force.
But I, no, I did not give myselfa period of mourning back then.
I, I kind of held myself hostage.
I kept kind of leveraging that pain and trying to kind of ram
myself back into the world. And to some degree I got, I did.
(44:23):
It worked OK, but I just kept forestalling this grief that I
finally started come to terms with later in my 30s and 40s and
still do now. I'm often impressed at how much
more grieving I have to do just to catch up with the life I've
LED so far. So the title of this this
podcast is the midlife chrysalis, suggesting there's a
(44:46):
Caterpillar, a cocoon, it could be dark and gooey, a transition
point. And then, you know, if we're
lucky, a butterfly. Have you gone through a midlife
chrysalis in the last five or ten years in the core of your
midlife? What has it been and what are
you learning from it? And has has there been some
grief along the way? Very much.
(45:06):
So. You're putting your finger.
I mean, it is, yes, yes. And it's not many of my big
losses, the dramatic ones or or earlier, you know, my sister's
death, my limbs, etcetera. And more recently, the losses
are, you know, loss of a friendship, you know, 12 years
ago, the loss of a marriage, theloss of a sense of myself, the
(45:31):
loss of feeling competent sometimes, you know, the loss of
a feeling like I lived in a country that was coherent, you
know, all sorts of all sorts of losses.
And, you know, loss is funny loss.
We don't, I don't think, I don'tthink it pays to weigh your loss
or compare your loss. Like like I had some very
(45:53):
dramatic losses at a young age, but they're not more impressive
or more important than, I don't know, losing a friendship, you
know, it doesn't pay to compare them.
Loss in some level, at some fundamental, I think is it
losses, losses, loss. So it took deep into my really
in my 40s and more recently thatI'm really letting myself access
(46:18):
that heartless hard feelings. I went right to the I knew I
needed to accept my limb loss. I just kind of beeline to
acceptance. I didn't let myself miss
anything. And so I was cutting my so I
kept doing that. And by the time I got to be 40s
and 50I realized I could no longer cry, which was a real
tell. I couldn't I couldn't even
(46:40):
summoned, I couldn't get to tears.
That was a big tell. I felt often kind of numbed out
and just sort of bland. I was not able to access the
peaks of joy and things like that as I had once experienced.
And I couldn't access access sort of depths of sorrow.
And that was a really important time I started to get, I started
to feel like I was really missing out on something in my
(47:01):
own experience. And it was through working with
patients and watching people andaccept and roll with their grief
that I realized that's what I had.
I had been missing the grieving process.
Letting myself feel those hard feelings was exactly the missing
ingredient. And so in recent years, it's
been much about putting, like letting myself feel any hard
(47:24):
feeling whenever it comes, almost loving it.
Actually, definitely loving it and letting myself feel it.
I now I can almost cry in movies.
I can almost cry when I lost my dog last year.
You know, there's I get real close.
I'm much I'm much closer to tears than I was five years ago.
So you and I are so similar. Tears are hard for me and I have
(47:48):
found that when I watch a movie on an airplane, that's so I, I
lose it. And yeah, some, some movies when
the underdog wins the sports event that that does it.
But I, you know, I, it, it is, it is a very, IE there's a, a
little bit of a fear, like if I really go there, will I ever
(48:10):
stop crying? I was just going to say that
Chip and I, I'm pretty sure thatthe answer is yes, we'll stop
crying. I've watched some people do it,
but I I harbor some old piece ofme harbors that same stealing
that I I can't I can't look at that stuff, then I'll only be
that stuff and off I'll then I'mgone.
It's. I don't think that's true, but
(48:32):
I've. I think a lot of a lot of men
have this issue. Yep.
So. Probably true.
Bronny Ware famously wrote a book about the five regrets of
the dying. She talked about the courage to
live in. These are the five regrets.
So there's a regret that they didn't live the courage to live
the authentic life, and they were living up to other people's
expectations. They have a regret that they
(48:52):
worked too hard. They have a regret that they
didn't really get to express their feelings, a regret that
they didn't stay in touch with some friends and a regret that
they didn't let themselves be happier.
How do you feel about those fiveand from your perspective, from
your observation of seeing people at the end of their life?
(49:15):
Frank Osaski, you know who you know well who started that
thing? I think he started the Zen
Hospice. He he, he once said to me when I
was going through, I'd had a flat line experience and he was
having some serious health challenges.
He said one of the things that people are wondering at the end
of their life is, was I well loved and did I love well?
(49:38):
What do you see at the end of a person's life in terms of how
they're doing the life accounting of of how it all
shaped up? You know, those five that you
that you listed and Frank's comment to you all light up for
me is accurate. And you know, so I have I don't,
(49:59):
I have nothing to say that wouldconflict there, but I I just
share with you that my own the way I think about it or feel
about it, it's a little bit moredistilled around honesty.
Like it's like I I would this isand maybe if we talk again in a
(50:19):
couple years, I may be off this where this may be my own
developmental arc. That's that.
I'm so I'm seeing everything through this lens, but I would
have sworn I was an honest person anytime you and I would
have talked anytime of the long across my life, you know, not in
some like I'm so cool way. I just pretty honest.
I, you know, when I'd lie, I'd feel terrible about it and I'd
usually fess up whatever. So, and as as I've gotten deeper
(50:45):
into life and like this note about force, trying to forestall
grief and the hard stuff, tryingto engineer sort of more good,
less bad, all that has gone intothat effort, that quixotic
effort has, has meant me kind ofengineering my, I squint at just
the right moment and open my eyes wide to just to kind of
(51:08):
curate my what's coming into my experience.
And it's just exhausting and futile.
And it just kept me at Bay from a lot too much of life.
So back to what I'm saying here is like what I see play out at
the deathbed for a lot of peoplereally comes down to their
capacity to be really honest with themselves.
Like really honest with themselves.
(51:30):
Not just to not tell a lie, but a deep set honesty about our
fears, but how we feel about anything.
That's even if assuming we can even access the feelings to be
honest about it. But I think most of us in this
country, in this life, in this hemisphere, perhaps these days
have only done so much engineering around trying to
(51:53):
look a certain way, feel a certain way at the expense of
the rest of life that I think I have to believe a lot of us are
in some a boat like this. And I do see that play out with
clients that I've worked with isand they really get real, really
all the way real with themselvesin the world.
And I don't see that often that people do.
(52:14):
I think there's a fair amount ofwork left for most of us at the
end. So there's a a movie that's
recently come out called The Last Ecstatic Days.
I don't know if you've seen it. It's about a guy.
Yeah. It's a guy in his late 30s who
has brain cancer. Real Glastoma.
Is that what it's called? A.
Glioblastoma, blastoma, very severe form of brain cancer,
(52:37):
very accelerated. And they film his, his final
days, his final weeks. And, you know, it's like dying
as a creative act. I think that's maybe a term that
you've used before even. Will you tell us a little bit
about what that means? Dying as a creative act, by the
way, for those who are, for those who are looking to come to
(53:00):
an MEA workshop, that that film will be one of the 58 films in
our MEA Film Fest in December inSanta Fe.
Beautiful Well, dying is a creative act, just like living
is a creative act. Again, living and dying much the
same thing. And I do think of, and that was
another nod to studying art and art history as a way, as a, as a
(53:21):
lens to see human endeavoring. You know, I, I, what I mean by
that dying as a creative act is we get to play with the material
of our life if we so choose. We get to play with our identity
and not get stuck or to fixed. Everything is in motion, even
stone is in motion to just different times.
(53:42):
So given that we're given that everything's in motion, it's it,
it really starts becoming about becoming, we are just, we're
never fixed. So we're always in motion.
So what are we? Well, we are becoming, I'm
moving from this to that, you know, this sort of the truth or
the math of, of time and space coordination, you know, so, so
(54:04):
if I'm always becoming well, then I get some, some, I get
some agency at how I steer and which thoughts I pick up and
which feelings I roll with. And that is a is a creative
process of, of working with the material of your life, including
your dying. It's unfortunate we kind of hold
(54:24):
dying as this, like your life was before the dying process.
