B.J. Miller —
Reframing Our Relationship to That We Don’t Control

“Let death be what takes us,” Dr. BJ Miller has written, “not a lack of imagination.” As a palliative care physician, he brings a design sensibility to the matter of living until we die. And he’s largely redesigned his sense of own physical presence after an accident at college left him without both of his legs and part of one arm. He offers a transformative reframing on our imperfect bodies, the ways we move through the world, and all that we don’t control.

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is executive director of the Zen Hospice Project, an assistant clinical professor of medicine at the University of California, San Francisco, and an attending specialist for the Symptom Management Service of the Helen Diller Comprehensive Cancer Center at the University of California, San Francisco.

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If you could stand in someone else's shoes... Hear what they hear. See what they see. Feel what they feel. Would you treat them differently? A video that speaks to the connections we all need.

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Dr. B.J. Miller at the Aspen Ideas Festival in 2015.

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Just off the cuff - all moms rue having only two hands (probably some dads too). But there were periods when I had that thought daily. Great talk.

This talk was such an inspiration thank you for triggering the importance of spending our time doing what matters in our busy lives!!! BJ Miller.

BJ Miller - what a wonderful perspective on life, death, designing your existence, questioning beliefs, redefining hopes....he's made me think about the reality that we all face, the end of our life as we know it in this time and space.

I love this show! I couldn't help commenting on this material since it's always been very close to my heart. For the bulk of my working life I have been very close to the 'disabled' I began working as a job coach at a pioneering non profit ARC in Connecticut. My first impression so long ago has only grown with maturity which is that labels are as restrictive and prejudice as initial impressions. It has in effect became one of those base lines that inform everything I do. Not only did I see with those younger eyes how labels limited our ability to help fellow humans but created a false sense of security with the 'us the staff' , saying in effect that because we were not 'disabled' we were qualified to help the 'disabled' Nothing could be further from the truth! I found myself working with other staff who had so many personal issues that clouded their judgments that what ever they did worked contrary to best practices and the benefit of those served. Who was disabled here? Since then I've watched a renaissance in thinking in this field and corresponding adjustments in law, Rights being one. Still it all hinges on education with a much wider lens including ourselves as a provider of services.

Hello Krista- I'm listening to Dr. BJ Miller talking to you and I'm enjoying the interview. The discussion is great... touches very deep for me. It opens up feelings and thoughts about living a full life. Such as, how to enjoy family, friends, meeting new people, keeping up with long time relationships and fully embracing my work and passions. And how to live with my limitations. My life is full of wonder and joy. There are sad things and wonderful things happening. Paul Kantner, a member of the Jefferson Airplane, passed away this past week. The day after, I awoke to the song, "Today". That song gets to my very core. I first listened to it while I was in my late teens. Rock showed me how music can be an all encompassing experience, as it combines lyrics, tune, instrumental texture and vocal variation and richness. As I got ready for work I sang the song to myself remembering being with my boyfriend listening to the song and laughing with joy. Then I was weeping, with sadness and joy all at the same time as the song released the memories from so long ago. That boyfriend is my life partner, husband, father of our children, artistic inspiration and friend. Being older than I was when I first heard the song, I know I have less time to live than I did when I was eighteen. When I was young, I didn't imagine that when I got to be 64, I would feel so much. I have many emotions and body experiences over the course of time. I have been content, joyful, sad, down, depressed, serene, energetic, barely moving, sick, healthy, confused, clear minded, understanding, argumentative, stumped by the limitations of other people, amazed at chance wonderful encounters with people and more. I meditate on hoping my children, husband, family and friends are healthy and have good attitudes. I include myself, too. My mother used to say, "When you have your health, you have everything". We all hope for good health but it is not always possible. Then I learned a new meditation from my friend and WHYY Radio Host, Dan Gottlieb. He said many years ago, "what happens when you don't have your health?" He was in a car accident when he was a young man and as an outcome is a paraplegic. Dan is a big thinker, a compassionate man and practices mindful mediation. After hearing him talk about having a good attitude, I meditate on health and good attitudes for myself and those that I love. Thank you for having this inspiring talk with BJ Miller today. And I listen to your program quite a lot. We air it on Sunday at 7am on WHYY-FM. I am usually up early on Sunday so this works out great. I haven't podcast-ed your show or many other shows, for that matter. It's good to know it's there, however. I send links to friends and family. BTW, I'm the Supervising Radio Engineer at WHYY. I love my work and people I work with. Now, I'm remembering that you may have met Dan Gottlieb and we may have met many years ago. Were you on Dan's program or was he on yours? Take care, Joyce

Thank you, Krista & BJ Miller, for the conversation---a thoughtful dialogue on the beauty, variation and mystery of the human condition. I was an officer & founding member of Hudson Hospice in NJ approx 30 yrs ago, and have always been drawn to the relationship of life & death---thank you for helping me to revisit the topic and reexamine my thinking on the matter.

