#738: Dr. Gabor Maté and Dr. BJ Miller AI transcript and summary - episode of podcast The Tim Ferriss Show

Go to PodExtra AI's episode page (#738: Dr. Gabor Maté and Dr. BJ Miller ) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.

Go to PodExtra AI's podcast page (The Tim Ferriss Show) to view the AI-processed content of all episodes of this podcast.

View full AI transcripts and summaries of all podcast episodes on the blog: The Tim Ferriss Show

Episode: #738: Dr. Gabor Maté and Dr. BJ Miller

Author: Tim Ferriss: Bestselling Author, Human Guinea Pig
Duration: 02:11:37

Episode Shownotes

This episode is a two-for-one, and that’s because the podcast recently hit its 10-year anniversary and passed one billion downloads. To celebrate, I’ve curated some of the best of the best—some of my favorites—from more than 700 episodes over the last decade. I could not be more excited. The episode

features segments from episode #298 "Dr. Gabor Maté — New Paradigms, Ayahuasca, and Redefining Addiction" and episode #153 "The Man Who Studied 1,000 Deaths to Learn How to Live."Please enjoy!Sponsors:Vuori Clothing high-quality performance apparel: https://vuoriclothing.com/tim (20% off your first purchase)Shopify global commerce platform, providing tools to start, grow, market, and manage a retail business: https://shopify.com/tim (one-dollar-per-month trial period)LinkedIn Ads marketing platform with 1B+ users: https://linkedin.com/TFS (free $100 LinkedIn ad credit for your first campaign)Timestamps:[00:00] Start[05:37] Notes about this supercombo format.[06:57] Enter Gabor Maté.[07:22] Compassionate inquiry and trauma vs. traumatic.[11:06] Self-reconnection resources.[14:40] How Gabor benefits from yoga.[16:27] Gabor’s thoughts on the therapeutic value of psychedelics.[18:14] What’s been revealed by Gabor’s experiences with ayahuasca?[25:32] Essential intention.[26:30] We don’t respond to what happens, but to our perception of what happens.[32:48] Enter BJ Miller.[33:07] What does BJ do?[35:32] What does the first meeting look like for a new patient at the Zen Hospice Project?[37:18] Defining palliative care.[40:54] What happens when a patient dies in Zen Hospice compared to a regular hospital?[45:03] How many deaths has BJ experienced?[45:42] What has observing hundreds of deaths taught BJ about living?[50:39] On keeping a mindfulness or meditation practice.[55:05] About the Dinky (a terrifying story of electrocution).[1:04:29] The miracle of a snowball in the burn ward.[1:07:48] BJ’s experience as an undergraduate student at Princeton.[1:08:46] On the idea of art.[1:14:46] How BJ would support someone who suffered injuries similar to his own.[1:16:57] What helps people most in hospice care?[1:21:22] Why cookies matter.[1:23:12] Thoughts on the use of psychoactive compounds in end-of-life care and treating existential suffering.[1:33:46] BJ’s secret habit that might surprise most people.[1:38:32] Suggested material for an introverted hospice patient.[1:45:04] What comes to mind when BJ hears the word “successful?”[1:48:13] Daily practices for seeing good in people.[1:51:00] How to ride a motorcycle when missing three limbs.[1:55:01] What purchase of $100 or less has most positively affected BJ’s life?[1:56:53] BJ’s billboard.[1:58:24] BJ’s advice to his 30-year-old-self.[1:59:58] What has BJ changed his mind about in the last few years?[2:01:26] BJ’s requests/asks/suggestions of the audience.*For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim’s email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim’s books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissPast guests on The Tim Ferriss Show include Jerry Seinfeld, Hugh Jackman, Dr. Jane Goodall, LeBron James, Kevin Hart, Doris Kearns Goodwin, Jamie Foxx, Matthew McConaughey, Esther Perel, Elizabeth Gilbert, Terry Crews, Sia, Yuval Noah Harari, Malcolm Gladwell, Madeleine Albright, Cheryl Strayed, Jim Collins, Mary Karr, Maria Popova, Sam Harris, Michael Phelps, Bob Iger, Edward Norton, Arnold Schwarzenegger, Neil Strauss, Ken Burns, Maria Sharapova, Marc Andreessen, Neil Gaiman, Neil de Grasse Tyson, Jocko Willink, Daniel Ek, Kelly Slater, Dr. Peter Attia, Seth Godin, Howard Marks, Dr. Brené Brown, Eric Schmidt, Michael Lewis, Joe Gebbia, Michael Pollan, Dr. Jordan Peterson, Vince Vaughn, Brian Koppelman, Ramit Sethi, Dax Shepard, Tony Robbins, Jim Dethmer, Dan Harris, Ray Dalio, Naval Ravikant, Vitalik Buterin, Elizabeth Lesser, Amanda Palmer, Katie Haun, Sir Richard Branson, Chuck Palahniuk, Arianna Huffington, Reid Hoffman, Bill Burr, Whitney Cummings, Rick Rubin, Dr. Vivek Murthy, Darren Aronofsky, Margaret Atwood, Mark Zuckerberg, Peter Thiel, Dr. Gabor Maté, Anne Lamott, Sarah Silverman, Dr. Andrew Huberman, and many more.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Full Transcript

00:00:00 Speaker_03
This episode is brought to you by Viori clothing, spelled V-U-O-R-I, Viori. I've been wearing Viori at least one item per day for the last few months, and you can use it for everything. It's performance apparel, But it can be used for working out.

00:00:18 Speaker_03
It can be used for going out to dinner, at least in my case. I feel very comfortable with it. Super comfortable, super stylish. And I just want to read something that one of my employees said. She is an athlete.

00:00:31 Speaker_03
She is quite technical, although she would never say that. I asked her if she had ever used or heard of Viore and this was her response. I do love their stuff, been using them for about a year.

00:00:42 Speaker_03
I think I found them at REI, first for my partner, t-shirts that are super soft but somehow last as he's hard on stuff, and then I got into the super soft cotton yoga pants and jogger sweatpants. I live in them and they too have lasted.

00:00:54 Speaker_03
They're stylish enough, I can wear them out and about. The material is just super soft and durable. I just got their Clementine running shorts for summer and love them. The brand seems pretty popular, constantly sold out.

00:01:04 Speaker_03
In closing, and I'm abbreviating here, but in closing, with the exception of when I need technical outdoor gear, they're the only brand I've bought in the last year or so for yoga, running, lounge wear that lasts and that I think look good also.

00:01:17 Speaker_03
I like the discreet logo. So that gives you some idea. That was not intended for the sponsor read. That was just her response via text. Viori, again spelled V-U-O-R-I, is designed for maximum comfort and versatility. You can wear it running.

00:01:32 Speaker_03
You can wear their stuff training, doing yoga, lounging, weekend errands, or in my case, again, going out to dinner. It really doesn't matter what you're doing. Their clothing is so comfortable

00:01:43 Speaker_03
And it looks so good and it's not offensive that you don't have a huge brand logo on your face. You'll just want to be in them all the time. They're men's core short, K-O-R-E. The most comfortable lined athletic short is your one short for every sport.

00:01:58 Speaker_03
I've been using it for kettlebell swings, for runs, you name it. The Banks short. This is their go-to-land to see short is the ultimate in versatility. It's made from recycled plastic bottles.

00:02:09 Speaker_03
And what I'm wearing right now, which I had to pick one to recommend to folks out there, or at least to men out there, is the Ponto Performance Pant. And you'll find these at the link I'm gonna give you guys.

00:02:20 Speaker_03
You can check out what I'm talking about, but I'm wearing them right now. They're thin performance sweat pants, but that doesn't do them justice. So you gotta check it out, P-O-N-T-O, Ponto Performance Pant.

00:02:30 Speaker_03
For you ladies, the women's performance jogger, is the softest jogger you'll ever own. Viore isn't just an investment in your clothing, it's an investment in your happiness. And for you, my dear listeners, they're offering 20% off your first purchase.

00:02:44 Speaker_03
So get yourself some of the most comfortable and versatile clothing on the planet. It's super popular. A lot of my friends I've now noticed are wearing this. And so am I. VioriClothing.com forward slash Tim. That's V-U-O-R-I Clothing.com slash Tim.

00:03:01 Speaker_03
Not only will you receive 20% off your first purchase, but you'll also enjoy free shipping on any US orders over $75 and free returns. So check it out. VioriClothing.com slash Tim. That's V-U-O-R-I Clothing.com slash Tim.

00:03:17 Speaker_03
And discover the versatility of Viori Clothing. This episode is brought to you by Shopify, one of my absolute favorite companies, and they make some of my favorite products.

00:03:30 Speaker_03
Shopify is the commerce platform revolutionizing millions of businesses worldwide, and I've known the team since 2008 or 2009. But prior to that, I wish I had personally had Shopify in the early 2000s when I was running my own e-commerce business.

00:03:45 Speaker_03
I tell that story in the 4-Hour Workweek, but the tools then were absolutely atrocious, and I could only dream of a platform like Shopify.

00:03:53 Speaker_03
In fact, it was you guys, my dear readers, who introduced me to Shopify when I polled all of you about best e-commerce platforms around 2009, and they've only become better and better since.

00:04:04 Speaker_03
Whether you're a garage entrepreneur or getting ready for your IPO, Shopify is the only tool you need to start, run, and grow your business without the struggle. Shopify puts you in control of every sales channel.

00:04:15 Speaker_03
It doesn't matter if you're selling satin sheets from Shopify's in-person POS system or offering organic olive oil on Shopify's all-in-one e-commerce platform. However you interact with your customers, you're covered.

00:04:26 Speaker_03
And once you've reached your audience, Shopify has the internet's best converting checkout to help you turn browsers into buyers. Shopify powers 10% of all e-commerce in the United States.

00:04:37 Speaker_03
Shopify is truly a global force as the e-commerce solution behind Allbirds, Rothy's, Brooklyn and millions of other entrepreneurs of every size across more than 170 countries.

00:04:48 Speaker_03
Plus, Shopify's award-winning help is there to support your success every step of the way if you have questions. This is Possibility powered by Shopify.

00:04:56 Speaker_03
So check it out, sign up for a $1 per month trial period at Shopify, that's S-H-O-P-I-F-Y, shopify.com slash Tim. Go to shopify.com slash Tim to take your business to the next level today. One more time, all lowercase, shopify.com slash Tim.

00:05:13 Speaker_03
At this altitude, I can run flat out for a half mile before my hands start shaking.

00:05:19 Speaker_00
Can I ask you a personal question?

00:05:21 Speaker_01
Now would've seen an appropriate time.

00:05:25 Speaker_05
What if I did the opposite? I'm a cybernetic organism living this year over a metal endoskeleton.

00:05:37 Speaker_03
Hello boys and girls, ladies and germs, this is Tim Ferriss.

00:05:40 Speaker_03
Welcome to another episode of the Tim Ferriss Show, where it is my job to sit down with world class performers from every field imaginable to tease out the habits, routines, favorite books, and so on that you can apply and test in your own lives.

00:05:54 Speaker_03
This episode is a two for one, and that's because the podcast recently hit its 10th year anniversary, which is insane to think about, and passed 1 billion downloads.

00:06:03 Speaker_03
To celebrate, I've curated some of the best of the best, some of my favorites from more than 700 episodes over the last decade. I could not be more excited to give you these super combo episodes.

00:06:15 Speaker_03
And internally, we've been calling these the super combo episodes, because my goal is to encourage you to, yes, enjoy the household names, the super famous folks, but to also introduce you to lesser known people I consider stars.

00:06:29 Speaker_03
These are people who have transformed my life, and I feel like they can do the same for many of you. Perhaps they got lost in a busy news cycle, perhaps you missed an episode.

00:06:39 Speaker_03
Just trust me on this one, we went to great pains to put these pairings together. And for the bios of all guests, you can find that and more at tim.blog slash combo. And now, without further ado, please enjoy, and thank you for listening.

00:06:56 Speaker_01
First up, Dr. Gabor Mate, Twitter at DrGaborMate and DrGaborMate.com.

00:07:05 Speaker_01
Gabor is an addiction and trauma expert and best-selling author of In the Realm of Hungry Ghosts, When the Body Says No, and The Myth of Normal, Trauma, Illness, and Healing in a Toxic Culture.

00:07:22 Speaker_03
One of the epiphanies for me in the last very recent year or two has been looking at my coping mechanisms very differently.

00:07:34 Speaker_03
And what I mean by that is for a very long time I had certain behaviors, certain defaults that I hated, which of course means I'm hating a part of myself. And that included anger, rage responses, use of stimulants, you name it.

00:07:50 Speaker_03
I always applied this loving kindness meditation to other people.

00:07:53 Speaker_03
And what was recommended is that I apply that loving kindness to the younger Tim, to the other versions of Tim who had these behaviors that I had grown to hate and resent and to actually thank them for the role they played.

00:08:07 Speaker_03
For instance, that rage, that anger was the fuel that got me out of Long Island.

00:08:12 Speaker_03
I'd just love to hear, and we can take it anywhere we want of course, but once you have shifted the focus from why the addiction to why the pain and you start to work with someone, what approaches have you found to help? What tools?