And then you're sort of just in the way and kind of you kind of
let's usher you out of here. You know, the with this, that's
unfortunately a lot of sort of the overlay of how we think of
of value in human life. If you matter because you exist,
not because you accomplished this or that thing, but if you
matter because you exist, which I believe is true, then and
(54:49):
that's how I choose to see being.
And if then and if life was given to us.
But I think one of the kindest ways to honor that gift is to be
affected by the rest of life, The breakdown barriers between
myself and others, to see these connections, to see how we
(55:09):
affect each other, to be affected.
I really think it was the most loving things I think we can do
is to be affected by each other.And it's, well, that too kind of
flies in the face with a lot of notions, especially of manhood.
So anyway, back to your question.
I think these are all the sort of the material bits of this
overlay of seeing dying, just like the rest of living as a
(55:30):
creative act. It's yours to play with, to work
with. And if you so choose, that's a
really good way to take yourselfout to your final breath and
really be alive until you're actually dead.
So BJ, one of the questions we end with is you've learnt,
you've built some wisdom along the way.
(55:50):
MEA is a midlife wisdom school and in 2026, you're going to be
actually leading a workshop on caregiving and grief.
And a lot of what we've talked about today, and we're very
honored to have you join us in Santa Fe.
If you were to distill down the wisdom that you've learned onto
(56:11):
a bumper sticker that really hasyour wisdom fingerprints on it,
what would be that bumper sticker and what might be the
origin story? We probably maybe already talked
about the origin story so you don't have to repeat something.
But at 54 years old, which is the average age of the person
(56:34):
who comes to MEA, what would be your wisdom bumper sticker?
You. Know there's a wow, there's a
few that notions that come to myroom.
Can I share a couple? Yeah, perfectly fine. 1 is a
answer I gave to a similar question once was don't believe
everything you think. And I've seen that bumper
(56:56):
sticker and so that's a bumper sticker that exists in the world
and that one works pretty well. Don't believe everything you
think. In other words, don't confuse
yourself with your thoughts or any other one component of who
you are. I think that's a pretty damn
good one. That's pretty rich.
That is a lot. A lot can flow from that Related
is is a phrase that I've liked. I can't remember the prompt that
(57:16):
you got me to this one, but we are the, the, the phrase is we
are freer than we think. And that sort of kind of again,
points to mind and the thinking mind as, as, as the cage much
more than anything else. And that's all sort of gets to
the, the, I think especially in this country, we talk a lot
(57:38):
about loving our freedom, but there's a lot of responsibility
that goes with that freedom. And so, you know, I there's many
reasons we don't choose freedom.So anyway, we are freer than we
think. I think you can chew on that for
a couple lifetimes. One more kind of comes to mind
is if in terms of a prescriptionfor me, that's that's really
(57:59):
been personal and one I like to I would like to see increasingly
part of how I organize my the rest of my life, which is
basically follow beauty. I think beauty is just under.
Yeah, it's just so awesome. And how do we define dude?
I don't mean pretty, I mean something true.
You mean? Awe.
You mean Dacher Keltner? You mean like the idea that in
(58:22):
awe is joy, in awe is wisdom, inawe is life?
Yes, and and awe is right sizingourselves too.
Like I am this teeny little thing, but I'm part of this huge
thing. I'm not separated separable from
it. It's not about me and it's not
not about me. There's a little paradox for you
in between those two is somehow the truth.
(58:43):
But I see beauty as like the truth Incarnate.
That's sort of a philosophical definition.
So that's that's that's what I want.
You are still an art history major, my friend.
You still taking it all the way back to the start of this
conversation. It comes back, it comes back to
beauty. So thank you very much.
We you're a role model in so many ways and thank you.
(59:06):
I just, I just wanted to say you're an inspiration and your
humility, including how you conducted this, this interview
just is, is a treasure. So you are you are a you are a
moral beauty. Thank you, Chip.
Those are words I will aspire toand I really appreciate being
with you buddy. It's such a joy talking to you
(59:28):
about this stuff and I can't wait to see you in Santa Fe next
spring or summer, whenever we. Do it.
Yeah, exactly. Oh, that was probably one of my
favorite episodes. I, after we record, finished the
recording, I said to BJ and he agreed we could have talked for
three hours. What an interesting cap.
(59:48):
I hope many of you will sign up for his weekend workshop in
Santa Fe next year. Gosh.
It's to distill it down to just three key bullet points is hard.
I would just maybe start with the idea that.
He has a comfort with failure. When you have come face to face
with death and when you've lost 3 limbs, your ability to pick
(01:00:15):
yourself up and realize that failure is you can have small
failures and big failures throughout your life and you're
still alive is huge. You have less to lose, as he
says, and you appreciate every single day of life.
I'd say that's one of the key lessons.
A second lesson would be this idea of the circle of care, the
(01:00:35):
reciprocity of this loop, that if you're a caregiver, you're
not caring for someone else, you're caring with someone else.
Now that is so hard to hear whenyou're in the midst of a lack of
sleep, when you're having a hardtime holding down your job
because you're taking care of someone else.
When society is not very good and the government is not very
(01:00:58):
good of taking care of the caregivers.
But figuring out that reciprocity, figuring out the
reciprocity not just with you and the individual you're caring
for, but the community, if therecan be a community that helps
support you in that process. And then I think thirdly, I
(01:01:18):
just, I awaken to the fact that this is a guy who's still in his
life has not maybe fully opened the door to all the grief of
what happened to an age 19. And many of us have that
experience, whether it's something from childhood, you
know, a violation of something as a kid, a painful life lesson
(01:01:45):
that hasn't been fully healed. You know, BJ has been a wounded
healer, healing other people andbeing at the bedside when
there's lots of tears and lots of grief.
But like me as somebody where I've shared tears with others,
it's usually their tears and my,my, my consoling.
(01:02:06):
There are times I do cry, but it, it, I still have a message
in my head that says big boys don't cry.
So that is a, that for both BJ and for me.
I think that is one of our one of the things that we want to
actually get better at as we getolder.
Hopefully we are getting better at being human our whole lives
(01:02:28):
and being able to like really surrender to grief and to the
the effect grief can have on ourbodies and our emotions and the
healing process that can come from that.
I think that's the third lesson I had from from, from BJ.
So I hope you enjoyed this. Share this with with a friend.
(01:02:49):
This is a particularly good episode to share with someone
that, you know, who's going through some caregiving
challenges or is in their own midlife chrysalis.
Maybe they're, they're going through their own, you know,
illness, you know, cancer or thelike.
Hope you enjoyed it and that it was instructive and inspiring.
(01:03:13):
See you next week. Thanks for listening to The
Midlife Chrysalis. This show is produced by Midlife
Media. If you enjoyed this episode,
help us spread the word by subscribing and leaving a review
on your favorite platform.
We see death in life as opposingforces, that death is this
thing, that this external thing that comes and robs us of life.
That's not accurate. You will die because you are
alive, not just because you had bad luck, you got cancer, bumped
into a bus or something. Your body is programmed to do
so. It is a dialectic.
(00:20):
It's not a duality. And we contain our own
opposition. We contain the up and the down.
It is a package deal and so therefore it's natural,
therefore it's normal. Therefore it's even something to
be celebrated just as life is. We don't look at that as a deep
or or a tragedy. We look at that as sort of life.
(00:42):
That's how it goes. What people really need was
direct care, the safe place to fall apart.
Welcome to the Midlife ChrysalisPodcast with Chip Conley, where
we explore how midlife isn't a crisis, but a chrysalis, a time
of profound transformation that can lead to the most meaningful
chapter of your life. Welcome to the midlife
(01:06):
chrysalis, and today's episode is courageous, inspiring, deep.
It's the kind of conversation wedon't have enough with a human
doctor. BJ Miller, who has a life story
that led to 22 million people watching his Ted Talk.