"I finally have suffering people can see."

Just before my 19th birthday I was a passenger on a motorcycle that was broadsided. The point of impact was my left leg. I was this slim, blond like-able girl. No one knew my suffering. Everyone thought I was this chipper, fairly simple-minded, privileged young woman. No one really ever took me seriously. That was 41 years ago. Although the accident was devastating to me and my family, it saved my life in so many ways. I feel privileged to have known suffering and overcoming the physical challenges and go forward to live an amazing life and contribute to others.

Thanks so much for this interview with B.J. Miller. There is so much you have both addressed here that has expanded my thinking.

B.J. Miller's point is not subtle it's overwhelmingly transformative. It can be used to move us forward in life in a negative way (as a victim) or in a positive way as B.J. Miller has done.

Thanks to both of you. I am dealing with low white blood cell counts at times, so "On being" is often my "church "... I am a >15 year listener . Dr.BJ miller is spot on and I love the laughs, especially the matter of fact humor. ...I am a nurse of 40 years, CRNA for 30 years...I had to have a stem cell transplant for my disease. I had had my chemo dose, no nausea, was walking out of the door of the Gift of Life Transplant House in Rochester, MN on a beautiful April day headed to dinner and a concert with my husband and a dear friend. ..... feeling sorry for myself......then in through the door came these two young guys laughing and punching each other. ... one was a triple amputee in running shorts....and remarkable legs of steel or carbon fiber!!!...whoa....we had a gourmet meal, a stunning performance to watch and no nausea and I got my bearings again. ....
One other point....... as a nurse and a CRNA, I cringe when I hear, "we can't give him false hope"....... there is hope then no hope ....then you die......I was always on the "frontline "....our role as caregivers is to be along for the journey, serve others and thus ourselves .
Keep up the good work... both of you..
Valorie Kammert

Thank you, Krista and the On Being team, for your continued phenomenal exploration of what it means to be human. There are no words for the beauty your program creates. Just a deep breath of holiness. Today’s program with Dr. Miller might be one of the best ever. What human experience was not represented in this program? We laughed with you when he could about his injury/near death experience. We cried when he talked about finally having a disability that was visible while struggling with a melancholic childhood. Our breaths were taken away from his wisdom, that while we might all be a grain of sand in a limitless desert, being a grain of sand was even sacred when approached from a sense of perspective as boundless as his. From the depths of his life, he has created beauty immeasurable in his work and life. I am into beauty, in landscape, in poetry and prose, in people; and what I mean by beauty can be visual or spiritual, and I just wish Dr. Miller the space he needs to continue his greatest of works.

“The mind that comes to rest is tended
In ways it cannot intend;
is borne, preserved, and comprehended
by what it cannot comprehend.” Sabbaths 1979-II
From the Timbered Choir by Wendell Berry

The image that has stuck with me after this program is that of your guest, as a one-handed amputee, asking children if they ever wished they had three hands, and when his audience reacted by judging his question to be “weird”, telling them that having one hand had become, for him, as “matter of fact” as having two is for them. The gist of it can be viewed as the outcome of an answered Serenity Prayer: « God, grant me the serenity to accept the things I cannot change ». “Reframing our relationship to that we don’t control” is indeed a crucial step.
Inspired by such a thorough acceptance of what is, I tried to apply the same question to the current state of the world, having especially in mind the abominable flow of millions of refugees and the daily drowning of desperate families. “Do I wish the world to be a different place?” O yes I do! A burst of indignation even rises in me at the idea that I could ever stop wishing the world to be a better place and striving to contribute to that goal.
Then, the question arises: when does reframing our relationship to what we don’t control become a duty and when does accepting “what is” become a cop-out? As I pondered it, the rest of the Serenity Prayer rescued me out of an apparent dead-end: “… the courage to change the things I can, and the wisdom to know the difference”.
Then, give me the Wisdom, lots of it, PLEEASE, because some days, I can't stand the fact that thousands of Alan Kurdi's are pushed off the screens of the nation by the obscene antics of pathetic dyed-hair clowns striving to acquire the power to make things worse !
Thank you for On-Being.