00:08:24 Speaker_00
I call it compassionate inquiry. So inquire in a compassionate way, not why did I do this, but why did I do this? Right. The first one is not a question. It's a statement. It's a self-condemnation. The second one is a question. Hmm. Wonder why I did this?

00:08:40 Speaker_00
Ah, it's with my pain. And so what your friend said that it served you. So thank it. Love it. but let go of it is absolutely right. I call it the stupid friend.

00:08:52 Speaker_00
The stupid friend is the one who helps you in a particular way at a certain time, but it can't learn that that way doesn't function anymore. Then instead of helping, now it's hurting.

00:09:02 Speaker_00
So it's a friend because it's really trying to help, but it's stupid because it's not learning that you're no longer that three-year-old or that five-year-old or that 15-year-old.

00:09:12 Speaker_00
Now, this leads to the question of trauma, because it's one thing to recognize that all this originates in childhood pain. It's quite another to transform that pain. And for that, we have to understand what trauma is.

00:09:25 Speaker_00
So people often think that trauma is what happens to you. So trauma is a divorce when you were small and your parents fighting. Trauma is your mother's depression. Trauma is your father's alcoholism. Trauma is your parents' argumentation.

00:09:42 Speaker_00
Trauma is physical or sexual abuse or some loss. Those aren't the traumas. Those are traumatic. But the trauma is not what happens to you. The trauma is what happens inside you.

00:09:54 Speaker_00
And as a result of these traumatic events, what happens inside you is you get disconnected from your emotions, and you're disconnected from your body, and you have difficulty being in the present moment, and you develop a negative view of your world, and a negative view of yourself, and a defensive view of other people.

00:10:13 Speaker_00
And these perspectives keep showing up in your life in the present. because they're the stupid friends.

00:10:20 Speaker_00
And so the issue is not just to recognize what happened 10, 15, 30, however many years ago, but to actually recognize the manifestations in the present moment and to transcend them. And how do you do that?

00:10:33 Speaker_00
By reconnecting with yourself, by restoring the connection with your body primarily and with your emotions that you lost. And once you do, When you found these things again, then you have what we call recovery.

00:10:46 Speaker_00
Because what does it mean to recover something? It means to find it again. So what is it that people find when they recover? They find themselves. And the loss of self is the essence of trauma.

00:10:58 Speaker_00
So the real purpose of addiction treatment, mental health treatment, any kind of healing is reconnection.

00:11:06 Speaker_03
For people who are listening and want to reconnect with themselves, with their bodies, for instance, what recommendations might you have, whether that's things they can do or resources they can look to or both or something else? What recommendations?

00:11:23 Speaker_03
Because I'm sure, I'm 100% sure, because I've had people come on and for the very first time on this podcast talk about sexual abuse that they endured as children and what they did to help recover from that.

00:11:37 Speaker_03
Many people listening, I am sure, have addictions, both traumatic past experiences and trauma.

00:11:43 Speaker_00
What recommendations could you make for them? So I want to say, first of all, that for trauma, you don't need terribly traumatic events. So there's two ways to look at trauma. One is that bad things happen that shouldn't have. We've talked about those.

00:11:56 Speaker_00
But the other way to get traumatized is when good things happen that should have happened. Good things didn't happen that should have happened. Look at that trauma of omission.

00:12:04 Speaker_00
Trauma of omission where the parents, not that they didn't love you, not that they didn't do their best, but they were too stressed, traumatized, distracted themselves. Then you didn't get the kind of attention.

00:12:13 Speaker_00
and the kind of acceptance and the kind of attuned being with that you needed, that itself can make you disconnect from yourself. The child needs that acceptance, that connection, that attunement. Our brain development requires it.

00:12:25 Speaker_00
Our emotional development demands it. And when we don't get it, not because the parents don't love us, but simply because of their own issues, we can also suffer that disconnection. So that's what I call developmental trauma. Now, how do we connect?

00:12:39 Speaker_00
Well, there are many, many forms of therapy. It's very difficult for anybody to do this on their own. Some people do it. I certainly couldn't do it on my own. I've needed a lot of help in terms of therapy that helps me understand what happened to me.

00:12:54 Speaker_00
And so that there's a reason for it. So that if there's a reason for it, then it's no longer me. I'm not somebody to be ashamed of. I'm just somebody who developed along certain lines for some very good reasons.

00:13:07 Speaker_00
But it's not in my deepest character, and it's not who I am, and I don't have to be that way. That's a relief to know. It's also not that I'm genetically programmed, so I'm doomed to stay that way. Number one.

00:13:18 Speaker_00
Number two, you have to reconnect with the body. There are various body therapies. My friend Peter Levine and his somatic experiencing... The Walking Tiger? Is that one of his books? Waking the Tiger. Waking the Tiger.

00:13:29 Speaker_00
Waking the Tiger was his first book, and he's written many wonderful books since then. That's the somatic. Somatic experiencing, his method is called, which he developed. It's brilliant.

00:13:37 Speaker_00
There is EMDR, eye movement desensitization reprogramming, which is a way of bypassing the conscious mind and getting to the emotional brain and quicker than talk therapy by itself can do.

00:13:52 Speaker_00
So it's combined with talk therapy, but it takes you past just the conscious defensive egoic mind. There is emotional freedom tapping that people do. There's various variations on that. There is motor sensory integration techniques.

00:14:08 Speaker_00
Then there is the traditional therapies like yoga. Now yoga was not simply a physical modality when it first developed. Yoga actually means unity.

00:14:17 Speaker_00
So the very essence of yoga is to regain that unity, not just with ourselves, but also with the larger creation.

00:14:23 Speaker_00
And so yoga, when it's practiced in its intended way, not just the hot yoga where you get a good workout, that's great, I'm not against it, but I'm talking about intentional yoga with a meditative aspect to it, which is taught by a number of disciplines, body work of all kinds.

00:14:39 Speaker_03
I'm just going to hit pause for one second. Do you practice yoga? And if so, what type do you practice?

00:14:43 Speaker_00
So I've always said that with my ADHD, I'm not a yoga person. I can't do it. Until a year and a half ago, I met actually a yogi. His name is Sadhguru. He's an Indian yogi with a big following. I was very skeptical, but I met the guy.

00:14:55 Speaker_00
I now have a 50 minute daily yoga practice, which I did this morning before coming to the interview. And this made an enormous difference in my life. With my ADHD mind, I really have trouble just sitting there.

00:15:05 Speaker_00
When I sit on the meditation cushion, my mind is like all over the place. But with the yoga, which is more body based, I can stay much more present. There is a meditational component to it. And so the answer is yes.

00:15:19 Speaker_00
If you had asked me 18 months ago, I would have said, no, I support it, but I don't do it. but now I'm actually a very committed practitioner and it really has made a difference.

00:15:30 Speaker_00
Is it a particular type of yoga that people could Google or learn more about?

00:15:36 Speaker_00
So I'm not a yoga expert and there's many forms of yoga that other people more knowledgeable than I am could recommend but the one I learned is called Inner Engineering and it's taught by either Sadhguru or his followers and you can look up Inner Engineering online.

00:15:49 Speaker_00
Inner Engineering. When I recommended France and others, everybody's been only being grateful, so I can highly recommend it.

00:15:55 Speaker_00
Typically, there's to me what seems to be a cult around the guy, which I don't take to particularly, but he's the genuine article in terms of having a deep experience and being able to transmit that experience to others and creating a

00:16:09 Speaker_00
practical system around it. So it's worked for me. I'm not here to recruit anybody else, but since you're asking.

00:16:16 Speaker_03
No, no, it's just my fans appreciate. Yeah. Well, you know, I'm not going to blame it on my fans. I like specifics.

00:16:21 Speaker_00
So Inner Engineering, you can look up online and it's taught here in the States and in Canada internationally, actually.

00:16:27 Speaker_03
But I did interrupt you. You're about to mention, I think, another technique or modality that can help.

00:16:33 Speaker_03
You talked about, for instance, the somatic experience, EMDR, emotional freedom tapping, motor sensory integration, technique or techniques, yoga, and then there's something coming up after that.

00:16:44 Speaker_00
Well, about 10 years ago, I began to work with psychedelics. Now, if 15 years ago you were to ask me, will I ever be working with psychedelics as a healing modality, I would have said, you're out of your mind.

00:16:56 Speaker_00
But then, through a series of events, I became aware of the potential role of psychedelics in healing, and I've been doing work with them now for 10 years. They're another potent method. They're not for everybody.

00:17:10 Speaker_00
And I have to emphasize that whatever modality you choose of a psychedelic nature, you have to do it with adept practitioners with deep integrity and deep knowledge and experience.

00:17:22 Speaker_00
But in such hands and in such a context, it can be like a superhighway to self-awareness, not in isolation.

00:17:32 Speaker_00
but it opens doors that otherwise might take years and so it's not unusual for me to conduct a psychedelic session with somebody or a series of sessions either in a group or individual setting and have them say that was like 10 years of psychotherapy in one day and I've had the same experience myself.

00:17:51 Speaker_00
So again it's not to be isolated from other kinds of work and it has to be integrated but it's another potent way of working and of course

00:17:59 Speaker_00
As I know you're personally aware, there's an increasing movement amongst psychologists, therapists, psychiatrists, medical doctors, other healers to find ways of incorporating psychedelic healing in the larger therapeutic scheme.

00:18:14 Speaker_03
So Gabor, you mentioned a series of events leading you to psychedelics or to consider psychedelics. potentially is a healing or medical modality. If you're able to, could you describe any of those events?

00:18:29 Speaker_00
Sure. So in 2008, my book on addiction, In the Realm of Hungry Ghosts, Close Encounters with Addiction, was published in Canada and very quickly became a number one national bestseller, subsequently published in the States as well.

00:18:44 Speaker_00
And I was on a book tour and people kept asking me, what do you know about addictions and ayahuasca as a treatment? Ayahuasca being a Peruvian or Amazonian vine that's made into a brew that has psychedelic properties. I knew nothing.

00:19:01 Speaker_00
the next speech or the next event, somebody else would ask, what do you know about ayahuasca and the two-node addiction?

00:19:06 Speaker_00
I finally started getting annoyed with it, like leave me alone, I've just written a book, I've spent years researching it, my life experience and all kinds of scientific exploration went into it, ask me about something I know about.

00:19:19 Speaker_00
And then I realized that maybe The universe was knocking on my door. And somebody said, did you know you could experience it here in Vancouver? There was a Peruvian shaman leading some ceremonies up in Vancouver. So who am I to say no?

00:19:33 Speaker_00
And I jumped right in and I sat in this tent with 50 other people. Yeah, that's how they set it up. It's not what I recommend, but that's how they set it up. They played beautiful music. And there was a little baby in the room.

00:19:49 Speaker_00
Mother and dad were there for the experience. The baby was in the room and the baby was cooing away. And tears started flowing down my face. And these were not tears of sorrow, they were tears of joy.

00:20:02 Speaker_00
And I got in touch with such profound love that I had never consciously experienced before. And there were tears of love. And it wasn't love for anybody in particular. It was just love.

00:20:16 Speaker_00
And then I saw in all the ways that I had closed my heart against love in my life. and how I betrayed love in my personal relationship with my spouse and my children and in other ways.

00:20:29 Speaker_00
So I just got this experience of love as something profound and universal and life-defining, but something from which I've been cut off in so many ways. And I got it.

00:20:43 Speaker_00
because I closed my heart against love precisely because when I was vulnerable and small, I'd been so hurt. Going to my mother's states of mind, she couldn't respond to me the way I needed to be responded to. Not her fault, but she couldn't.

00:20:57 Speaker_00
And then when I was a year old, she gave me to a stranger to save my life. And I didn't see her for a month, which is a huge... Can you just explain that for a second? So again, it's Budapest, Hungary, Second World War, January.

00:21:09 Speaker_00
The Russians have circled Budapest and are fighting the Germans. The government in power is a right-wing, fascist, anti-Semitic military force.

00:21:21 Speaker_00
And even though the deportations of Jews had stopped, the Germans had annihilated half a million Hungarian Jews in three or four months.

00:21:28 Speaker_00
But now the Hungarian fascists were killing Jews in Budapest, including in the house where my mother and I were living. So my mother gave me to a stranger in the street, a Christian woman, because she didn't know if she'd be dead or alive next day.

00:21:39 Speaker_00
Wow. Or that I would be. And I was quite sick. So I didn't see her for a month, which I experienced as a deep abandonment. How else could I experience it? So my heart closes. against love. And I got all this.

00:21:54 Speaker_00
And so I got that if this plant that as you say manifests the mind can show me both the ways in which I've closed off from myself and that I don't need to because the love is still there, what healing potential it has.

00:22:10 Speaker_00
Now, I wish I could say that after that experience I became a loving husband and a loving human being. I didn't. It's not that simple, you know, as my wife could tell you. Nevertheless, it opened the door for me and I got right away.

00:22:25 Speaker_00
Now, however, the thought that I had was that I had no induction, I had no introduction, I had no processing afterwards.

00:22:34 Speaker_00
Ayahuasca is a medicinal plant that has been used in the Amazon basin for hundreds of years, maybe longer, in a cultural context, in a tribe, in a village where people know each other, where they know the shaman, where they share the same assumptions and the same history.