But it's not about I didn't invite him on because he's, you
(01:31):
know, an Internet sensation. I invited him on because his
journey of living has been informed by his personal
experience of nearly dying and his process of being bedside
with the dying. This is a human who can teach us
a lot about caregiving and grief, even though in his own
(01:52):
way, he expresses some of his challenges with going deep into
grief. And I expressed some of mine as
well. So I, I think you'll find this
to be a, a rich conversation, one that is particularly
valuable for anybody out there who's going through a dark time
(02:12):
or has a family member going through any kind of health issue
or anybody who's a caregiver. I hope you enjoy it.
BJ Miller, thank you for joiningus on The Midlife Chrysalis.
Thanks for having me, Chip. It's really nice to be here.
Thank you. 11,000 volts, 22 million views.
Let's let's explore this as a starting point.
(02:35):
Tell us about your tragic in accident that really quite
obviously changed your life, theeffect of it and the fact that,
you know, if there, if this was the movie Sliding Door with
Gwyneth Paltrow, what would whatwould BJ Miller's life have been
(02:56):
like if that experience had never happened?
I almost shudder to think. I mean, because as a single
event, it's hard to imagine something that's been more
generative. Ultimately, I mean, I want to be
careful. All my comments here about my
injuries, I tend to head towardsthe positive, but I want your
(03:18):
listeners to, I don't want to sort of cheapen it.
And for folks going through similar transitions and tough
moments, you know, lots of pain,lots of trickiness at least came
with this one. But to back to your question,
honestly, my life has been so beautifully ultimately informed
(03:41):
by that experience that it's hard to imagine where I would
have gone, and it's hard to imagine liking my life.
Anymore, tell us what happened. You know, so sophomore year
college, you know, we were, I was 19, sophomore.
There's even a adjective, right?Sophomoric.
I was being sophomoric. Do things, whatever.
(04:03):
Silly things. My friends and I, we had just
gotten back from Thanksgiving break and so we were excited to
see each other had been all of four days or whatever.
So but it was a it was a Monday night.
We were doing school work and stuff, but but a couple of my
friends and I decided to go havea a, a beer and go out on the
town for a moment. It wasn't crazy.
(04:25):
We didn't get silly, too silly. It was relatively campaign for
our behavior and we decided to go ahead to the Wawa market,
which in New Jersey in Northeastis sort of like a, you know,
like a 711. So we were going to get a
sandwich and we're just walking through campus and there there's
a commuter train that runs rightup onto the edge of campus.
(04:50):
Those just parts is sitting there, you know, not not on it
was not operating hours or so wethought.
And so we just decided to climb it much like you'd climb a tree
and it did not feel we weren't train surfing or what it didn't
feel like such a big deal. There's a ladder on the back.
We just jumped up on top and I happened to be the first one up.
(05:11):
And when I stood up, this, this train runs by the power, it runs
overhead so that depending on where your listeners live, you
may be familiar. Like in San Francisco, the buses
work like this. Anyway, when I stood up, I had a
metal watch on and I got close enough to the power source at
the electricity arcs to the watch.
(05:32):
And you know, that was it, a bigexplosion and had some very
extensive burns and rushed off and on, you know, touch and go
for many weeks, ultimately landed ultimately obviously
survived, but lost both legs below the knees and, and my left
arm below the elbow. But anyway, in a, in a nutshell,
(05:54):
that's, that's the event itself.But of course, there are so many
more storylines in there, but that's the the details in some
to some degree. We're going to move on to soon
enough to you having an interestin medicine, having an interest
in death and dying. But what was your what was your
(06:17):
grief like during that time? I mean, you were a very healthy
guy with a full life ahead of you.
You were at Princeton, I believe.
And so in some ways, you were a Golden Boy and all of a sudden
three of your limbs had been severely damaged.
You were you potentially were going to die.
If you can look back, if our painful life lessons are the raw
(06:39):
material for our future wisdom, what wisdom do you take from
that experience? It'd.
Be hard to pick one. Pick a few.
You could pick a few. Well, and I, and by the way, I
agree with the premise there. I do think life's harder moments
are these gateways or portals orpoint us to what end up being
(07:01):
the more beautiful moments too. They are related.
So I, I totally agree with that premise.
Saluted But you know, for me, asyou said, I was in the body of
something of a golden child likeyou say, you know, that's my my
older sister would have agreed with you that, you know, I was
(07:21):
the favorite and everything kindof went an easy.
You know, I went to Princeton, you know, I, you know, I worked
hard and all that stuff, but I, from the outward appearance, you
might say I had something of a silver spoon.
And given all the life's blessings, I freshman year, I
rode crew. I was, you know, almost 65 then.
You know, I had a sort of a physical body that a lot of
(07:42):
people might shoot for. I had a brain that worked pretty
well, you know, on and on and on.
And as it goes for all of us, maybe at least many of us, our
experience of being in the worldis shaped by our physicality and
our circumstance, but doesn't always necessarily feel like our
(08:02):
own. I, I spent a fair amount of my
childhood feeling like I was in somebody else's life, or that
maybe I was born at the wrong time.
I just, I felt I had a very common daily experience of
feeling sort of out of place. I was a very sensitive kid, sort
of aired melancholy. I grew up around disability,
which ended up being a really helpful thing.
(08:24):
My mom had polio and post polio and I was used to being around
disability and that was a huge leg up.
But back to your good question, Chip.
I mean, one of the first memories being in the burn unit
at Saint Barnabas Hospital in New Jersey.
You know, you know, it was, it was a, it was a nightmare in, in
(08:44):
what are probably pretty obviousways, lots of pain, etcetera,
scary. And the same time I was
experiencing so much love from my friends, from my family, from
the staff nurses, the burn techs, all this care and
compassion was coming my way too.
(09:05):
And that felt amazing to be heldand loved in a certain way
complicated, of course, you don't.
You wonder if you deserve it andthings like that.
But that experience of, of, of feeling the compassion of others
finally, which in a way I had longed for.
I had felt like in touch with a lot of the world's pain as a
(09:27):
kid, but didn't get any quote UNquote, credit for it.
You wouldn't look at me and think, oh, that kid struggles.
So I, it was an isolating experience.
My, my pain was isolating in a way, and MIT my, my outward
appearance was misleading in a way.
So now I I remember the feeling or the thought being like oh
(09:47):
now, now I look like I've alwaysfelt or something like that.
Did you articulate it that at that age or, Or is this
something you've observed over time?
Observed over time. I don't know if I would have had
this language. I know I wouldn't have had this
language per SE, but it wouldn'thave been far.
I would have been a little bit more confused by my own thoughts
on this than I am now. But I do remember that thought
(10:11):
very plainly. I remember coming out of the
first surgery, there were multiple surgeries.
Remember the first surgery and they just removed the legs.
And I remember being wheeled outof the OR and seeing my mom.
And again, she had polio. And I just remember the first
thought, the first thing that came to mind was say, oh, mom,
look, now we have even more in common.
(10:31):
You know, it was just sort of like, because I knew already
that bad things happen to good people or, you know, that life
didn't reside in our toes. And so I armed with that as a
young person, I think, I feel, Ifeel like I got to sidestep a
lot of the self loathing that might have come my way
(10:53):
otherwise. And I was relative relatively
quick to see this as a point of potential connection versus
dislocation or something like that.
All kinds of social science thatI know you're familiar with,
which shows that when you compare the, the, the happiness
set point of a lottery winner versus a paraplegic after, you
(11:17):
know, a, a down or an up, depending upon the
circumstances, people sort of end up back at their set point.
How did this happened when you were 19, I think?
And so how did, how did your 20s, what was your 20s like both
in terms of the physical rehabilitation, the, the sense
(11:38):
of your identity as well as yourcareer path?
Because really, what we're goingto spend most of our time on
today is the career path you've chosen, which I don't know if
you would have chosen if this experience hadn't happened.