I was completely blown away by this interview! I am a physician, with a strong interest in end-of-life issues (I work with HIV patients, mostly, and end-of-life used to be a big issue for us; now less so). I have considered pursuing a palliative care fellowship for many years (and still may). There are so many ideas that were mentioned that struck me as important, but the most important, IMO, was the idea that life (and its events) are not in our control. I think the myth that we have control is one of the main factors that gets so many of us into trouble, especially in the West. When we can learn to accept that we have very little control, we can liberate ourselves to appreciate what we do have. And I thought that the final thoughts were just perfect!! Thank you.


so many

in a boat

we carry

what remains

what essentials
what arts

of heart
of hand

can create home

can touch
can hold


Maybe it's a trite phrase, but I think BJ Miller truly embodies "be all that you can be".

My mother was dying of cancer last year, and about a week before she passed, she asked me "am I dying"? She knew her diagnosis, and not really wanting to get into a discussion, I said yes. But almost immediately, I thought, and wish I'd said that we're all dying, no one really knows exactly how much time we have left.

BJ's insights are full of authentic wisdom and perspective, earned from rich and varied experiences. I'm inspired by the thoughtful discourse on design, "proportionality," and crafting a meaningful life. BJ, you speak beautifully about gratitude - here's gratitude to you, for the work you do, and the kindness you role model.

As a former copywriter who worked with graphic designers every day, I so appreciate this idea of designing our lives, especially the "crescendo" of the end of our lives. And I also appreciate his reflection on the beautiful design of his prosthetic legs. As an Episcopal priest who has a good deal of experience with the dying and their families, I know the holiest and most peaceful deaths are the people who have lived their lives with imagination and vitality, even if their bodies were failing them. As a preacher of the Gospel, there is gold, especially during the Christian season of Lent, in Dr. Miller's understanding of wounds and the power they can have for good and the healing of others when they are outward and visible. And also in accepting the realities of our lives. Beautiful. I may already have my Good Friday sermon written!! Blessings on your work, Dr. Miller.
Hunt Priest, Emmanuel Episcopal Church, Mercer Island, Washington

I only heard the last half of Mr. Miller's interview but I latched right on to the quote that begins the above summary. What a shame to die of a lack of imagination. Over the last five years I have buried three members of my immediate family - sister, mother and mother-in-law - and my father-in-law won't be around much longer. (My own father died suddenly 38 years ago.) I have witnessed good and bad deaths. The experiences led me to Stephen Jenkinson, author of Die Wise and the Orphan Wisdom School. Reading and hearing Messrs. Jenkinson and Miller as well as others, I have come to the personal conclusion that the separation of life and death into discreet events - opposite poles, being and nonbeing - is the primary failure of imagination that leads us to bad deaths. Once one is able to accept death as a natural outcome of life, we can leave the dread behind and start imagining how to bring the same dignity, grace and élan to dying that we imagine for other deeply personal events in our lives. A great beginning for anyone interested in moving toward this acceptance (not resignation, defeatism or cynicism, but acceptance) is Ernest Becker's Denial of Death. Dying is one of the most important responsibilities we have to our families and communities. The alternative taints what came before, haunts our loved ones and is contributing to the bankrupting of our society. Live well, through to the end.

This was amazing! On Sunday mornings I listen to the TED Radio Hour & was fascinated to hear BJ Miller's talk on What Really Matters at the End of Life. On Sunday evenings, I listen to On Being and this week I was STUNNED to hear your wonderful interview with. . . BJ Miller! On the SAME DAY! Amazing. Both his talk and interview are worth listening to repeatedly, as there's SO much there to digest.

THANK YOU, Krista! I love your show. It inspires me & gives me good solid food for thought, time & again.

I ran across this TED TALK
where Sonia Shah discusses our history and relationship to malaria, a disease, suffering. Regardless of one's position/conclusions
about an effective response she raises interesting questions of design in encountering what is and what isn't inside our control.