00:22:49 Speaker_00
That's not the same as a bunch of Westerners, strangers to each other, coming together for one night, drinking and stuff, and then going their separate ways. Agreed.

00:22:57 Speaker_00
So, immediately the question that came up for me was, how can we create a setting that at least resembles, as best we can, fashion, the original setting?

00:23:09 Speaker_00
So we came up with the idea of a retreat where a small number of people get together with properly trained shamans who have integrity and experience, deep experience, and with me facilitating people's preparation and their post-ceremony integration.

00:23:28 Speaker_00
And so I've been doing that now for 10 years. A lot of learning involved. We made mistakes, but it evolved. And the essence of it is that people don't come into it cold.

00:23:37 Speaker_00
They come into the preparation in a safe setting where pretty soon a group becomes a family to each other, which means that not only do they love each other and support each other, but they also trigger each other.

00:23:48 Speaker_00
I mean, basically I tell people, guess what? You're back and you found your virgin and everything you've hated but you found urgent is going to show up here. But in the context where it's safe for that to happen. And so I've seen a lot of great healing.

00:24:03 Speaker_00
I've had people with multiple suicide attempts heal from depression. I've seen people get much better with their autoimmune diseases.

00:24:10 Speaker_00
I've seen people deal with all kinds of addictions and life issues, relationship problems, come out of it much more themselves, much more able to deal with these issues, so long as the proper integration is done afterwards.

00:24:22 Speaker_00
So that was my personal experience. Well, can I again give you a quote? Yes, please. Which I love. It's from one of my favorite teachers, and his name is A.H. Almas.

00:24:33 Speaker_00
And he says, your conflicts, all the difficult things, the problematic situations in your life are not chance or haphazard. They're actually yours.

00:24:42 Speaker_00
They're specifically yours, designed specifically for you by a part of you that loves you more than anything else. The part of you that loves you more than anything else has created roadblocks to lead you to yourself.

00:24:53 Speaker_00
You're not going to go in the right direction unless there's something pricking you on the side saying, telling you, look here, this way. That part of you loves you so much that it doesn't want you to lose the chance.

00:25:04 Speaker_00
It will go to extreme measures to wake you up. It will make you suffer greatly if you don't listen. What else can it do? That's its purpose. And I found this to be true of physical illness and

00:25:17 Speaker_00
mental problems and everything, you got to see what is the teaching here.

00:25:21 Speaker_00
So we can look at all these things as problems to get rid of, which is what the personality wants to do, or we can look at them as learning opportunities, which is what your true self wants to do. Now, two things.

00:25:34 Speaker_00
One is you talked about intention in life. So my wife and I had a holiday recently in Costa Rica. Partly it was a working holiday, but partly it was just a holiday.

00:25:43 Speaker_00
Traditionally, we've had terrible times during holidays, partly because of my workaholism. And once I go into a holiday, I just collapse.

00:25:50 Speaker_00
And now my wife is dragging a corpse around, you know, because, because I'm a workaholic, you know, and I hadn't clear space. So, so this time we actually went into the holiday with intention.

00:26:01 Speaker_00
This is nothing to do with psychedelics, just to do with what we said, an intention. What is our intention?

00:26:06 Speaker_00
And if we have an intention, I've learned from a couple of very wise teachers, what structures we want to set up to support our intention, and how we're going to handle when there's kind of disagreement or conflict.

00:26:17 Speaker_00
We had a beautiful holiday because it was the first intentional holiday that we've had. So that intention in life in general is absolutely essential. Like every morning, what is my actual intention? So the problems, the upset.

00:26:30 Speaker_00
So want to do a bit of an exercise? Sure. Okay. And then, you know, if you don't like it, just tell me.

00:26:35 Speaker_00
This is something I do in my groups or when I speak or in the song, when I teach, I ask people to tell me some recent episode when they're upset with somebody with their lives.

00:26:45 Speaker_00
And something that they're open to sharing, so it doesn't have to be anything sordid or something. But just something, you know, whether it's your spouse, partner, the bus driver, I don't care who. Sure. A friend. Okay. So are you going to go there?

00:26:55 Speaker_00
Anything. Okay. I can share anything? Just where you were upset with somebody.

00:26:59 Speaker_03
Okay.

00:26:59 Speaker_00
Yes. Okay. So what happened? Describe it.

00:27:02 Speaker_03
What happened? Yeah. All right. There were a number of issues in my home broken aspects of the home, things that were falling apart or needed to be fixed. Physically. Physically. Yeah. Right. And I had hired someone to do these things while I was gone.

00:27:19 Speaker_00
Okay.

00:27:19 Speaker_03
And I came back and none of them were fixed.

00:27:20 Speaker_00
Okay. And your emotional reaction was?

00:27:23 Speaker_03
Anger.

00:27:23 Speaker_00
Rage. Anger. Okay. Anything else besides anger? I think they're close cousins. Frustration.

00:27:30 Speaker_03
Frustration is anger, yeah? Yeah. I was disappointed. Disappointed is sadness. Yeah, it's a different feeling.

00:27:40 Speaker_00
So I was disappointed in myself also, because I started to look at how maybe... Well, disappointed is not so much an emotion as a state of mind. I'm asking what the emotions were. What's inside disappointment?

00:27:52 Speaker_00
Something didn't happen, I want it to happen. How do I feel? Isn't there sadness there?

00:27:57 Speaker_03
Sure. Yeah, there's sadness.

00:27:58 Speaker_00
I'm not talking into it. I'm just asking.

00:28:00 Speaker_03
Well, I suppose I might be confusing states of mind and emotions. I'm not sure how to do it.

00:28:06 Speaker_00
I'm looking at the raw emotion.

00:28:08 Speaker_03
Yeah, sadness.

00:28:10 Speaker_00
So there's anger and sadness. Those are the emotions. Let's go with that. Okay. So I'm going to ask you a silly question. What were you sad and angry about?

00:28:18 Speaker_03
Well, I suppose the answer, which is not the right answer I'm expecting, was I was angry that someone had made commitments to me and not fulfilled those commitments.

00:28:29 Speaker_00
Okay, well, that's what happened. They had made the commitment in the phone, but that doesn't tell me what you were sad or angry about. What does that mean that they didn't fulfill their commitments? It meant that they didn't care about

00:28:42 Speaker_00
me, they didn't respect me. So they didn't care about you, they didn't respect you. What kind of person doesn't get cared for or respected? I might need a lifeline here.

00:28:51 Speaker_03
Don't know. Someone who doesn't deserve to be cared for or respected.

00:28:53 Speaker_00
Exactly. Somebody unworthy, right? Sure. Of respect and care. Okay. Now, if there are other people here, which there usually are when I do this exercise, I would ask them, OK, we just listened to Tim tell us about this experience.

00:29:07 Speaker_00
Are there other reasons why this other person might not have done the work that has nothing to do with him or her not caring about him or not respecting him? So what are the reasons might there be?

00:29:18 Speaker_03
A million and one. He could be in the hospital. His partner carried one, could have been in a car accident. He had a flight delay and got caught on Puerto Rico during a hurricane.

00:29:33 Speaker_00
He's got ADHD and he can't follow through. He's under stress and he couldn't

00:29:40 Speaker_03
Right, the email that I was supposed to send sitting in drafts and I thought I had sent it but in fact he never received it.

00:29:45 Speaker_00
Okay, and any number of possibilities. Now, of all the possibilities that you've just outlined, including they don't care about you or respect you, which is the worst one? The one I immediately defaulted to. Right. Well, I mean the worst.

00:30:00 Speaker_00
No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,

00:30:11 Speaker_00
A, you, I should say we, because we're all like this, we don't respond to what happens. We respond to our perception of what happens. That's what the Buddha said. It's with our minds we create the world.

00:30:23 Speaker_00
So that if you'd found out he had ADHD or he was stressed, you might have been sad for him, but you would not have been angry and you would not have been sad.

00:30:34 Speaker_00
So, first of all, we don't respond to what happens, we respond to our perception of what happens, to our interpretation of what happens. Number one. Of all the possible interpretations, we choose the worst one, the two.

00:30:45 Speaker_00
Thirdly, what I just said isn't true. We didn't choose it. It's not like you went through all these possibilities and you said, was it multiple choice? I chose option D. Oh no, he doesn't care about me. He doesn't respect me. You didn't do that.

00:30:56 Speaker_00
Your brain jumped there automatically, right? The question is why? Now here's the learning. First time in your life that you felt hurt and angry that when you perceive somebody didn't care about you or didn't respect you, or has it happened before?

00:31:09 Speaker_03
This is where the exercise might go sideways. I'm going to hit pause on that. I think that's probably for more of a conversation over wine.

00:31:15 Speaker_00
But you probably agree it's not the first time.

00:31:17 Speaker_03
It's not the first time.

00:31:17 Speaker_00
Very good. And most people I talk to, it goes back way back.

00:31:21 Speaker_03
Yeah, this goes way back.

00:31:23 Speaker_00
Into childhood.

00:31:27 Speaker_03
Just a quick thanks to one of our sponsors, and we'll be right back to the show. This episode is brought to you by LinkedIn Ads. As a business-to-business marketer, your needs are unique.

00:31:37 Speaker_03
The B2B buying cycles are long, and your customers face incredibly complex decisions. Isn't it time you had a marketing platform that was built specifically for you and your needs?

00:31:47 Speaker_03
LinkedIn Ads allows you to build the right relationships, drive results, and reach your customers in a respectful environment.

00:31:53 Speaker_03
You'll have direct access to and build relationships with decision makers, 1 billion members, 180 million senior level executives, and 10 million C-level executives.

00:32:03 Speaker_03
You'll be able to drive results with targeting and measurement tools built specifically for B2B.

00:32:09 Speaker_03
In technology specifically, LinkedIn generated a 2-5x higher return on ad spend than other social media platforms, based on an assessment by Analytic Partners. 79% of B2B content marketers said LinkedIn produces the best results for paid media.

00:32:24 Speaker_03
So, make B2B marketing everything it can be and get a $100 credit on your next campaign. Check it out, go to linkedin.com slash tfs to claim your credit. That is linkedin.com slash tfs as in Tim Ferriss show. One more time, linkedin.com slash tfs.

00:32:42 Speaker_03
Terms and conditions apply.

00:32:48 Speaker_01
And now, Dr. B.J. Miller, Twitter at BJMillerMD, a hospice and palliative care specialist, author, and speaker, whose TED Talk, What Really Matters at the End of Life, has been viewed more than 17 million times. B.J., welcome to the show.

00:33:08 Speaker_03
Thank you, Tim, it's nice to be here. I have been wanting to talk to you, or I should say I have wanted to talk to you for years now. And just give a few examples and illustrate that.

00:33:22 Speaker_03
The first was an article that I came across in the Princeton Alumni Magazine, Princeton Alumni Weekly, about your work. And then the next was a profile in a magazine here in San Francisco.

00:33:37 Speaker_03
Following on the tales of that, Adam Ghazali, who is just an incredible neuroscientist at UCSF who's been on the podcast, reached out to me, and that was related to a, I think it was a senior partner at IDEO who had also reached out to him to suggest that you be on the podcast.

00:33:55 Speaker_03
So I feel like this was fated to be, and I've been increasingly over the last few years thinking about death and the value of meditating on death, among other things.

00:34:12 Speaker_03
But before we get there, and I suppose we'll get there rather quickly, when people ask you what do you do, how do you answer that?

00:34:22 Speaker_02
I guess I generally say, you know, generically I'll say, oh, I'm a physician. And if people seem like they actually really want to talk things out, I'll say, well, I'm a palliative care doc. Then people won't talk out from there.

00:34:35 Speaker_02
I'll say I work at a remarkable place called the Zen Hospice Project and do some work at UCSF and do increasing amounts of speaking and beating the drum, I like to say.

00:34:46 Speaker_02
So depending on how interested the person asking the question is, that's what they might hear from me.

00:34:52 Speaker_03
Let's say they're very interested. I don't know if you drink, but let's say the other person's had two drinks, so pleasantly drunkenly curious, and they say, what drum are you beating? I'm really interested to hear more. What is the drum?

00:35:07 Speaker_02
Well, the drum, I suppose, really is getting society to pay attention to the inevitables in life, helping each other look at hard stuff. helping each other to live with hard truths.

00:35:20 Speaker_02
I'm trying to get people to pay attention to the fact that we all die and that the way we die could be a lot better than it is in general.

00:35:32 Speaker_03
Let's dig into that because I really enjoyed, for instance, your TED talk and maybe you've given multiple, but at least the one that I saw. Just one, yeah. Which is, and one is enough, by the way. No kidding. But let's look at sample experience.

00:35:52 Speaker_03
So you have a new patient come into your facility. What does the first meeting look like and what does that first day look like for them?

00:36:03 Speaker_02
Let me pre answer your question because it's so depends so for example at zen hospice project by virtue of coming to our place by virtue of enrolling in hospice. Many corners will have been turned just to get to that place so.

00:36:21 Speaker_02
When we're meeting close to the folks the first time is that hospice. Day for the most part are aware that time is short are aware that they're dying soon are aware that there's really not much more to beat back their disease to be done.

00:36:36 Speaker_02
And there's plenty of work to be done even on the far side of turning that corner another way of answer your question is really upstream of hospice.