Yeah. And probably wouldn't have
medicine was not on my radar. It's not like I always wanted to
be a doctor or came from a line of doctors that wasn't really on
(11:59):
my radar. But I'm I'm not sure what was
really. I was very much in the liberal
arts bent. I was just going to learn how to
learn and be interested in life.I had that good fortune to be
able to take that time. So it's not like I was heading
this way and then all of a sudden I had to go that way.
That's the, it's not honestly that kind of a story.
So, but you know, another cue I got very quickly from my mom and
(12:24):
other people would work in the disability rights movement sort
of advocacy work. I knew a couple of things and
like, I, I knew not to take the bait that this all of a sudden I
was special because that's sort of one of the sweet ways that
people end up exempting you fromlife.
You, they, it's a way to kind ofsweetly remove people from life
(12:45):
often, especially around disability that we're in special
as a lot of connotations. I'll, I'll take out, I'll
receive that comment. Oh, you know that I'm special as
long as everyone else agrees that they're special too, you
know, so that's sort of the deal.
That time I knew not to take that bait.
That was just going to lead me down a path of blandness.
(13:05):
I also knew to not take the bait, that this was something to
overcome or put behind me as a story and maybe for for my
friends and outlookers to kind of digest and then move on.
But for me, this was going to bea daily experience.
And so it wasn't about overcoming it.
It became about, OK, here's someraw material to work with in in
(13:29):
my life and to play with. And yes, very challenging stuff,
but that kind of gets back to how my 20s went.
So again, with these sort of topline thoughts, they were the
organizing thoughts. And again, I just want to note
for anyone out there wondering and also looking at their own
experiences, this took months and years to kind of really play
(13:52):
out and figure out there was pounds and pounds of physical
pain and emotional pain and feeling out of sorts and guilty
for surviving and guilty for allthe care I had received from my,
from peers, etcetera. So it's complicated.
But with that caveat, back to your question, you know, as I
kind of came out of that rock bottom in a way, I've come to
(14:17):
love rock bottoms in a way because the view, it's all, I
mean, it's just like, I know you're like, you can't go much
lower. Of course, we always can.
That was more I could lose. But you know, I was pretty far
down. I was on my knees, let's say,
you know, And the view from there, once you kind of, you
know, transition to accepting itor something like that, or just
(14:41):
being real about it, that view, that vantage point, it's not a
place many of us would wish to be and myself included.
But if you find yourself there, you have less to lose.
Yeah. And that I feel it was a very
empowering notion for me. And I was also armed with now
this, this very common appreciation for life that comes
(15:03):
when with grief, when you lose something is when you is very
often right when you really appreciate it.
So yeah, I'd lost plenty, but I still had plenty.
And so I was really primed to appreciate what I had and a
little bit freed up to worry about comparing or contrasting
myself with my peers. So in a way, it freed me to some
(15:27):
degree. And I, I let it.
I cultivated that freedom. So in my 20s, you would have
found me. You know, much of my 20s are
spent in the San Francisco area.You would have found a very free
spirit. I got into like, looking weird.
I got, my hair was all over the place.
I wore strange clothing. I just was like, you know, I
just looked around and I saw allthis everyone trying so hard to
(15:47):
kind of live within this very narrow range of what constituted
normal. And I was given a little chance
to free myself from that. And I took it, you know, so I
just kind of got, I was very open.
Anyone wanted in my life, they're welcome to it.
And I just, and it actually became a little problematic.
I didn't think I went a little too far with some of that but
you would have found a very openfree spirited person.
(16:11):
Maybe a little Moody too as I still working out all the pain.
And you were and you were dating, you know, as a 20,
someone in their 20s would be doing and yeah, and getting
used, getting used to dating andcareer wise, what was going on
during that time? So shortly after I went back to
college and I graduated with a degree in art history.
Then we can talk about that, butour art, that was a great move.
(16:34):
I learned a lot about perspective making and and
treating life as raw material toto work with, even play with.
So, but that was awesome, but itdidn't set me up for work.
So graduation was sort of a Cliff.
I didn't really know what I was going to do.
But given all that we just said,I knew I did.
I wanted to use these experiences.
And so medicine lit up as a way to do that.
(16:54):
You know, I just thought about if I had, if if a doctor walked
into my room looking like me, how how helpful that would have
been without even a word, Sarah,just seeing my person and
knowing that I had been in the bed and it was that kind of
trust and making good on the this outlandish experience that
that medicine seemed to offer me.
So I went back and did the pre meds after college.
(17:17):
So that took a couple years and then into Med school.
And the deal with myself, Chip was simple.
Like, you know, I also knew thatlife was way too precious to be
sacrificing to something that you didn't really care about.
So I've made a deal with myself medicine.
If I, if I either, if it's too hard or I just don't like it,
I'll, I'll get out, but might aswell get on this horse.
And by now failure had ceased tobe the worst case scenario.
(17:40):
Failing was like, ah, OK, fall down.
OK. No, it was.
It was just more about day-to-day experience and
therefore I became much more used to it.
I've got very good at falling. When did you start focusing on
palliative care? Deep into Med school, so often
medical schools at UCSF, I figured I, well, I, you know,
this is not so much of A love ofscience, but a love of humanity.
(18:00):
And, and I was trying to go intomedicine as a way, as an excuse
to, to put myself in front of other people who are trying to
figure themselves out. So I figured, oh, well, I should
do rehab medicine, work with other folks who are freshly
disabled. And that's even the highest,
best use of me. And so all through Med school, I
just assumed that's what I was going to do until deep into
fourth year Med school and I finally did a rotation and
(18:22):
rehabilitation medicine, it's called physical medicine and
rehabilitation is the full name of the specialty.
And I did not like it. I mean, it was very mechanical.
It was, you know, it was, it made me, it honed my interest.
I realized what I was really interested was not so much the
physicality, but the emotional, spiritual, existential questions
(18:44):
like what do people do when theybump up against things they
can't control? That I, it helped me get clear
on that was my issue less about the angle of a joint or
something like that. So I dropped out of the
residency match and was going todrop out of medicine.
I didn't know what else I would do in it.
But my Dean talked me into, I was, you know, 1 semester away
(19:06):
from graduate. I was going to graduate, but
then my Dean talked me into doing a year of residency, the
internship just as a, as a better stopping place.
You can get back into it if it easier if you've done your
internship. So that's what I did, and then
during my internship I stumbled on an elective and palliative
care and fell immediately in love with it.
(19:29):
And was that was there an experience of being at the
bedside of someone who was dyingwhile interning that had an
effect on you? Yes, there are several
experiences. So I was at the Medical College
of Wisconsin for my internship. My parents at that point were
living in Milwaukee, so I thought I had left home at an
early age. And so I went back to be with
them for that year and just do the internship, get it done.
(19:51):
And it just so happens that the Medical College of Wisconsin has
one of the oldest palliative care programs.
A fellow named David Weissman did beautiful work, established
sort of a pioneer in the field. And so he just happened.
He and his crew happened to be there.
And so I I got to work with a very seasoned practitioner and
just watching him at the bedsideand being part of his team.
(20:14):
And how he talked to people and how he handled this event,
whether it was someone dying from heart failure or whatever
it was cancer. It didn't so much matter the
details of what was as what was challenging them or taking their
lives. Soon it was just that they were
bumping into what it means to bemortal and what it means to
(20:35):
lose. And the way he and I came to
realize the field handles that, we don't look at that as a
detour or a tragedy. We look at that as sort of life.
That's how it goes. It changes the affect at the
bedside. You're no longer looking at a
patient to see whether you can fix them.
It's less transactional, more transformational.
(20:56):
Very that's really well put, Chip.
Exactly. It's about accompanying, you
know, that fix it mentality can be powerful when you've got
something that is fixable. But the, the way that healthcare
has devoted itself or the, the directions it's taken in recent
decades kind of leaves you feeling like if you're not
fixable, then you're kind of in the way.