My husband recently suffered a major stroke. It has caused me to think about what life means - what is life? His mind is alert, aware and responsive; his speech does not express that he is "normal" in his thinking. His right side is paralyzed, but slowly regaining strength, tone and movement. This man is alive - he can smile, laugh and cry. It is a redefinition of what life means and for him, for now, it is an expansion of the definition of being normal. I appreciate B.J. Millers discussion of "space and time", our relationship to the clock, or lack of same. The clock no longer expresses how time passes for my husband and for me. And we have come to accept this challenge and move within it with grace. Thank you for this wonderful interview.

This was a beautiful, powerful story and interview. I am amazed by the human spirit.

Surrounded, in our CCRC, by hundreds of very elderly people doing what they can, I'm inspired by their grace, their acceptance of what cannot be changed, and their efforts to change what can be changed. My husband is 90, enjoying life to the hilt, despite what he's lost, as are so many others here. At 79, I'm relatively young and healthy, and hope to deal gracefully with what may come. Our companions here are an inspiration: we have laughs, song, fun activities, and a warm and loving community. I only wish everyone our ages could be so lucky. I wish this were available to others with fewer financial resources. Everyone deserves this kind of experience.

Thank you. This part-man, part-God is doing that which all of us yearn to do--
he's living fully in the present moment.

God bless.

So much of this moved me deeply and helped re-frame what is currently a difficult time in my life. I recently learned that the person I have been in a relationship with for 3 years is battling big demons (substance addiction, shame, fear, hopelessness). It feels like the person I thought I knew is dead. I love him and have faith that he will emerge as more than what he was before, whether or not I'm there to see it. What resonated for me in B.J. and Krista's discussion was finding meaning in a major struggle. B.J. made the point that struggle grows you into something you never imagined was possible. Something that helps you live fully and can be shared as a gift of life with others. The piece on hope was re-framing for me, too. The observation that, at its essence, hope is a verb . Hope for what? What specifically do you hope for in the time you have left? It's a question that seems strange to ask someone days away from leaving this life. But we can hope for something as small as a slice of pizza or as personally meaningful as seeing a child's graduation--it almost doesn't matter. Hope sparks new life, renewed living even so close to death. Thank you.

How could the concept of death applied metaphorically to the death of ideas, or even the death of our environment? Does this type of thinking help a person, in any position in life, become whole?

It seems like Mr. Miller is a really adept ecological thinker. His devotion to design, and more importantly to his willingness to keep changing and improving design, his cognizance of the fact that he can always do things better, are great examples of true ecological thinking. What a great outlook on life!

What a great example of resilience and using change and disruption to recreate yourself into something better. You never know what moments are going to change your life.

Every day I try to walk a 2.7 mile loop at a local reservoir. Today I did so in the aftermath of a rainstorm. The water was rushing down the hillsides crossing my path, moving fast to flowing downhill. I listened to your conversation while delighting at the visuals and the ideas and wisdom I heard. My parents were recipients of hospice care back in 1997. I became a trained hospice patient & family care provider afterwards. It is sacred, hospice work, dying and death, just like all births are sacred. I'm moved that more people are aware of the nature of palliative & hospice care and therefore take advantage of the tender human-centered care. I loved so many of the thoughts voiced in this conversation. The way words are limiting -- like the containers that they are, black lines on paper, or uttered out of our mouths, the meaning of them in the dictionary spelled out correctly of course. But what does death mean? Or dying? The word may be able to be defined, but not the experience....for that one must slow down and take time, plumb for more words, more meanings, sit with the heat of another close by, look into another's eyes, their face, see a grimace or a smile, watch for tension in their shoulders, the grip or release of their hands...the shift of their body, the desire for privacy or sharing. One must sit, be still, listen, absorb, and be. In my hospice training our class was taught "it's not about you" that above all, we were not to bring our own definitions, limits, expectations or worries into the room, but be an open vessel, be fluid and able to move with the tenor and tone of the patient, the day, the family, the circumstances. None were the same, everyone different...even though the common thread is always we are here, we have been born and someday we will die. Still, so much in between. It's the in between that we are after, what happens there? Everyone, different, and everyone the same. It's an ageless mystery and puzzle, and also not mystery at all. We all know, don't we? That life goes. My thanks and gratitude for an outstanding podcast series. I loved this particular podcast more than words. Every good wish. Karen Mulvaney

I’ve come to the conclusion
that control
is basically an illusion.
We all just react
to that reality differently.
Some of us are out on the waves
learning to surf
while others chose to remain on shore,
fault lines beneath their feet.