00:36:46 Speaker_02
When folks are struggling, gone to war with their disease, engaged in that fight, whether it's chemotherapy or whatever, that's the kind of person I'll meet in clinic at UCSF.

00:36:59 Speaker_02
So part of my job is on faculty at UCSF, and I work in a clinic that's called the Symptom Management Service. It's about 10 years old. And that's just basically a euphemism for palliative care.

00:37:10 Speaker_02
The Cancer Center wanted us to call it the Symptom Management Service because it felt that the palliative care phrase had too much baggage around it.

00:37:17 Speaker_03
And is palliative care, I'm just going to plead ignorance here, is that synonymous with hospice care or are those different things?

00:37:25 Speaker_02
They are related but different. And thank you for asking that question, Tim. I mean, this is part of the drumbeat. So hospice is that portion of palliative care that's at the end of the road.

00:37:35 Speaker_02
And hospice is an insurance designation as much as it is a philosophy of care. So hospice is, by definition, end-of-life care. Time is not an issue in palliative care. You just have to be suffering.

00:37:47 Speaker_02
You can see folks in palliative care for many, many years. far in advance of their death. So yeah, all hospice is palliative care, but not all palliative care is hospice. Got it.

00:37:59 Speaker_02
All right, so palliative care, just to kind of make it, is basically, within the context of dealing with illness, palliative care is the pursuit of quality of life. Period. That's it. So the fulcrum in palliative care is suffering.

00:38:16 Speaker_02
Are you suffering in some intractable way, struggling more than you need to? And if so, then come see us in palliative care. We'll help.

00:38:27 Speaker_02
And in palliative care, you can receive our support and continue on with your more aggressive, invasive, life-sustaining interventions as well. You don't have to give up one type of care to add palliative care to the mix.

00:38:44 Speaker_02
Whereas once you're entering hospice because of its insurance details and vagaries, you do have to, in general, you have to give up curative intended care to qualify for hospice. And we could spend a lot of time on this.

00:38:56 Speaker_02
There are a lot of wonky details, but does that sort of make sense to you? It totally makes sense.

00:39:01 Speaker_03
And the first thing that leapt to mind for me, and that will lead to a lot of tangents, I apologize in advance, but was that the way that you define palliative care would seem to include almost everyone on the planet in some respect, suffering more than they need to.

00:39:19 Speaker_03
And we'll dig into the learnings and philosophies and so on that that you've cultivated. So let's say they have gone through the paperwork and the process to get to the Zen Hospice project. What does their first day look like?

00:39:35 Speaker_02
So first day at Zen hospice is usually, there's always the folks by, almost by definition are in a pretty fragile state. So just the ride, getting to the house and into the house is often plenty overwhelming.

00:39:48 Speaker_02
So very often the resident will just sleep much of the first day. But as soon as they're beyond the logistics of the trip over, the first day is generally our nurses, our volunteers,

00:40:02 Speaker_02
The kitchen crews are swarming around that resident and their family and just getting to know them. That's where all the potency comes. It's inherently a relationship.

00:40:13 Speaker_02
There's some details around medications, etc., but most of the early work is just getting to know people and making them feel that this is their home now. They've come to live here.

00:40:23 Speaker_02
Yeah, they're going to be dying soon, but they're here to live until they die. So it's a very non-medical establishment, and the first day doesn't feel anything like being admitted to a hospital.

00:40:35 Speaker_02
You know and pretty soon you as you get to know someone within the first day you invariably questions get ask you tell us what's most important to you now you know.

00:40:44 Speaker_02
You want something we can whip up something in the kitchen or will tend to the family it's very casual is meant to be feel like you're entering a warm embrace of a familiar setting.

00:40:53 Speaker_03
And what does the, just to highlight also the differences, can you describe upon the patient's death, what happens in Zen Hospice Project versus in a conventional hospital setting? And you can present either first. Yeah, well, so,

00:41:18 Speaker_02
Hospice and palliative care in general, but certainly places like Zen Hospice Project, in many ways, they were created as antidotes to the hospital. So in some ways, you'll feel like opposites. That's to some degree by design.

00:41:34 Speaker_02
But a death in a place like Zen Hospice Project,

00:41:38 Speaker_02
is usually very peaceful because we've gotten to know that person, we've been living with that person, we know what they want, what their idiosyncrasies are, and we work with local teams of hospice agencies who come in and provide the medical care.

00:41:53 Speaker_02
So for the most part, people can enjoy and expect a much more comfortable and peaceful death at Zen Hospice Project and places like it.

00:42:04 Speaker_02
That's what the all the expertise is geared towards you're not distracted by beeping machines and other things and other agendas happening research agendas whatever it is.

00:42:13 Speaker_02
And to your question, Tim, so when the person dies, invariably the mortuary needs to come and retrieve the body, and we have this ritual that we offer people, which is on their way out the building, the mortuary guys have picked up the body, and if there are family or friends around, and certainly staff and nurses and volunteers will gather around, and we'll all gather on the porch,

00:42:40 Speaker_02
And we will do this, our flower ceremony, which is basically we gather around, and the mortuary guys pause for a moment, and we maybe say a few words or sing a song or whatever it is, just reflect on our time and remember the person who was just leaving us.

00:42:57 Speaker_02
And then we'll sprinkle the body with flower petals. It's just this very simple, gorgeous moment. Then the body bag is zipped up, as it has to be by law, and the body heads out the door.

00:43:13 Speaker_02
But it's this very stunning, poignant, gorgeous, simple moment, and you can feel everyone entering into this grieving phase more fully, especially, of course, the family.

00:43:25 Speaker_02
And you can watch folks have this little bit of closure, perhaps, but more the point is you watch them swarmed with warmth and love,

00:43:35 Speaker_02
and easing into the grief process, because there's space for it, and there's this sweet segue, and you can just feel that something's been completed there, and then the family now have to live on, but can do so with some imagery that's sweet and beautiful to remember, rather than traumatic.

00:43:55 Speaker_02
So counter that with the typical hospital deaths. And by the way, Tim, we can talk about all sorts of things together, I hope we do, but no knock on hospitals.

00:44:05 Speaker_02
They're incredible places, they're just not really designed to have a beautiful experience, per se, and they're not really designed to help you die well.

00:44:14 Speaker_02
Can you feel that mismatch so i've worked on a lot of work in hospitals as a patient but also as a physician and typical hospital that is. Is in a more sterile room usually line with a bunch of machinery and all the sounds and lights emitted.

00:44:32 Speaker_02
And it's very cold. I mean, the second the person dies, you can feel the cleaning crew waiting to descend on the room, and they need to get the body out of the room because someone invariably is waiting for the room.

00:44:43 Speaker_02
And there's no ushering in of grief. There's a sort of a snuffing of it. And it's very disorienting for everybody involved, including the clinicians, because there's no pause moment to reflect on the experience you've just had with this person.

00:44:58 Speaker_02
It's just kind of on to the next. And it's a stark, stark contrast.

00:45:03 Speaker_03
Since you began your work with palliative care and hospice care, how many deaths have you witnessed or experienced, even in the periphery? Not necessarily watching someone die,

00:45:19 Speaker_03
Under your care or in your periphery, how many deaths have you experienced?

00:45:24 Speaker_02
You know, my guess now, I mean, I've finished my final bits of training, and then there's all the deaths during residency and fellowship, of course, but I've been out of my final training now for 10 years.

00:45:35 Speaker_02
If it's not a thousand people, it's approaching a thousand. I don't know that for sure, but it's certainly many, many hundreds.

00:45:42 Speaker_03
What, and this is a huge question, so we can certainly slice it and feel free to tackle it any way you like, but what has observing that many deaths and the march towards death taught you about living, and specifically your own life?

00:46:06 Speaker_02
Well, that's the perfect question, man. I mean, there's like a, Those of us who work in the field of hospice and palliative care, it can feel like you're sitting on a secret.

00:46:16 Speaker_02
Because I think the assumption is that, oh, wow, that's got to be very morbid. It is. I mean, it's got to be very morbid work or very depressing work. And sure, it is loaded. I mean, it is emotionally laden work, without a doubt.

00:46:30 Speaker_02
I don't mean to make it sound easy, but. Those of us who work in the field, you pretty quickly get a real sweet hit that paying attention to this zone of life is very nurturing.

00:46:45 Speaker_02
The sort of secret is that paying attention to the fact that you die can help you live a lot better. So a lot of my colleagues and I are very aware of the clock. Sure, that can make you anxious as well, but we know we're aware of our finitude.

00:47:07 Speaker_02
We're just a little more likely to be kind to ourselves and others, and we're a little less likely to squander that time because we have all these remarkable vicarious deathbed moments with our patients and their families, and you can learn a lot.

00:47:24 Speaker_02
One of the things I love thinking about, a real organizing theme for me is, is avoiding regret, essentially.

00:47:32 Speaker_02
And we avoid regret by, again, paying attention to our decisions, paying attention to how precious things are, and getting very good at forgiveness and reconciliation. And these are themes that play out in this work all the time.

00:47:46 Speaker_02
So in a sense, we're exercising these muscles on behalf of others that all of us need to exercise on behalf of ourselves at some point. We just get pretty well practiced at it.

00:47:55 Speaker_02
So this is where the work gets extremely beautiful and really nurturing and can help you live better. And I guess that's part of the drumbeat. Why do we want to talk about this?

00:48:04 Speaker_02
Well, there are some systems issues or some economic issues, but there's these beautiful civil issues on behalf of kindness, on behalf of justice and equality, the fact that we all die.

00:48:15 Speaker_02
Well, paying attention to this has all this potential for this to be a bond among human beings. The fact that we die and the fact that we're cognizant that we die, that's part of this drumbeat.

00:48:28 Speaker_03
And in the case of paying attention to decisions, what would be examples of some specific decisions you've made or habits you've developed that have been impacted by this work?

00:48:43 Speaker_02
One thing, you know, caveat is I, like anybody else, am flawed and I'm a work in progress and I forget all the lessons that I've learned a million, I have to learn them over and over again.

00:48:53 Speaker_02
So, you know, I got all sorts of work to do it myself, but as we all do. Yeah, yeah, amen, brother.

00:49:01 Speaker_02
But I do think I've gotten a lot better at, I'm pretty good as a hyper-educated person at rationalizing all sorts of things and behaviors, and I can convince myself to stay in relationships or in situations that don't necessarily feed me or that aren't working very well.

00:49:18 Speaker_02
And I think I've gotten a lot better at calling that, for everybody's sake. So I might be, I think I'm a little bit better these days

00:49:28 Speaker_02
Not squandering my time and in terms of friendships and relationships navigating them not taking them seriously so that we're just not wasting each other's time so i feel that in my relationships.

00:49:43 Speaker_02
I feel these lessons in my relationship to nature, so that's a great salve for me, is being out on Mount Tam, out here in Marin County, or just about anywhere, and feeling, letting myself really delight and bask in the crazy grandeur of being alive at all.

00:50:02 Speaker_02
And I get thrilled that I can feel anything, sometimes even pain. The way I deal with my own pain is I remind myself that I'm glad to feel anything at all. So my relationships, I think, are impacted. My orientation to Mother Nature is impacted.

00:50:24 Speaker_02
I've got a lot better at forgiveness, so not holding grudges. You know how we walk around with anger at others and ourselves, and it's just unnecessary. It doesn't help anybody. So I've got a lot better, I think, of letting go of certain things.

00:50:37 Speaker_03
So to drill into that, I apologize for interrupting. Yeah, yeah, no. Because this is a particular Achilles heel of mine, and I've improved.

00:50:44 Speaker_03
I think I'm trending in the right direction over the last few years, but I have always had a lot of difficulty letting go of grudges.

00:50:52 Speaker_03
And those loops that we tend to repeat, or at least I tend to repeat and reinforce, like a groove in a record that can just create this Bitterness might be a strong word, but it's not totally out of place.

00:51:06 Speaker_03
When you find yourself, when you catch yourself angry with someone or not letting go, what is the internal dialogue? What do you say to yourself? How do you ameliorate that?

00:51:18 Speaker_02
Well, this is where meditation, mindfulness, self-awareness, whatever you want to call it, can be so helpful. Because one thing is to just get better at realizing you're doing it in the first place. Definitely.

00:51:31 Speaker_02
Even before you're able to change it at all, there's great potency in just being aware that you're doing it.

00:51:39 Speaker_02
I used to be much where i could walk around for months with grudges and chips on and bitterness is et cetera before i really even realize i would just be really moody or whatever else up, no job one i guess is just paying attention yourself and seeing it for what it is.

00:51:53 Speaker_02
And then the next steps actually that's the hard part i think at least for me i mean the next step is actually kind of easy cuz then as you watch yourself spinning out.

00:52:02 Speaker_02
Then you can kinda call it the silly useless thing that it is, and you kind of take the wind out of its sails. You disempower the anger. And for me, in my life, the absurdity, the being in touch with absurdity has been very, very helpful.

00:52:21 Speaker_02
So that's my next step is the awareness and then it's sort of watching the silliness of it all and then that anger.

00:52:28 Speaker_02
And maybe with some deep breaths or whatever else or a walk to sort of bleed off that physical anxieties of it but then i can sort of unschool on wind. And maybe even quickly can laugh at myself.