(21:17):
There's not really, there's sortof like, and oftentimes even
worse medicine accidentally makes you feel like that's your
fault. So there's, there's a lot to say
and critique of that approach. But just to say sitting with
someone, being with someone and not trying to change where they
are, rather trying to be with who they are and accompany them
and see them, that was very, very powerful to me, beautiful
(21:40):
to me. So that was a real initial hook.
And so from that point, focusingon palliative care, wait, first
of all, just so those who don't know, how do you define
palliative care? Yeah.
Thanks, Chip. It's a great question, really
poorly understood field. So it grew out of Hospice.
So Hospice is sort of a subset of palliative care.
(22:02):
It's the same training this, this, the field is officially
called Hospice and Palliative medicine since its inception in
2006. It's one of the newest
specialties out there, but it's one of the sort of the oldest
mentalities of of approach to care.
It's it's sort of ancient beforewe were so seduced with curing
people. So it grew out of Hospice in the
(22:22):
80s and 90s. It's a similar kind of approach
to quality of life. And so a basic sort of wrap
around term for palliative care might be something like multiple
or multidisciplinary pursuit of quality of life in the treatment
of suffering. So we treat suffering, not
disease. We treat people, not disease.
(22:42):
So your art history gave you a little bit of a dose of
understanding the human condition in life and in death.
So and what do you do with that?Like, so how do you, how do you
become, what do you do with, I know at, at some point you ended
up at the, I think the San Francisco Zen Center is in
(23:05):
Hospice, But what, what, what was the path that you took as a
doctor in working with the dying?
And, and then, you know, obviously later in your career
or, you know, more recently, thelast 5-10 years, you've become
pretty famous about this. So what, what, what, what
happened along the way? We.
Can talk for a long time. I mean, I think in general I
(23:29):
went the sort of, well, just thesort of the mechanics of it.
So I went back, finished my internal medicine residency,
then did a fellowship in Hospiceand pad of care, the sub
specialty training. And then I came back to San
Francisco and joined the facultyat UCSF and went down the path
of sort of rigorous academic medicine and trying to learn as
(23:52):
much as I could at that time. Much of my training as it goes
in the field, especially for the, the, the medical piece of
the puzzle, a lot of it was about symptom management, you
know, pain management, nausea, etcetera.
So helping people physically feel as well as possible.
And that was fine. I, I, I enjoyed that.
(24:12):
Having spent a lot of time with pain, I know it's no fun.
And so it was it was wonderful to be learning how to help
people hurt less. But all along the way, given the
reasons that you just pointed toin our conversation here, I'd
those were talking about someone's pain or nausea was a
way to gain their trust so that we could get into what it like
(24:35):
the issues of identity, a word you use a bit back a bit ago.
It's great. That's and how they're groping
with the person they thought they were and the person they
are now. That's the meaty stuff I
couldn't wait to get to. And but all those earlier years
was really about learning the the trade and so much of that
about with that was about the prescription pad and the
(24:56):
physiologic. But I think I did well as a as a
young pad of care doctor compared to my peers because I
had AI had been a patient. I knew so much of what I was
guiding people through. And I also had really wrestled
with this questions around identity and grief and loss and
gain and how they come together.Those are more sort of those
(25:18):
were on the side or sort of on the margins of what we learned
in our training. Those became sort of
increasingly front and Center for me.
I'm going to pause there before I go on so long and there's so
much more to say about that. But does that kind of make
sense? Can you picture that Chip?
Yeah, it does. I'm curious if at any point
along the way up, up to you're 54 years old now, have you ever
(25:40):
imagined going to divinity school?
And I say that not that you would necessarily want to go do
that and all the regimen of it, but it feels as if there's a
clerical element to this, this there's a science and an art and
clearly a spirituality. So maybe touch on that a little
bit about just what is it like to be a doctor, being in service
(26:05):
and caregiving to those at the end of their life from a more
spiritual or religious perspective, Has it deepened
your sense of the mystery? Absolutely it has.
So yes, yes, yes. So so as you mentioned, I went
from, I stayed at UCSF all throughout my clinical work, but
then I took a job at Zen Hospiceproject in part because of what
(26:27):
you're pointing to. Yeah, the medical piece is
helpful. And medicine has become sort of
the arbit arbiter of death. It's sort of it's become the
church, it's become the family, it's become many things.
The ER is not just for medical issues.
So anyway, but the sense was just as you're pointing to that
(26:48):
this was sort of a, the, the stuff that's really meaty here
is not the stuff of medical science and much more the stuff
of spirituality, philosophy, aesthetics.
So I, I was looking for ways to augment my understanding.
So working at Zen Hospice was very helpful to work in a place
(27:09):
with the spiritual basis of care.
But again and, and again and again, I just have come back to
my own experience being a patient, being a human being,
someone who cares and wants to be cared for.
That is the best teacher I have.It's my daily teacher.
And that's that's been profound.And to your question, you know,
(27:31):
if I found myself kind of marching down a particular
belief system, I most certainly would pursue training or
clerical work in that, you know,if it were Christianity, if it
were whatever Buddhism, but I never found myself lighting up
with anyone path. So otherwise, I, I think I
(27:53):
really would, to your point, andwhen I was a kid trying very
hard to be a Christian, there was a lot I loved about the
message of love and forgiveness.And at one point I did think
about pursuing the cloth. Anyway, back to my later
experiences. Yes, I felt very much pulled in
the spiritual direction, but notin an organized way, more in a
(28:16):
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What do we get wrong about deathin the United States?
(29:00):
Let me count. Let me count the ways.
Well, there's, yeah, it's a longlist.
I mean, one is, I think all trouble at root.
I think the biggest problem is that we've tried to wrestle
dying away from living that thatwe see death and life as
opposing forces, that death is this thing, that this external
(29:23):
thing that comes and robs us of life.
That's all our language, you know, the sort of succumbing to
illness or you know, this sort of it's all the sort of language
of giving up or giving into thisthing that's going to that robs
us of our life. It's inherently tragic.
That's not accurate. And you just spend the need to
(29:47):
spend a little time with your with yourself, really paying
attention to the world at all tosee how or just better yet walk
in the woods that you know, if we're parts of nature, you just
there is no separating life and death and nature there.
They are one in the same. They are part and parcel.
So I back to your question, I think that is the fundamental
(30:07):
error that we make. And there's all the rest of it
is sort of fallout from that misplaced notion that we can
forestall death, keep it at Bay.I think a really stop here
saying I think a really important note.
Then I find myself thinking about it a lot for myself and
(30:28):
the people I care for, which is you will die because you are
alive, not just because you had bad luck, you got cancer, bumped
into a bus or something. If nothing, if you have a
Christine, if you're in bubble wrap, you will still die.
Your body is programmed to do so.
It is a dialectic. It's not a duality.
And we contain our own opposition.
(30:49):
We contain the up and the down. It is a package deal.
And so therefore it's natural. Therefore it's normal.
Therefore it's even something tobe celebrated just as life is.
So older cultures have gotten this, you know, go to Varanasi
in India, go to, you know, I've been there.
A lot of cultures have been around the planet for a little
(31:10):
bit longer than the US per SE, have gotten this memo.
And you can feel it. You were an advisor to a
President of the United States and you could have one wish
about a public policy or change in the culture regarding
caregiving and or death, and you're welcome to have more than
(31:32):
one wish. What would that be?
Well, let's see here, that's a fun one.
Let's, I mean, excuse me, let's start with healthcare because
it's still too huge to ignore and it has such potential.
I'm alive because of modern medicine.
It's it can be so beautiful, butour systems have really gummed
(31:55):
it up or the man made stuff, theconstructs that the policies,
etcetera. So I would take healthcare down
to its studs and reimagine it asinherently palliative in nature.
It's more like. All healthcare should be pout of
care. By that we mean, do I care about
your quality of life? Do I care how this illness or
(32:15):
this event is affecting you and your family?
Of course I do, you know, just, it's just putting care in the
sort of groundwork of, of the healthcare.
So all healthcare would be trained in palliative care.