00:52:42 Speaker_02
And that's great, because A, you've let go of the junk, and B, it's an exercise in humility and forgiveness, which is always pretty dang useful.

00:52:52 Speaker_03
And for those people listening, you might have these same issues, and a lot of us do, of course. There's a book with a very bland title called Radical Acceptance by Tara Brach that I found very, very particularly helpful to me in this instance.

00:53:09 Speaker_03
You mentioned mindfulness meditation. Do you have a regular meditation or mindfulness practice?

00:53:15 Speaker_02
No, not really.

00:53:19 Speaker_03
Well, I guess your whole job, in a way, is a mindfulness practice, so that perhaps might be overkill to just add another session on top of everything else you're doing.

00:53:29 Speaker_02
Thank you for that way out, brother. You're welcome. There is some truth in it, actually.

00:53:37 Speaker_02
This is another reason why this work is so potent and fun, is your personal and professional lives are deeply entwined, almost necessarily, because so much of this work is

00:53:47 Speaker_02
just being aware, is listening, is paying attention and bearing witness, and come to terms with all the stuff you can't control, whether it's for my own sake or my patient's sake.

00:54:00 Speaker_02
So there is some real truth that I kind of feel like doing this job well, and empathy is job one in this work. And so I do feel that much of my daily life, the daily grind for me is itself sort of meditative. I also want to be clear.

00:54:15 Speaker_02
I mean, I have my own relationship. For me, it's a bike ride, or it's time with my dog, or it's time sitting in my backyard just looking out at the hills. And it feels to me like a meditation. I like movement.

00:54:33 Speaker_02
It's something, ever since I became disabled, I think I'm particularly primed to appreciate movement.

00:54:40 Speaker_02
So I like a walking or a bike ride, and it feels like meditation, so I feel like I'm doing it a lot in a way, but I also want to honor those folks in the audience and elsewhere who truly have a meditation practice, and that is really its own discipline.

00:54:55 Speaker_02
So I don't really have that, but I got those other things.

00:54:58 Speaker_03
I think they're all present state mindfulness practices. If you're riding a bike, now you mentioned something we haven't covered and I didn't cover it very deliberately but it makes sense I think at this point to rewind the clock.

00:55:13 Speaker_03
Could you tell us about the dinky?

00:55:17 Speaker_02
Yeah i'm sorry i love speaking of absurdity the dinky this what i mean i lost three limbs to a thing called the dink sorry i'm laughing but i laughed no please laugh it is kind of silly but anyway.

00:55:37 Speaker_02
So as you know i love tiger yeah there's this commuter train that runs on the campus of princeton university although i guess it doesn't run on campus anymore but and it's a commuter train it's called the dinky with affection to some.

00:55:51 Speaker_02
And the dinky runs from princeton to princeton junction and commuters can take the trains into philly or new york or whatever else.

00:55:59 Speaker_02
That's what the dinky is the why it's significant in my life in particular is one night it was november i was just after thanksgiving vacation sophomore year november twenty seventh nineteen ninety.

00:56:14 Speaker_02
Couple friends of mine and i were out just hanging out having fun not a crazy night but we're walking will you remember the market.

00:56:22 Speaker_02
Tim i do i was at forbes so i walked by the dinky and the wall every single day multiple times right so you know, so late night visit to the market was pretty common and so we're heading over to get a sandwich whatever you know when we just walking by the dinky.

00:56:38 Speaker_02
It was just part there's not operating hours and you know it has a ladder on the back and we just. Walk by and just decided to climb it you know like you would climb a tree.

00:56:49 Speaker_02
We really did not think we're doing anything that daring but put it this way we've done a lot stupider things besides that at least we thought but i just happened to be the first one up on top of the train and those trains run.

00:57:02 Speaker_02
Like the buses in san francisco wires that run overhead and then there's this metal thing called the pantographs i think it's what it's called. And that connects the train itself to the power source missus big metal pole.

00:57:16 Speaker_02
So when i stood up on top of the train i had a metal watch on and i happen to be close enough to the power source and the electricity art. Choose a watch and. Yeah, enter my arm and then blew down the feet. How was that? So what happened at that point?

00:57:33 Speaker_02
Well, I should say I don't really remember anything about that night, but my friends were with me pieced it back together.

00:57:39 Speaker_02
But there's, you know, it's a big explosion and I was thrown some distance and one friend came up on top of the train while the other friend ran and called 911 and

00:57:53 Speaker_02
You can imagine, I mean, both of my friends were freaking out and right into action mode. And, you know, getting up on top of the train that had just in ways they couldn't have possibly understood and just electrified their friend.

00:58:07 Speaker_02
And yet they got up on top of the train to help me. I mean, just ever a daily shout out to my friends, Jonathan and Pete and Tommy too. for all they did for me that night and oh, God, and so many nights.

00:58:20 Speaker_02
But yeah, so Pete held me down because I guess at some point I came to and I was just thrashing about. Electricity enters your body and so you've got all this heat you burn from the inside out.

00:58:32 Speaker_02
Apparently, it's very common that people wake with extreme energy. I mean, you are electrified. I'm just flailing, punching him through. I'm just a wild tear apparently.

00:58:46 Speaker_02
So Pete, who was a very particularly large, strong, and sturdy, heroic friend of mine, held me down so I didn't roll off the top of the train and make things worse.

00:58:55 Speaker_02
And then the ambulance came, and I don't blame them one bit, but the ambulance drivers refused to get on top of the train, as they should have.

00:59:03 Speaker_02
But between my friends and a Princeton police officer by the name of Officer Dawson, I believe his name was, who went on to become, was promoted, I think, after that to Sergeant Dawson.

00:59:15 Speaker_02
But anyway, Sergeant Dawson got up on the train with Pete, and together with Jonathan, they got me into the stretcher and handed me down to the ambulance. Guys in the ambulance whisked me off to the local hospital.

00:59:27 Speaker_02
And the local hospital did these things where they basically just slice open the skin to allow the heat out. It's called this fasciotomy, so that you stop burning yourself, essentially. And then I was flown to the burn unit at St.

00:59:39 Speaker_02
Barnabas Hospital in Livingston, New Jersey, which is New Jersey's one and only burn unit. At least it was at the time. And that was that.

00:59:47 Speaker_03
And flash forward to when you became fully cognizant of what had happened. you open your eyes, what does the scene look like?

00:59:59 Speaker_02
It's interesting. It's like I was conscious, I was awake throughout the ordeal, and it's just more the sleepiness of memory. It was not like coming out of a coma where I was asleep and then awake. There was not a singular moment reprisal.

01:00:17 Speaker_02
But I tell you the first memory, which actually some freakish reason I love this story, I don't know why. I do like this story, so I will tell it to you. Anyway, please do. So your blood pressure is unstable. You're just a hot mess.

01:00:33 Speaker_02
So surgery can't happen until you're more stable if it can be avoided. And so it's common to wait several days before the surgical amputation of the dead tissue.

01:00:44 Speaker_02
And it's also in part because it's not totally clear what tissue is viable and what tissue is not. Anyway, it was maybe day five or day six before the first amputations, and I woke up the night before. I remember this very, very well.

01:01:00 Speaker_02
You know that feeling where you wake up from a dream? and it's been a bad dream and there's a moment of sort of panic and then you sort of orient yourself, you look around, you orient yourself and you realize, oh, thank God, that was just a dream.

01:01:15 Speaker_02
You know that sensation and it's an incredible somatic, it's a beautiful feeling of relief that washes over you. So anyway, somehow I looked around a burn unit, which is a particular environment.

01:01:29 Speaker_02
It's not like our guest house that I was just describing a moment ago. That's an auspice it's a very technical sterile intense environment and somehow in my stupor i looked around and saw all these machines.

01:01:42 Speaker_02
And still managed to think oh thank god that was just a dream. And so i had a sensation i had to use the bathroom. I said, oh, well, get out of bed and go to the bathroom. And in this state, I was intubated on a ventilator.

01:01:59 Speaker_02
I extubated myself, which is not easy to do by any stretch. So I extubate myself. I pull out, I have all these lines running into my jugular veins in my neck. I pull those out. I just decouple myself from all these machines.

01:02:16 Speaker_02
and get out of bed on my crispy little feet and start heading for the door to go to the bathroom, just obviously out of it. But in my mind, very clear, everything's fine. You know what a Foley catheter is, Tim?

01:02:31 Speaker_03
I don't know what a Foley catheter is, but a catheter I would understand is something that's probably in your urethra.

01:02:38 Speaker_02
There you go, pal. You got it. That's right. And the way it stays in there is there's a little balloon on the tip of it. So the tip is fed through your urethra into your bladder, and the catheter just is there to spontaneously drain your bladder.

01:02:52 Speaker_02
But the way that thing stays in there is there's a little balloon that gets inflated once it's in your bladder, So that it doesn't slip out of your bladder so there's no small ping pong ball at the end of it.

01:03:04 Speaker_02
It's now inflated so i'm walking the door and they usually clip the cats are in the bag on to the side of the house so you know this is going so i'm walking to the door and the thing runs out of slack.

01:03:17 Speaker_02
And it yanks the dang catheter, of course, and it comes not all the way out, but like partially out. Sorry to you and all your listeners.

01:03:28 Speaker_03
Wait, are we talking like a small python in a golf ball kind of situation? No offense, I mean, large pythons that ate a golf ball.

01:03:36 Speaker_02
No, no, no, small pythons. Yeah, so no, that's right, man. So, I mean, this is... And the total reverse, that total warm bath of relief that you experienced thinking it was a dream, that just goes totally in reverse.

01:03:52 Speaker_02
And in a millisecond, I realized that all of this was not a dream. I fall down to the floor, because all of a sudden, I really can't walk either. I just fall on the floor, and I'm screaming.

01:04:04 Speaker_02
I'm trying to break the rubber tubing on the catheter, which there's no way I could to somehow relieve the pain. Anyway, finally, a nurse comes running in and gets me back in bed, and that was that. Anyway, that's my first real memory. My God.

01:04:20 Speaker_03
I can see why it's vivid. Oh, yeah. I'm sort of bent over as I'm talking to you. Let's contrast that with one that I've heard you tell, but I don't recall the details. And this is snowball. Am I getting this right? Could you tell the snowball story?

01:04:41 Speaker_02
So a burn unit is, like I said earlier, a particular place. They're gruesome places. They're very difficult environments. The pain that the patients are going through is gut-wrenching. And so working in a burn unit is very difficult.

01:04:54 Speaker_02
People often don't last in a burn unit very long as a clinician. It's incredibly difficult work. And we learn from wars over time, is my understanding of certain medical history, that

01:05:06 Speaker_02
The way burns often kill people is indirectly through infection so once you've disrupted the integrity of your skin you're much more vulnerable to infection and so the thing that often kills burn victims after they survive the initial trauma is infection.

01:05:20 Speaker_02
So burning it's are incredibly sterile environment so everyone's gowned up masked loved. for the first maybe several weeks, I could only have one person in my room at a time. It's just like you're in a bubble, in other words.

01:05:34 Speaker_02
And therefore, you're cut off from everything. There's no day, night runs together. There was no window in my room. There's no, you're in a little cell. And even when people are at your bedside, there's all this garb in between you and them.

01:05:49 Speaker_02
So there's no relationship to the natural world. You can touch nothing.

01:05:55 Speaker_02
And also you're in a fair amount of pain of course which does not necessary reward your paying attention anything so it's just it's not fun so this is november at some point in december maybe is early january.

01:06:09 Speaker_02
And honestly, I can't remember who brought me the dang snowball. I can't remember. There were two nurses in particular that I felt very close to, and it may have been one of them. And I think it was, it may have been, her name was Joy Varkardepone.

01:06:23 Speaker_02
It may have been Joy. But anyway, it was snowing outside, and I didn't know that. I didn't know if it was night or day. And she had the bright idea of just smuggling in a snowball to me so I could hold, so I could feel snow.

01:06:38 Speaker_02
And man, it was just stunning. What a simple little thing, right? But to put it in my hand,

01:06:46 Speaker_02
and just feeling the contrast of that cold snow on my sort of crisp, like, you know, the burnt skin, the obnoxious inflamed skin, and also watching it melt and watching the snow become water.

01:06:59 Speaker_02
And just the simple miracle of it was just a stunner for me. And it really made it so palpable that we as human beings, as long as we're in this body,

01:07:11 Speaker_02
We are feeling machines and if we're caught up we can't take our senses are choked off we are choked off. And it was the most therapeutic moment i can imagine and i would never guess this but just holding a snowball first of all the sensation.

01:07:26 Speaker_02
But also the implied inherent perspective that it helped me make credit. Everything changes. Snow becomes water. It's beautiful because it changes. Things are fleeting. It just felt so beautiful to be part of this weird world in that moment.

01:07:43 Speaker_02
I just felt part of the world again rather than removed from it. It was potent.

01:07:48 Speaker_03
BJ, what did you study undergrad or what were you planning on studying or studying at the time? I always forget when people make decisions in undergrad even though I went through it myself.

01:07:58 Speaker_02
Yeah, well, like you, I started out, I was at Princeton 89 and 93, and I started out, I went there really high on the idea of learning things that were foreign to me, totally seeing a different worldview and really delighting in the liberal arts education.

01:08:15 Speaker_02
So with that, Tiananmen Square had just happened before freshman year, and China was on my mind. I started studying Chinese language and was heading for a major in East Asian studies.

01:08:26 Speaker_02
But when i was out with this injury art which i'd always been interested in special music i became much more interested in art.

01:08:36 Speaker_02
Not just listening to it looking at it but the idea of art so i switch my major to art history and that's what i ended up studying what do you mean by the idea of art.

01:08:48 Speaker_02
What is this art stuff i mean why do humans that we seem to be unique as a species that we reflect. on our lives, we reflect on our mortality, we reflect on our experiences, and we, one way or another, we reproduce them. We use them as creative grist.

01:09:07 Speaker_02
So, either in our sort of daily lives, or those of us who make art, you know, we use it to make art. You know, what's the purpose of making art? Art is inherently kind of useless, and that seems to be part of its charm.

01:09:22 Speaker_02
The fact that we as a species make art and care about it seemed to me really important because I was trying to figure out, well, who am I now? Am I less human because I have fewer body parts? Is that the measure of what it means to be a human being?

01:09:40 Speaker_02
No, but I couldn't really answer the question, what was my humanity? What did it mean to be a human being? Why was I happy to be still alive? Those are the kinds of questions I was trying to wade through, essentially questions of identity.

01:09:55 Speaker_02
So studying art, the hunch was, well, this seems to be a peculiar, the situation I'm in was peculiar to being a human being, that one could survive injuries like that and go back out into the world in this damaged way and make their way again and return ostensibly to some sense of wholeness in themselves.

01:10:16 Speaker_02
And it seemed to be rightly placed to focus on something like art as a guide to help me get creative with the reality I was now facing. In a way, it was the thing I was trying to learn how to do was make perspective.

01:10:32 Speaker_02
And that's what art really helps you exercise that muscle. It helps you learn how to see, how to listen. And that was really empowering because I, there's so much I would have loved to change about what I was seeing.

01:10:46 Speaker_02
You know, when I looked at my body, I would have loved to change so much about it, but I couldn't. Well, I could change with this knowledge. I could change my perspective. I could change how I saw myself.

01:10:59 Speaker_02
That's what art helped me learn and where to focus my energies. It really paid off, I have to say. It's very helpful.

01:11:06 Speaker_03
I'd love to explore that some more because I've been, in the last few months in particular, asking myself over and over again, why do humans

01:11:19 Speaker_03
care about music create music like a compulsion and dance every every group of humans on the planet and it just seems so peculiar yet unsurprising if you look at a bird song and animal mating calls and mating dances and all this that the other thing but there seems to be many layers

01:11:39 Speaker_03
How did it pay off? I mean, you gave one example already in terms of changing perspective, but were there any particular classes, teachers, books, pieces of art that really influenced you?

01:11:55 Speaker_02
Really so much of art history, the way the curriculum was set at the time, it really didn't actually dig in so much around why humans make art.

01:12:06 Speaker_02
It just presupposed that we do and that that's interesting and went from there, which was cool, basically put me in front of a lot of art and helped me tweak my eye and my ear. That was great.

01:12:17 Speaker_02
But on this sort of identity, sort of philosophical front, like the existential, like why do we do this? What's the meaning of this? That was actually kind of left up to me as an individual and in my relationships.

01:12:31 Speaker_02
And there was one of my dearest friends, a guy named Justin Burke, who is a philosopher and art historian. I mean, that's what he studied to his doctorate.

01:12:40 Speaker_02
And frankly what's up we're talking about right now tim and the benefits i read from it was really in cut from conversations with justin fed the backdrop by this pounds of artwork that i got to spend time with but.

01:12:53 Speaker_02
working through this philosophical stuff was really with my buddy Justin. So that's one point. And there was no particular work of art. Again, it was more the idea of art than it was any particular piece of art that was so potent for me.

01:13:05 Speaker_02
And even this day, I mean, I love going to museums, but I just like being around art. Sometimes I don't even look at it. I just like that it exists, and I like to reward places to help it exist.

01:13:16 Speaker_02
So there's no one work I can point to, although I would say probably the painting of Mark Rothko has proven to be very poignant and potent for me. Any chance I get to stand in front of a Rothko, I will do.

01:13:28 Speaker_03
How do you spell that last name?

01:13:29 Speaker_02
I'm an ignoramus when it comes to this type of thing. Rothko, R-O-T-H-K-O, Mark Rothko, abstract expressionist, mid-20th century guy, made these big, beautiful, color form paintings.

01:13:42 Speaker_03
Non representational quick random anecdote that might be. Entertaining so i grew up on eastern long island where jackson pollock basically turn himself into one of his paintings by driving a car into a tree.

01:13:57 Speaker_03
And he actually used to show up at one of my relatives' homes completely shit-faced drunk all the time. And he would bring his poor dogs in the car and he'd show up at like 9 o'clock and this man and his wife would say to themselves, oh no, it's...

01:14:15 Speaker_03
Fucking jackson again and they would pretend to be going out to dinner no matter what time it was never got old we're so sorry we can't stay or just on our way to dinner because what would happen is he would stay.

01:14:25 Speaker_03
He would forget about the dogs that shit all over the car he would take the dogs home. leaving the shit intact in the car, and then blame it on my relatives to his wife, who then had to contend with the whole mess.

01:14:40 Speaker_03
So, anyway, related but totally unrelated. If you were, this is an awkward transition but here we go, that's kind of my MO.

01:14:51 Speaker_03
If you were brought in as a physician slash let's just say mentor, guide to someone who had just suffered nearly identical injuries to yourself, 20 some years old, what would your conversation be like with them or what resources or reading or otherwise would you point them to?

01:15:15 Speaker_02
I find myself every once in a while, I'll get called by friends in the hospital, come visit with someone who is in similar shoes. Actually, I wish I remembered his name, but someone did that for me when I was in the burn unit.

01:15:27 Speaker_02
He'd had a similar accident. I think he lost two legs below the knee. I should say both legs. I learned a lot from how I gained from his visits to me, I have just reproduced, which is,

01:15:42 Speaker_02
Basically walking in these rooms with almost no agenda almost no plan to advise in any way. The potency especially early on was just seeing someone in similar shoes.

01:15:54 Speaker_02
My early questions when i was in the bed was like what we look like what's it gonna feel like to walk on prosthesis and. That's nuts and bolts kind of stuff. Will anyone want to date me again? I don't know. It was on that level.

01:16:10 Speaker_02
And so when this guy would come visit me, it was just seeing him, just seeing him upright, just knowing that by virtue of the fact that he'd entered my room, he came from somewhere else, he was out in the world, knowing he was a functioning human being out in the world.

01:16:25 Speaker_02
And just seeing him look me in the eye with some kinship, that was the therapy of it. I think I've gotten in trouble when I've tried to come in with some predetermined idea of advice giving. Oftentimes, that's not really what's needed.

01:16:40 Speaker_02
It's more just the camaraderie and the bearing witness. And so, to answer your question, when I do go into folks' room, I'm there and I avail myself to any questions they have.

01:16:50 Speaker_02
But I think most of the power of visit is just visiting, just being together and sharing this awkward body.

01:16:57 Speaker_03
From what I've heard and read of yours, one of the recurring themes appears to be, and please correct me if I'm getting this off at all, is how powerful simple things can be, or maybe are, and that our tendency is to perhaps undervalue the things that are not expensive or difficult to obtain.

01:17:21 Speaker_03
The snowball. Could you talk about the things you've noticed that most help people in hospice care?

01:17:30 Speaker_03
And the reason I ask is specifically related to cookies, which maybe you could talk about, but I'd be curious to hear sort of what really brings the most peace to these people.

01:17:42 Speaker_02
So you're right i mean i think one of the joys about one of the upshots for silver linings about the end of life is that if you wanted to if you let it. You can let a lot of the rules that governor daily lives fly out the window.

01:17:55 Speaker_02
because you realize that we're walking around in systems and society and much of what consumes most of our days is not some natural order. We're all navigating some superstructure that we humans created.

01:18:09 Speaker_02
That is the work day, the work week, whatever it is. I think part of the trick is if when you're dealing with serious illness or some unnatural trauma or facing the end of your life, Oftentimes, that becomes crystal clear.

01:18:26 Speaker_02
Like where you've been hanging out and spending so much of your time and energy and worry is like living in someone else's dream, you know? It's not, sure, I mean, society and what we've structured there is a lot of importance to it.

01:18:38 Speaker_02
I don't mean to dismiss it, but we inherit that. We don't spend a lot of time creating our realities in a, most of us don't, in a sort of clear or intentional way. And so when you have this excuse to forget all that, it can be really liberating.

01:18:59 Speaker_02
A little bit scary, too, because a lot of people then invariably realize that they feel like they've been wasting so much of their time on things that actually weren't that important.

01:19:07 Speaker_02
And that's part of the trick of checking yourself over time in a daily way. Am I doing things that I really care about, et cetera? So back to your question, to this point about simple things, I mean, the simple things,

01:19:20 Speaker_02
The small things ain't so small, actually. Like I say about the snowball, there's the joy of feeling anything, of having a body at all, of being capable of movement at all.

01:19:33 Speaker_02
That is so profound, it's so potent, and yet I think most of us take that for granted. So as a clinician and as a person i love looking for moments where the rules get to go out the window.

01:19:47 Speaker_02
I love when i have you know i love having residents at the guest house at zen hospice who smoke frankly you know or you know anything that just kind of gets that kind of reorient us and put things in proper proportion relationship to the natural world.

01:20:02 Speaker_02
read jiggers are priorities i love that i love that reorienting feeling and again it does seem to be one of the silver linings for folks in this zone.

01:20:12 Speaker_02
I think about this most nights every night anywhere you are of course you can look up and usually find a star.

01:20:20 Speaker_02
I mean, I feel like, you know, when any of us is struggling with just about anything, look up, just ponder the night sky for a minute, just to realize that we're all on the same planet at the same time, and as far as we can tell, we're the only life, only planet with life like ours on it, anywhere nearby, and then you start looking at the stars and you realize that the lights that are hitting your eye is ancient, and that the stars that you're seeing may no longer exist.

01:20:48 Speaker_02
By the time the light gets to you and just just sort of mulling the bare naked facts of the cosmos for me is enough to just thrill me. awe me, freak me out, and kind of put all my neurotic anxieties in their proper place.

01:21:07 Speaker_02
So, yeah, and a lot of people, when you're standing at the edge of your horizon on death's door, you can be much more in tune with that cosmos than you are with what the body is doing in a day-to-day kind of way.

01:21:20 Speaker_03
Does that make sense, Tim? Can you imagine? So just because i brought it up and i don't want people to be harassing me about it on the internet the cookies can you mention.

01:21:29 Speaker_02
Yeah what do you know i'm in the smell of. Fresh bread are for most of us the smell of a chocolate chip cookie does magical things you know. First of all, food is primal. Our sense of smell, it is one of our oldest senses. It is primal.

01:21:49 Speaker_02
You can walk by someone who may be wearing a cologne or perfume of someone you knew 30 years ago. It's been maybe a few years, but there's a perfume that I would smell that my babysitter wore when I lived in St.

01:22:02 Speaker_02
Louis when I was in preschool, and it would throw me back there instantaneously. The sense of smell is potent. And food is primal and potent. I mean, it's nourishment, it's nutrition, it's how we live in some ways, right?

01:22:15 Speaker_02
So there's all this symbolic stuff happening too. But there's also just the basic joy of smelling a cookie. It smells friggin' great. And it's like the snowball. Like in that moment, I am rewarded for being alive and in the moment.

01:22:29 Speaker_02
Smelling the cookie is not on behalf of some future state. It's great in the moment by itself on behalf of nothing. You know and this is another thing back to art art for its own sake.

01:22:41 Speaker_02
Art is part of its poignancy and music and dance is it's purposelessness and just delighting enough wacky fact of perhaps a meaningless universe and how remarkable that is.

01:22:54 Speaker_02
That's kinda what I'm shooting for, and that's a way for all of us to live until we're really dead, until we're actually dead, is to prize those little moments.

01:23:03 Speaker_03
You guys, I might be fabricating this, but make cookies at the Zen Hospice Center, for this precise reason, right?

01:23:11 Speaker_03
And so you mentioned absurdity a few times, this is something I've been thinking about a lot, and for reasons that may inferentially become super clear in a second, but just the,

01:23:22 Speaker_03
being able to try to laugh at the cosmic joke, so to speak, I mean, like the meaninglessness, if it is in fact meaningless, of things, as opposed to taking all things so damn seriously, which in a way prevents you from doing a lot of the serious work you'd like to do.

01:23:41 Speaker_03
But the question I was gonna ask is to get your opinion on a modality, we'll call it, or a tool, and I'm gonna explain this vis-a-vis a friend I'll keep anonymous. So this is a female, young woman, who used to work in hospice care.

01:24:00 Speaker_03
And she found, just as you alluded to earlier, that she felt like she was sitting on a secret. It gave her incredible joy and presence to do that work. She really loved the work. At some point, became very frustrated with the

01:24:18 Speaker_03
insurance policies and vagaries of our health care system and now does something that is illegal, but I think should not be, which is guided work with psilocybin. And she said, now I get to experience people dying every weekend.