And then on top of that, you'd add these beautiful ways to
forestall illness or treat illness or suffer less, but
(32:36):
would all be in the name of supporting the human and human
condition as natural beings. So that would be 1.
I think we'd have a very different country if that were
the case within a generation. We probably also, we probably
appreciate midlife more. I think 1 of there are many
reasons why midlife is not appreciated in the US and called
the midlife crisis. But one of the many reasons is
(32:59):
because it's the doorway to the second-half of your life and the
fact that you're going to die and and people just don't want
to think about that. Right, which is don't want to
think about it. So there's some same way saying
like they don't want to think about their life, they don't
want to think about life. Like, you know, this is where
the problem of separating these these things.
So and then you find yourself atodds with reality and boy,
(33:21):
there's your grand ticket to suffering right there.
So right, I'm, I'm completely with you, Chip.
That's really well said. So you know, there.
So there's, there's a beat as towhat else we might change.
Well, I would tell to talk to the culture makers in the world
and find ways to get real about aging as well as sort of
(33:41):
celebrate it, usher in aging in a different way, which I know
means a lot for you, which is your work too.
So that could be up to the culture makers to some degree.
From a policy point of view, we've got to crack the code on,
on how do we, how do we support caregiving in this country that
period. So I think those are my top
(34:03):
three moves that would change the country I think, pretty
quickly. Tell tell us about mental health
spelled METTLE because in many ways you're trying.
You're creating a role model fora company dedicated to
caregiving and in So explain, explain what it is you're you're
(34:24):
now an entrepreneur, my friend. Who knew?
Who knew? I know it's nuts.
I mean, this is the playful thing with identity.
Once you get to note that you'renot your job, you're not any one
thing, it's can be a little devastating, but also frees you
up to kind of play with it. So yeah, I've been a doctor,
I've been a patient, I've been an author, I'm a speaker now I'm
an entrepreneur. What, you know, who knows what
(34:46):
else is going to come? But.
But anyway, yeah, back to your good question.
So Metal. So my business partner, Sonia
Dolan and I, we had been workingtogether for a few years, worked
on a lot of the sort of public engagement, trying to talk to
people, get folks paying attention just like you're doing
here, to the realities of life. We were heading down a different
(35:09):
path. We were going to start at a
library of resources to help people not fall into the rabbit
holes of Googling their diagnosis and help information
float a little bit differently. But then the pandemic hit and so
Sonia and I decided that what people really needed was direct
care. They needed a safe place phrase
that we've come to love. It's a safe place to fall apart
(35:29):
essentially, with this big existential crisis.
So and that allowed me to devotea, a practice to the things that
that I knew I cared about most. I got to let go the prescription
pad. We pulled metal out of the
medical model. So I'm no longer practicing
medicine technically. And in this practice, we could
(35:50):
focus highly on the existential,spiritual, social nature of all
this stuff. So it allowed me to put my chip
down on the things that I had knew were my prime loves.
But I was doing these other things, symptom management,
other things, just to to get to that other stuff.
So anyway, we started mental health early in the pandemic
(36:13):
2020. I hung our shingle and at that
time, telehealth was on the risetoo.
So we could just, we just started Zooming with people one
hour at a time, just talk to anyone, just about anything and
allowed us also to welcome caregivers into the equation.
You didn't have to be a patient.So therefore you can be anything
and talk to us. And so off we went.
And so that's how that's how mental health got started.
(36:35):
And so it is a consulting service or a retainer.
People, people really look to you to provide the combination
of medical, spiritual, psychological help at a later
stage of life. Really any stage of life, cause
a good question is when you start dying.
And it's not about death so much.
(36:56):
It's about as much as it is about transitions.
I know catchment you play with too, you know, It's really the
details of. How old you are?
Or whether you're dying or losing something, it's become
less important. It's just like life ain't what
you thought it was. You're now scared or freaked out
or lost, and you got to go. You need somewhere to turn,
(37:19):
someone to talk to. So it is all those things.
We do help people navigate healthcare.
All our counselors are former clinicians, so we know
healthcare. We can help you navigate
healthcare. We can help you reconfigure your
identity, we can help you fall apart and then help put you back
together again just by being an honest reflective device with
you. So it goes many directions.
(37:40):
And I would say maybe 60% of ourclients are caregivers or family
members. They're not the ones who are
technically dealing with the illness themselves.
So and then a subset of still offolks who are going through an
existential crisis, they're struggling to find meaning in
their life, but there's no tragedies befallen, they're just
kind of languishing. And then another even smaller
(38:01):
subset are clinicians themselvesare often times calling us
because they're burned out or need help with a patient of
theirs, etcetera. So we see an array of things of
people. What are your prescriptive tips
for caregivers? I mean what what can you word to
wisdom do you have for people who are have been forced into
(38:23):
the caregiving profession because of family or friends as
opposed to doing people who are doing it as profession?
Yeah, and I think the advice actually ends up being much the
same for depending no matter what landed you in a caregiving
role, personal professional, whether you sought it or it
befell you or its duty driving you or obligation or you're just
(38:44):
stuck. I think, you know, I think a, a
root notion, much like, you know, reacquainting living and
dying, I think we're trying to reacquaint sort of self and
other and the healthcare as I was trained and the world I grew
(39:07):
up in caring for my mom, etcetera.
The messaging sort of suggested that you want to be a good
caregiver, then you need to minimize your own needs.
You know, you need to shrink yourself so you can grow for
another over here. And that's sort of the math that
is and that it is a selfless act, this kind of stuff.
(39:32):
I mean, you know, you see everyone gets to see it how that
how whatever feels right. But I think that way I got to
see it and it's sort of to a sort of logical tragic
conclusion in healthcare where you where everyone's burning
out. I mean, you're just you don't
sleep, you don't eat, you're notsupposed to have any hot, you
know, you become a machine of output, of care as an output.
(39:58):
And that is really importantly wrong.
This gets that sort of self-carefor caregiving.
But even this, the phrase self-care is problematic.
It implies that you know, you know that self and other are
somehow so different that you have to note that it's important
to take care of yourself in order to care for another.
(40:19):
It is that sort of a conceit. Because of this sort of one way
notion of caregiving, we suffer in this way.
What I saw play out in among some individuals who got there,
how however they did, and what Isaw play out in more into the
sort of Buddhism tenets of care was that care was much better
(40:42):
conceived of as a loop. This circle of care that me,
let's just say you're my patientchipped.
Well, OK, I will. Sure I will care for you.
I will care, but I'm really caring with you.
I'm jumping in. I'm sitting next to you, not
above you, human to human and worked, trying to see how we can
kind of make something a little less hard together.
(41:03):
And so I'm partnering with you. I'm not caring at you and in so
doing, I get to be accompanied too in my humanity.
I get to be receive your attention.
And this sort of care care caregiving when it's going well
is really as much care receivingas it is giving.
It's a it's really a loop of reciprocity.
That's when it works really well.
(41:25):
Now, as I say that, I just real quick, I know I'm saying a lot
of words here, Chip, but I mean to say, I know that might sound
to any caregivers out there listening to it might sound,
well, that sounds great. But you know what, I've got 8
zillion to do things to get mom to the appointment or whatever
it is. And yeah, how the hell am I
going to take care of myself andall this mix and, and I get it.
This is, it's sometimes feels impossible, but it much of the
(41:49):
impossibility is, is really because of the world we've
created around caregiving. We don't support it.
You are not encouraged to take care of yourself.
You're supposed to somehow find this time and not sacrifice
work, not sacrifice your own family's needs, etcetera.
It's it's an impossible set up. Caring is not impossible.
(42:10):
Caregiving in modern life has started to feel impossible.
But that is an invented thing. That's a made-up situation.
I guess it is a we've always, we've had caregiving since the
start of time. So what advice and wisdom do you
have around grief? Oh, just just that I, I've
become such a fan of it. I, I've just been really.
(42:33):
And I, it took me a while, you know, I didn't really let myself
grieve in a, in a, in a thoughtful way when I lost my
limbs, I lost my sister some years later and didn't really
let myself grieve there, not consciously.