01:24:34 Speaker_03
The only difference is they come back to life.

01:24:38 Speaker_03
And many people listening to this will have read or should read an article that was titled The Trip Treatment by Michael Pollan in the New Yorker about the use of, I believe specifically, psilocybin, for those people not familiar, which is extracted or the psychoactive compound in

01:24:57 Speaker_03
magic mushrooms, for end-of-life care in terminal cancer patients. I'd just love to hear your opinion on the use of compounds such as those in end-of-life care or otherwise.

01:25:12 Speaker_02
Yeah, well I'm so glad you're asking this question. So there's all sorts of stuff coming out of the closet these days, and it's really wonderful. And there's a movement afoot to revisit psychedelics from a therapeutic perspective.

01:25:30 Speaker_02
And I don't pretend to know the full history of how psychedelics went from considered therapeutic to considered toxic and the devil's work. But here we are, there's a revisiting happening with fresh eyes and serious eyes.

01:25:45 Speaker_02
So it's not folks who are just with a wink trying to justify their own recreational use of these. It's UCSF, UCLA, Johns Hopkins. Johns Hopkins, you got it right, NYU. Friends at the River Styx Foundation have been funding some of this work.

01:25:58 Speaker_02
The people I know who are involved in this work, Are deeply thoughtful caring loving people anyway so that's a preamble but you know to get to your question i am thrilled for this.

01:26:11 Speaker_02
For a number of reasons one is just the counterculture fun kind of things coming out of the closet.

01:26:18 Speaker_02
Another is a whole generation I eat the baby boomers who are now the focus of so much of our efforts in healthcare and the aging population how do we cater to this population well.

01:26:29 Speaker_02
A lot of folks of that generation have experience with these compounds and now they get to sort of be above board potentially so anyway i love the subject for many reasons as a clinician you know i'm particularly excited because.

01:26:42 Speaker_02
We're pretty good at treating nausea, treating pain as a rule, and where things get very difficult, and in palliative care we talk about this, we call it existential distress.

01:26:54 Speaker_02
And basically existential distress is a crisis of meaning in some way or another.

01:27:00 Speaker_02
So it's particularly potent at the end of life when people don't have much time left to make meaning and they realize they haven't been living a very meaningful life or haven't thought much about it.

01:27:10 Speaker_02
It can be really traumatizing to realize, oh, gosh, to all of a sudden take that seriously and then realize you don't have much time to do much with it. So anyway, this idea of existential distress is huge in medicine and palliative care.

01:27:25 Speaker_02
It's very nascent. I mean, the way we treat it now is, well, if someone comes to us and they're miserable, well, we rule out and or treat pain, nausea, other anxiety, depression. We look for a diagnosis that we can treat and then we treat it.

01:27:41 Speaker_02
And if folks, after all that, are still miserable and shut down, then we'll sort of invoke this phrase, existential suffering or existential distress. This is what we call in medicine a diagnosis of exclusion.

01:27:54 Speaker_02
And no one knows what the hell to do about this. So diagnosis of exclusion. So you just rule out everything else that you understand, and then whatever you're left with, you just call it this bucket term.

01:28:06 Speaker_02
And in this case, that bucket term is existential suffering. Not particularly inspired, but this is where it also gets thrilling.

01:28:14 Speaker_02
This is my favorite thing about my field, which is palliative care, first of all, organizing around the human condition and suffering and what it means to suffer, this highly subjective state that we all have some experience with in our lives.

01:28:26 Speaker_02
So it's total ubiquity, absolutely un-esoteric field, absolutely relevant. No one I know has not suffered. it seems to be elemental to being a human being. And this is our fulcrum in palliative care.

01:28:40 Speaker_02
And what's more, we have named this thing existential suffering, which is so mysterious, right? And there's so much, it's so ripe to invite the arts into this mix, philosophy into this mix, like we've already talked a little bit.

01:28:54 Speaker_02
So this is my favorite sort of strategic zone to upload into healthcare all these otherwise non-medical issues. So that was on a ton of reasons why I love this space.

01:29:05 Speaker_02
And I'm getting around to an answer to your question, which is, we have named- I'm not in any rush, man, this is a long podcast.

01:29:12 Speaker_03
It always is.

01:29:13 Speaker_02
Good, good, because I love this subject.

01:29:16 Speaker_02
So we have the leverage, now that palliative care is accepted and part of healthcare, and has called out the nature of suffering, and has called out this thing, existential suffering, we have this portal to upload all these other fields and interests.

01:29:32 Speaker_03
And to keep them to make them relevant this is where it gets really meaning you have a channel because you what's your foot in the door palliative care.

01:29:38 Speaker_03
Yeah through which you can insert other things that wouldn't otherwise have an easy gateway exactly you got it right so now enter the relevance of the arts philosophy design.

01:29:51 Speaker_02
You name it what field isn't relevant in some way or other to the human condition right so all of a sudden there's this.

01:29:58 Speaker_02
Huge invitation early possible invitation to the rest of the world besides the medical that sort of narrow medical sciences per se. That's really exciting.

01:30:09 Speaker_02
So back to psychedelics, well, so we can call out this existential suffering, but today, as clinicians, we don't really have much to offer it.

01:30:19 Speaker_02
We're aware that we've talked about this, we've talked about bearing witness and non-abandonment, accompanying people in their struggles is itself a great salve, and that's beautiful work. But what else can we do?

01:30:31 Speaker_02
Well, I often find myself prescribing people for their existential suffering to remember what it is that they love, to keep an eye out for aesthetic moments in their days where they feel something, anything, whether it's that snowball or sun on their skin, some just to note when you feel happy to be alive.

01:30:52 Speaker_02
And there's our little toehold to work from.

01:30:54 Speaker_02
So there's a lot to build around this but what we haven't had is we certainly haven't had any chemicals to offer people to help in this way and it seems the data to date seem really robust that it may be that compounds like mdma psilocybin and other things maybe radically helpful.

01:31:15 Speaker_02
in fostering a meaning-making moment for someone, of fostering a sense of belonging in this sort of cosmic way. And so in other words, we have potentially with these compounds a way to respond to this wacky thing called existential suffering.

01:31:33 Speaker_02
So this is just thrilling for all those reasons.

01:31:37 Speaker_03
Yeah, I couldn't agree more. And for people who want to dig into this, and I would encourage everyone listening to take a closer look at this. There's a great organization.

01:31:45 Speaker_03
I think they're really well organized and comprised of very good MDs and PhDs called the Hefter Research Institute. H-E-F-F-T-E-R. It's just hefter.org.

01:31:58 Speaker_03
and they do some incredible work with not only patient-focused studies but also research studies using things like fMRIs and different types of neuroimaging to look at the specific effects of different types of

01:32:13 Speaker_03
psychedelics, whether you call them entheogens or psychoactive psychotropics, whatever it might be. So it's a very, very, a lot of interesting, interesting work.

01:32:21 Speaker_03
And you can learn a lot about how these compounds function just by looking at, for instance, some of these studies and examining sort of the methodology, right? The protocols that they use.

01:32:32 Speaker_02
So if we look at And by the way, Tim, can I just interrupt? Absolutely. I've also had some really fascinating conversations with other folks in this space and another organization to point your listeners to is a group called Compass. Compass? Compass.

01:32:47 Speaker_02
And they are beginning to also support research in this vein and also starting to try to align healthcare systems and other institutions to participate in this work one way or another and to sort of pull this stuff again out of the closet.

01:33:02 Speaker_02
I'm not sure where they are in their development, but it's another group to be aware of. And I think their website is compasspathways.org. So just another group in this space that's doing cool stuff.

01:33:11 Speaker_03
Cool, and you know what, I'll throw one more in there, Maps, which is doing a lot of investigation, interesting work related to policy and the legal side of things as well, and that's worth checking out.

01:33:24 Speaker_03
And for people wondering, these will all be, links to all these things will be in the show notes at fourhourworkweek.com forward slash podcast, all spelled out. But coming back to your story and your life, I mean, I really,

01:33:40 Speaker_03
I have so much I would love to ask and we'll dig into some of them but we're not gonna have time for all of them, which is fine.

01:33:46 Speaker_03
The question that I'd love to ask next is what you feel you do on a daily or weekly basis that is different from most people? routine-wise, thinking-wise, self-talk-wise, anything. Different from other physicians or just people in general?

01:34:04 Speaker_03
People in general because I don't want to make it exclusively professional.

01:34:07 Speaker_03
This is because I'm looking for, what I'm fishing for are practices that you've adopted or developed habits, whatever it might be, that people listening might be able to test drive for themselves.

01:34:23 Speaker_02
Well, let's see here, my friend. I have two answers to that question. So the one is, we've touched on a little bit, but I find myself increasingly interested in the aesthetic domain.

01:34:36 Speaker_02
And by aesthetic, I mean just the life of the senses, not just beauty, but just the felt environment at all. That is the world of the aesthetic domain.

01:34:46 Speaker_02
And one of the reasons I'm particularly interested in the aesthetic domain, besides just delighting in having a body to feel anything like we've talked, is it's how it prizes purposelessness. So I am all for meaning.

01:34:59 Speaker_02
I see human beings as meaning-making machines. And we talked about this a little bit. Whether there is some grander meaning in the universe, I don't really know. And frankly, I'm fine not knowing. I enjoy the mystery of it.

01:35:12 Speaker_02
And I'm okay if there's meaning on a grand scale or not, frankly. But meanwhile, I am aware of our talent as a species to make meaning for ourselves and to string together narratives and stories and to make sense of our lives.

01:35:26 Speaker_02
I think it's a profound impulse and a lot of good comes from it. And I also just increasingly want to carve out a space for meaninglessness, purposelessness.

01:35:37 Speaker_02
So like again like the snowball or anything that makes us feel in our bones feel happy to be alive in that moment. On behalf of nothing else but that moment and that is i think.

01:35:53 Speaker_02
we could all benefit from letting ourselves delight in things that don't necessarily have any meaning, but just feel good and don't hurt anybody else, but just give ourselves a space to delight, delight in purposelessness.

01:36:10 Speaker_02
That to me is a huge deal, and I see it's therapeutic relevance for my patients very often who are beyond their life of purpose. They can no longer do that job they loved or their role in their family has changed.

01:36:22 Speaker_02
And they're so crestfallen because they don't have that reason to get out of bed. So let's find new reasons to get out of bed. Let's repurpose ourselves. Yes, yes, yes.

01:36:33 Speaker_02
And let's get really good at honoring just the joy of smelling a cookie, and that can be enough. Watching a ballgame, that can be enough. It doesn't have to be big. It doesn't have to be a means to an end.

01:36:47 Speaker_02
So anyway, I think that's one answer to your question. I don't know how many of us are out there prizing purposelessness, but I do.

01:36:56 Speaker_03
Well, it made me think of This might be a strange connection but let me think of Kurt Vonnegut, the writer who I actually consider a fantastic philosopher in a lot of ways, if you read his fiction.

01:37:13 Speaker_03
But one of his quotes that I've always loved is, I tell you we are here on earth to fart around and don't let anyone tell you different. And there's a story, I think it's actually in a dialogue,

01:37:26 Speaker_03
with another writer at some type of event, and I'm sure someone will be able to find it. I'll try to put it in the show notes, but it might be tricky to find, where he talks about this long walk that he takes to mail something at the post office.

01:37:39 Speaker_03
And his wife doesn't scold him, but just laughs and asks him why he wasted so much time. And he's like, no, no, no, no, no, you don't get it. I didn't waste time because, and he runs through all of these seemingly meaningless

01:37:54 Speaker_03
seemingly trivial but to him very important and absurd interactions with multiple people along the way. And it's just a very good meditative exercise because I feel like it's extremely easy to

01:38:11 Speaker_03
think that the big overarching abstract things are the important things, and the small tangible things with sensory inputs are the unimportant things. And I am not convinced at all that that is the case. In fact, it might be quite the opposite.

01:38:31 Speaker_03
And if you had a patient come in, they are finally getting comfortable at Zen Hospice Project, very introverted, and they say to you, you know, I'm going to want to talk to everybody and get to know them, but I'm not quite ready. I just want to read.

01:38:52 Speaker_03
What one to three books would you suggest I read?

01:38:57 Speaker_02
So funny because, I mean, I'm laughing because I am probably the least well-read person you will ever meet, especially one with degrees, college and stuff.

01:39:12 Speaker_03
If they said give me one to three things that I can watch, do, absorb, look at, et cetera, without human interaction, what would your answer be?

01:39:23 Speaker_02
Thank you. That's better for me. I mean, hey, I'm all for books too. Those apparently are cool. But for me, I love film, I love music, I love art, I love doing nothing, I love being outside. So that's for me to lit me.

01:39:41 Speaker_02
But I would put big picture books in front of people. I mentioned Mark Rothko, staring at Mark Rothko work is just a gorgeous splendor, but it suit your taste. So for me, I guess I put a picture book of Mark Rothko paintings in front of them.

01:39:59 Speaker_02
I would put probably any music from Beethoven into their ears, and I probably would reserve that third thing for staring into space.

01:40:09 Speaker_03
Before they stared into space, if they wanted to watch a movie, what would you put in front of them? Man, there's so many good ones.