I kind of bought into grief was the kind of a, you know, that
(42:54):
was a root to sort of sad sack and, you know, and something
weak or something not good, not valuable.
I, I have to admit that it was deep into my 30s before I really
started letting myself see otherwise.
And it was my patients who were teaching me this, you know, even
though I'd had a good reason to grieve, I just really hadn't
(43:15):
taken it up. I hadn't and I was suffering
because of it. I was at odds with parts of my
experience, like, you know, my sister died.
I could I because I was unwilling to consciously grieve
or lean into my grief. I walled her off, I couldn't
even summon my memory of her so I just kept losing more and so I
find. This actually, BJ, did you do
the same for your own injuries? I mean, did you, did you ever
(43:38):
have a chance to grieve back then or has it been something
that you have ever been able to,to truly no.
No, no, I've revisited it. I have.
You know, grief is mysterious and that odd and just makes me,
makes, makes a person feel weird.
(44:00):
It's a, it's a, it's a wild force.
And I think that's a really goodFrench word, a wild force.
It is nature. It is a natural force.
But I, no, I did not give myselfa period of mourning back then.
I, I kind of held myself hostage.
I kept kind of leveraging that pain and trying to kind of ram
myself back into the world. And to some degree I got, I did.
(44:23):
It worked OK, but I just kept forestalling this grief that I
finally started come to terms with later in my 30s and 40s and
still do now. I'm often impressed at how much
more grieving I have to do just to catch up with the life I've
LED so far. So the title of this this
podcast is the midlife chrysalis, suggesting there's a
(44:46):
Caterpillar, a cocoon, it could be dark and gooey, a transition
point. And then, you know, if we're
lucky, a butterfly. Have you gone through a midlife
chrysalis in the last five or ten years in the core of your
midlife? What has it been and what are
you learning from it? And has has there been some
grief along the way? Very much.
(45:06):
So. You're putting your finger.
I mean, it is, yes, yes. And it's not many of my big
losses, the dramatic ones or or earlier, you know, my sister's
death, my limbs, etcetera. And more recently, the losses
are, you know, loss of a friendship, you know, 12 years
ago, the loss of a marriage, theloss of a sense of myself, the
(45:31):
loss of feeling competent sometimes, you know, the loss of
a feeling like I lived in a country that was coherent, you
know, all sorts of all sorts of losses.
And, you know, loss is funny loss.
We don't, I don't think, I don'tthink it pays to weigh your loss
or compare your loss. Like like I had some very
(45:53):
dramatic losses at a young age, but they're not more impressive
or more important than, I don't know, losing a friendship, you
know, it doesn't pay to compare them.
Loss in some level, at some fundamental, I think is it
losses, losses, loss. So it took deep into my really
in my 40s and more recently thatI'm really letting myself access
(46:18):
that heartless hard feelings. I went right to the I knew I
needed to accept my limb loss. I just kind of beeline to
acceptance. I didn't let myself miss
anything. And so I was cutting my so I
kept doing that. And by the time I got to be 40s
and 50I realized I could no longer cry, which was a real
tell. I couldn't I couldn't even
(46:40):
summoned, I couldn't get to tears.
That was a big tell. I felt often kind of numbed out
and just sort of bland. I was not able to access the
peaks of joy and things like that as I had once experienced.
And I couldn't access access sort of depths of sorrow.
And that was a really important time I started to get, I started
to feel like I was really missing out on something in my
(47:01):
own experience. And it was through working with
patients and watching people andaccept and roll with their grief
that I realized that's what I had.
I had been missing the grieving process.
Letting myself feel those hard feelings was exactly the missing
ingredient. And so in recent years, it's
been much about putting, like letting myself feel any hard
(47:24):
feeling whenever it comes, almost loving it.
Actually, definitely loving it and letting myself feel it.
I now I can almost cry in movies.
I can almost cry when I lost my dog last year.
You know, there's I get real close.
I'm much I'm much closer to tears than I was five years ago.
So you and I are so similar. Tears are hard for me and I have
(47:48):
found that when I watch a movie on an airplane, that's so I, I
lose it. And yeah, some, some movies when
the underdog wins the sports event that that does it.
But I, you know, I, it, it is, it is a very, IE there's a, a
little bit of a fear, like if I really go there, will I ever
(48:10):
stop crying? I was just going to say that
Chip and I, I'm pretty sure thatthe answer is yes, we'll stop
crying. I've watched some people do it,
but I I harbor some old piece ofme harbors that same stealing
that I I can't I can't look at that stuff, then I'll only be
that stuff and off I'll then I'mgone.
It's. I don't think that's true, but
(48:32):
I've. I think a lot of a lot of men
have this issue. Yep.
So. Probably true.
Bronny Ware famously wrote a book about the five regrets of
the dying. She talked about the courage to
live in. These are the five regrets.
So there's a regret that they didn't live the courage to live
the authentic life, and they were living up to other people's
expectations. They have a regret that they
(48:52):
worked too hard. They have a regret that they
didn't really get to express their feelings, a regret that
they didn't stay in touch with some friends and a regret that
they didn't let themselves be happier.
How do you feel about those fiveand from your perspective, from
your observation of seeing people at the end of their life?
(49:15):
Frank Osaski, you know who you know well who started that
thing? I think he started the Zen
Hospice. He he, he once said to me when I
was going through, I'd had a flat line experience and he was
having some serious health challenges.
He said one of the things that people are wondering at the end
of their life is, was I well loved and did I love well?
(49:38):
What do you see at the end of a person's life in terms of how
they're doing the life accounting of of how it all
shaped up? You know, those five that you
that you listed and Frank's comment to you all light up for
me is accurate. And you know, so I have I don't,
(49:59):
I have nothing to say that wouldconflict there, but I I just
share with you that my own the way I think about it or feel
about it, it's a little bit moredistilled around honesty.
Like it's like I I would this isand maybe if we talk again in a
(50:19):
couple years, I may be off this where this may be my own
developmental arc. That's that.
I'm so I'm seeing everything through this lens, but I would
have sworn I was an honest person anytime you and I would
have talked anytime of the long across my life, you know, not in
some like I'm so cool way. I just pretty honest.
I, you know, when I'd lie, I'd feel terrible about it and I'd
usually fess up whatever. So, and as as I've gotten deeper
(50:45):
into life and like this note about force, trying to forestall
grief and the hard stuff, tryingto engineer sort of more good,
less bad, all that has gone intothat effort, that quixotic
effort has, has meant me kind ofengineering my, I squint at just
the right moment and open my eyes wide to just to kind of
(51:08):
curate my what's coming into my experience.
And it's just exhausting and futile.
And it just kept me at Bay from a lot too much of life.
So back to what I'm saying here is like what I see play out at
the deathbed for a lot of peoplereally comes down to their
capacity to be really honest with themselves.
Like really honest with themselves.
(51:30):
Not just to not tell a lie, but a deep set honesty about our
fears, but how we feel about anything.
That's even if assuming we can even access the feelings to be
honest about it. But I think most of us in this
country, in this life, in this hemisphere, perhaps these days
have only done so much engineering around trying to
(51:53):
look a certain way, feel a certain way at the expense of
the rest of life that I think I have to believe a lot of us are
in some a boat like this. And I do see that play out with
clients that I've worked with isand they really get real, really
all the way real with themselvesin the world.
And I don't see that often that people do.
(52:14):
I think there's a fair amount ofwork left for most of us at the
end. So there's a a movie that's
recently come out called The Last Ecstatic Days.
I don't know if you've seen it. It's about a guy.
Yeah. It's a guy in his late 30s who
has brain cancer. Real Glastoma.
Is that what it's called? A.
Glioblastoma, blastoma, very severe form of brain cancer,
(52:37):
very accelerated. And they film his, his final
days, his final weeks. And, you know, it's like dying
as a creative act. I think that's maybe a term that
you've used before even. Will you tell us a little bit
about what that means? Dying as a creative act, by the
way, for those who are, for those who are looking to come to
(53:00):
an MEA workshop, that that film will be one of the 58 films in
our MEA Film Fest in December inSanta Fe.
Beautiful Well, dying is a creative act, just like living
is a creative act. Again, living and dying much the
same thing. And I do think of, and that was
another nod to studying art and art history as a way, as a, as a
(53:21):
lens to see human endeavoring. You know, I, I, what I mean by
that dying as a creative act is we get to play with the material
of our life if we so choose. We get to play with our identity
and not get stuck or to fixed. Everything is in motion, even
stone is in motion to just different times.
(53:42):
So given that we're given that everything's in motion, it's it,
it really starts becoming about becoming, we are just, we're
never fixed. So we're always in motion.
So what are we? Well, we are becoming, I'm
moving from this to that, you know, this sort of the truth or
the math of, of time and space coordination, you know, so, so
(54:04):
if I'm always becoming well, then I get some, some, I get
some agency at how I steer and which thoughts I pick up and
which feelings I roll with. And that is a is a creative
process of, of working with the material of your life, including
your dying. It's unfortunate we kind of hold
(54:24):
dying as this, like your life was before the dying process.
And then you're sort of just in the way and kind of you kind of
let's usher you out of here. You know, the with this, that's
unfortunately a lot of sort of the overlay of how we think of
of value in human life. If you matter because you exist,
not because you accomplished this or that thing, but if you
matter because you exist, which I believe is true, then and
(54:49):
that's how I choose to see being.
And if then and if life was given to us.
But I think one of the kindest ways to honor that gift is to be
affected by the rest of life, The breakdown barriers between
myself and others, to see these connections, to see how we
(55:09):
affect each other, to be affected.
I really think it was the most loving things I think we can do
is to be affected by each other.And it's, well, that too kind of
flies in the face with a lot of notions, especially of manhood.
So anyway, back to your question.
I think these are all the sort of the material bits of this
overlay of seeing dying, just like the rest of living as a
(55:30):
creative act. It's yours to play with, to work
with. And if you so choose, that's a
really good way to take yourselfout to your final breath and
really be alive until you're actually dead.
So BJ, one of the questions we end with is you've learnt,
you've built some wisdom along the way.
(55:50):
MEA is a midlife wisdom school and in 2026, you're going to be
actually leading a workshop on caregiving and grief.
And a lot of what we've talked about today, and we're very
honored to have you join us in Santa Fe.
If you were to distill down the wisdom that you've learned onto
(56:11):
a bumper sticker that really hasyour wisdom fingerprints on it,
what would be that bumper sticker and what might be the
origin story? We probably maybe already talked
about the origin story so you don't have to repeat something.
But at 54 years old, which is the average age of the person
(56:34):
who comes to MEA, what would be your wisdom bumper sticker?
You. Know there's a wow, there's a
few that notions that come to myroom.
Can I share a couple? Yeah, perfectly fine. 1 is a
answer I gave to a similar question once was don't believe
everything you think. And I've seen that bumper
(56:56):
sticker and so that's a bumper sticker that exists in the world
and that one works pretty well. Don't believe everything you
think. In other words, don't confuse
yourself with your thoughts or any other one component of who
you are. I think that's a pretty damn
good one. That's pretty rich.
That is a lot. A lot can flow from that Related
is is a phrase that I've liked. I can't remember the prompt that
(57:16):
you got me to this one, but we are the, the, the phrase is we
are freer than we think. And that sort of kind of again,
points to mind and the thinking mind as, as, as the cage much
more than anything else. And that's all sort of gets to
the, the, I think especially in this country, we talk a lot
(57:38):
about loving our freedom, but there's a lot of responsibility
that goes with that freedom. And so, you know, I there's many
reasons we don't choose freedom.So anyway, we are freer than we
think. I think you can chew on that for
a couple lifetimes. One more kind of comes to mind
is if in terms of a prescriptionfor me, that's that's really
(57:59):
been personal and one I like to I would like to see increasingly
part of how I organize my the rest of my life, which is
basically follow beauty. I think beauty is just under.
Yeah, it's just so awesome. And how do we define dude?
I don't mean pretty, I mean something true.
You mean? Awe.
You mean Dacher Keltner? You mean like the idea that in
(58:22):
awe is joy, in awe is wisdom, inawe is life?
Yes, and and awe is right sizingourselves too.
Like I am this teeny little thing, but I'm part of this huge
thing. I'm not separated separable from
it. It's not about me and it's not
not about me. There's a little paradox for you
in between those two is somehow the truth.
(58:43):
But I see beauty as like the truth Incarnate.
That's sort of a philosophical definition.
So that's that's that's what I want.
You are still an art history major, my friend.
You still taking it all the way back to the start of this
conversation. It comes back, it comes back to
beauty. So thank you very much.
We you're a role model in so many ways and thank you.
(59:06):
I just, I just wanted to say you're an inspiration and your
humility, including how you conducted this, this interview
just is, is a treasure. So you are you are a you are a
moral beauty. Thank you, Chip.
Those are words I will aspire toand I really appreciate being
with you buddy. It's such a joy talking to you
(59:28):
about this stuff and I can't wait to see you in Santa Fe next
spring or summer, whenever we. Do it.
Yeah, exactly. Oh, that was probably one of my
favorite episodes. I, after we record, finished the
recording, I said to BJ and he agreed we could have talked for
three hours. What an interesting cap.
(59:48):
I hope many of you will sign up for his weekend workshop in
Santa Fe next year. Gosh.
It's to distill it down to just three key bullet points is hard.
I would just maybe start with the idea that.
He has a comfort with failure. When you have come face to face
with death and when you've lost 3 limbs, your ability to pick
(01:00:15):
yourself up and realize that failure is you can have small
failures and big failures throughout your life and you're
still alive is huge. You have less to lose, as he
says, and you appreciate every single day of life.
I'd say that's one of the key lessons.
A second lesson would be this idea of the circle of care, the
(01:00:35):
reciprocity of this loop, that if you're a caregiver, you're
not caring for someone else, you're caring with someone else.
Now that is so hard to hear whenyou're in the midst of a lack of
sleep, when you're having a hardtime holding down your job
because you're taking care of someone else.
When society is not very good and the government is not very
(01:00:58):
good of taking care of the caregivers.
But figuring out that reciprocity, figuring out the
reciprocity not just with you and the individual you're caring
for, but the community, if therecan be a community that helps
support you in that process. And then I think thirdly, I
(01:01:18):
just, I awaken to the fact that this is a guy who's still in his
life has not maybe fully opened the door to all the grief of
what happened to an age 19. And many of us have that
experience, whether it's something from childhood, you
know, a violation of something as a kid, a painful life lesson
(01:01:45):
that hasn't been fully healed. You know, BJ has been a wounded
healer, healing other people andbeing at the bedside when
there's lots of tears and lots of grief.
But like me as somebody where I've shared tears with others,
it's usually their tears and my,my, my consoling.
(01:02:06):
There are times I do cry, but it, it, I still have a message
in my head that says big boys don't cry.
So that is a, that for both BJ and for me.
I think that is one of our one of the things that we want to
actually get better at as we getolder.
Hopefully we are getting better at being human our whole lives
(01:02:28):
and being able to like really surrender to grief and to the
the effect grief can have on ourbodies and our emotions and the
healing process that can come from that.
I think that's the third lesson I had from from, from BJ.
So I hope you enjoyed this. Share this with with a friend.
(01:02:49):
This is a particularly good episode to share with someone
that, you know, who's going through some caregiving
challenges or is in their own midlife chrysalis.
Maybe they're, they're going through their own, you know,
illness, you know, cancer or thelike.
Hope you enjoyed it and that it was instructive and inspiring.
(01:03:13):
See you next week. Thanks for listening to The
Midlife Chrysalis. This show is produced by Midlife
Media. If you enjoyed this episode,
help us spread the word by subscribing and leaving a review
on your favorite platform.
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