01:40:19 Speaker_02
Ratatouille, no. I have a real soft spot for waiting for Guffman. Not that it has this great meaning per se, but speaking of absurdity, I just think it's hilarious.

01:40:33 Speaker_03
Waiting for Guffman, I've never even heard of it.

01:40:35 Speaker_02
You've never heard of waiting for Guffman? No.

01:40:38 Speaker_03
Wow just a string of ignorance on my part of this conversation will you don't read books i feel that even just out so yeah but this is good news cuz man you have so much to look forward to me so this of this movie.

01:40:50 Speaker_02
Is by christopher guest and company guys who did spinal tap oh wow best in show sure sure how do you say government or how do you spell government i think it's g u f f m a n. It's frigging hilarious. That is just always a long-term favorite.

01:41:08 Speaker_02
As a kid growing up, Kentucky Fried movie.

01:41:12 Speaker_03
My God, I haven't thought about that in decades.

01:41:15 Speaker_02
Yeah. Wow. That was really an important movie in my childhood. We watched it probably, I don't know, 100 times every day. That and Groovetube, it was formative for us.

01:41:30 Speaker_02
And I heard that you asked another question specifically about documentary film of other guests. And I was thinking about that. And one that leaps to mind, I don't know if you'd really even consider it a documentary, but I guess it is.

01:41:44 Speaker_02
It's the movie Grizzly Man. Oh, man. Oh, man. Yeah, I consider that a documentary. Yeah, sure. Let's call it a documentary. Yeah, of course it is.

01:41:55 Speaker_02
Any piece of art where I simultaneously, I'm not sure whether to sob or laugh hysterically, I love that feeling where you just can go either direction. You're not even sure which is the correct emotion.

01:42:10 Speaker_02
You're simultaneously attracted and repulsed to something. That was my experience watching that film. I just think it's a beautiful, amazing piece of filmmaking.

01:42:21 Speaker_02
I also particularly like its poignancy around our human's silly dance around nature and how we humans think of ourselves as somehow opposed to nature. Yet when we try to reinsert ourselves into the wild, it doesn't necessarily go very well.

01:42:40 Speaker_02
How we romanticize Mother Nature can cuddle us. I spent a lot of time in the desert in Southern Utah as much time as I can. I just love that landscape.

01:42:50 Speaker_02
Speaking of perspective making, I've been thinking on geologic time and making myself feel very, very small and inconsequential is really deeply therapeutic for me. when i got newton i got gotten lost twice walking around this particular area.

01:43:05 Speaker_02
And it's the same feeling i had watching grizzly man which is mother nature as far as i can tell is pretty indifferent to us. Yeah i would say so so anyway there's my answer for you.

01:43:16 Speaker_03
So that brings my two things the first is you mentioned that feeling which is two sides of the same coin almost that of being. Simultaneously repulsed but wanting to laugh and unsure of which way to go that seems to me to be a very primal.

01:43:35 Speaker_03
emotion, like a singular emotion in a way. When, for instance, I've watched nature footage of chimpanzee troops when one of them is torn to pieces by a jaguar or some such on the ground.

01:43:47 Speaker_03
And the response tends to be breaking out into what would be considered by primatologists, hysterical laughter. And this seems to be something very, very hardwired. So returning to that in some way and it being therapeutic doesn't surprise me.

01:44:03 Speaker_03
The second is just to tie together a few things you said related to sort of the meaninglessness, which may be too loaded a term for some people, it might come off as very negative, but seeming inconsequential or small and meditating on that, or not even meditating on it, experiencing it in a very visceral way by being in the desert or looking up at the sky.

01:44:26 Speaker_03
I think it's very compatible with something that struck me, which was told to me by Tony Robbins, who's also been on the podcast. And he said that, and I'm paraphrasing, but that most human suffering comes from a focus on me, like a self-focus.

01:44:44 Speaker_03
And if that is true, it makes perfect sense that focusing on This expansive geological timeline which which puts are like shitty week into a just hilarious. The diminutive perspective makes a lot of sense.

01:45:02 Speaker_03
This is unrelated but what do you think of who do you think of when you hear the word successful.

01:45:09 Speaker_02
I think of, well, you just pointed to something, the relationship of self and the silliness of self and the power of the self. I think we do ourselves disservices by playing into polemics around selfishness or selflessness.

01:45:27 Speaker_02
So there's a lot to say about that. But to segue to your question about success, On one hand, I sort of think of it in terms, I guess I think of it as a sort of a self-actualization. Someone who has realized, has played themselves all the way out.

01:45:42 Speaker_02
And that might be seen and appreciated by practically no one, and therefore not make the measure of some external success.

01:45:50 Speaker_02
But someone who has sort of become themselves, delighted in themselves, including their quirks and awkwardness, and played that self out, insisted on itself all the way to the end, to me that may be a version of success.

01:46:04 Speaker_02
So I guess one part of my answer to your question is I think of it as really an internal process. But then beyond that too, I guess I'm a little torn here because I agree that what I just said sort of focuses us and success back into the self.

01:46:21 Speaker_02
And I suppose the second half of the question really has to do with orienting oneself to the other, to everyone but oneself, and to the relational dynamics between the self and the other.

01:46:36 Speaker_02
And so I think probably success may be, or the second half of it has to do with In a way, maybe seeing yourself in others and others in yourself and realizing the unseen connections between us all.

01:46:49 Speaker_02
This is another reason I love our mortality as it has the potential to be this equalizing, uniting force.

01:46:56 Speaker_02
Success may be this self-actualized piece, but part of that self-actualizing is exploding the sense of self and feeling part of everything around you and vice versa. That consonance with the world around you, that seems like great success.

01:47:12 Speaker_03
Is there anyone who embodies that for you or comes closest?

01:47:17 Speaker_02
Well, I recently had the joy of sitting with Oprah Winfrey and watching her make use of her life and also point her energies to promoting and helping others. This is a very, I mean, a remarkable life's work. And it's just a name we all know, and wow.

01:47:37 Speaker_02
But, you know, I'm also,

01:47:39 Speaker_02
Interested in all the gazillion successful people we walk by every day and don't even know it you know this kind of happiness this kind of success doesn't necessarily brag about itself and i love presuming it when i'm unaware of it and assuming it exists and others that i walked by on the street in a way you find yourself kind of.

01:47:59 Speaker_02
imbuing others with an idea of success that changes how you look at them and how you treat them that's a sweet favorite daily exercise of mine.

01:48:09 Speaker_02
So no it's hard for me to say a single person that i would point to is embody all this so let's you actually touched on a much more interesting.

01:48:17 Speaker_03
answer or point than my question deserved, which is your morning practice. So could you elaborate on that please? When do you do it? How do you do it? So you're walking just to take us through this morning exercise.

01:48:32 Speaker_03
How I get up in the day to start the day know what you just talked about assuming the presence of this type of success you said it's morning exercise of yours.

01:48:42 Speaker_02
Oh i'd love to just hear you elaborate on that oh i don't know how i didn't remember saying morning that's what trip me off so that daily daily exercise perhaps other way i could have made up the morning part.

01:48:53 Speaker_02
Who knows, but sure, but it's sort of, any time of day or night, this is useful. It's kind of like just the power of meaning well, of wanting well of others, and when there's a choice in the matter, to choose to see good.

01:49:08 Speaker_02
And if you can't know, assume good. And this kind of builds an argument to your day of gratitude and happiness and some amount of comfort. So I'll catch myself being bitter or I get kind of road ragey.

01:49:23 Speaker_02
I'm very aggressive on my motorcycle and car and actually just today I was really annoying someone by following them too close. Whatever, I get in my bullshit zone pretty quickly.

01:49:33 Speaker_02
But when I'll catch myself, and then, so when I walk by, you know, particularly here in the Bay Area, the homeless epidemic is enormous.

01:49:39 Speaker_02
And it's just, I'm particularly acutely aware of this exercise when walking by someone who otherwise the world would assume, in a sense, that they are failures in one way or another. I like to invert that whenever possible.

01:49:53 Speaker_02
So I'll just fill in the blanks whenever I see a homeless person, that I'll assume that whatever they're going through is vital to them, and that maybe whatever junk we project onto them, that inside, maybe they're alright with who they are.

01:50:08 Speaker_02
Maybe the way more right with who they are than a lot of people i see striving and otherwise looking successful.

01:50:13 Speaker_02
So it's really just simply that i actually learned this my mother took me to a deep chopra conference when i was pretty young i was a long long time ago the one thing i heard that stock was really interested me was.

01:50:25 Speaker_02
is getting in the habit of saying, when you hear anyone sneeze, either say it out loud or to yourself, say bless you. It's like a neural loop of goodness. And it just means in that quick second, you meant well towards somebody.

01:50:42 Speaker_02
And even if you don't say it out loud, even if you don't share it, say it to yourself. And I gotta believe that that resonates and registers somewhere, that that lands somewhere, that that lends itself to a vibe.

01:50:54 Speaker_02
So that's the kind of stuff you walk around and you see people and you just project well-wishing onto them.

01:51:01 Speaker_03
Now, I hate to focus on something maybe superficial, but you said riding your motorcycle. Now, I apologize if this sounds like a weird question, but you, have three limbs that have been damaged, how do you ride a motorcycle?

01:51:19 Speaker_02
So yeah, so this was a long dream that recently came true.

01:51:25 Speaker_03
Congratulations. I mean, it's awesome.

01:51:26 Speaker_02
I'm just so curious about the logistics. Thank you. Well, it's interesting you ask, because right now there's the man who helped make this dream come true, Randy.

01:51:35 Speaker_02
He ended up being my patient and our resident at Zen Hospice Project not long after he converted my motorcycle. So there's a lot to this story, my friend.

01:51:44 Speaker_02
So cheers to Randy and his family and his wife, I mean, and his mother, Eleni, who I'll be seeing next week actually. So that's one piece of this story. But the other is, I love two wheels, I love gyroscopic lifestyle, I love the feeling of it.

01:52:00 Speaker_02
So I've always loved riding bicycles. Then I'd always wanted to get on a motorcycle, but I kept going to shops and people would look at me and no one got into it.

01:52:09 Speaker_02
I could never find a mechanic who was willing to take it on and try to help make it happen. A fellow name martin law will lose an old.

01:52:18 Speaker_02
Motorcycle racer champion legendary in that world he has to live around here in timor on and he built a prosthetic component.

01:52:27 Speaker_02
I don't know what the story that inspired to do this but he's a machinist himself enough handy fellow in his retirement he got in this.

01:52:35 Speaker_02
This is a building this prosthetic component that lends itself very well to mounting an arm onto a bicycle or a motorcycle.

01:52:44 Speaker_02
So the first piece of this puzzle was discovering Mertz's invention and getting a hold of it myself, which allowed me to get my prosthetic arm attached to a handlebar in a very functional way.

01:52:55 Speaker_03
So you have throttle, rear brake, and then typically front brake on the left. How are those controls modified?

01:53:03 Speaker_02
Okay so randy what he what he figured out so first was to get the arm piece and then what randy figured out was well then a prilia.

01:53:10 Speaker_02
And i know honda had made a version of this as well but really makes a model the mona m a n a that is clutchless so that was a huge to get out of the way so this is essentially an automatic transmission.

01:53:25 Speaker_02
So that do away with the clutch and gear changes. So that's a huge piece of the puzzle out of the way. And then Randy figured out a way to splice the brakes front and rear in a certain ratio into a single lever.

01:53:37 Speaker_02
So I'm doing nothing with my prosthetic feet. except to hold onto the bike. I'm doing nothing with my prosthetic arm except for holding onto the bike.

01:53:46 Speaker_02
So all the actions in my right hand breaks into one lever, and Randy built this box and moved all the controls, the turn signals, horn, and all that stuff over to the right side of the bike in good distance for my thumb to reach them.

01:54:00 Speaker_02
So I have throttle, brake lever, and then the turn signal box all going with one hand. And that's awesome. That's it. You know, that's that's a way away you go.

01:54:13 Speaker_03
OK, I just have to pause here for a second and just ask everyone listening what bullshit excuses you have for not going after whatever it is that you want. Like, please write in.

01:54:29 Speaker_03
Tell us on social media why these are real excuses with hashtag bullshit afterwards. Oh my God, man. That's such a great story. I'm so glad I asked about it and what a really fantastic. Workaround, man, congrats, that's awesome.

01:54:48 Speaker_02
Thank you, and thanks, Randy, and thanks to the folks at Scooteria, the bike shop in the city. A lot of people helped me make this come true, and it took a long, long time of trying to find the right folks to make it happen, so amen.

01:55:01 Speaker_03
Amen to that. Just a few more questions. I want to be respectful of your time, but I'm having a blast here. What $100 or less purchase has most positively impacted your life in recent memory? I'm guessing not the motorcycle.

01:55:15 Speaker_02
No, that was a little more than a buck. Holy cow, man, wow. You know, I would probably point us to a beautiful Pinot Noir from Joseph Swan up in Sonoma County. It's like the artwork of Andy Goldsworthy or anyone who delights in anything ephemeral.

01:55:35 Speaker_02
The charm in a bottle of wine, the craft, all the work that goes into it. actually delighting in the fact that it's perishable and goes away, I find really helpful.

01:55:48 Speaker_02
So I've gotten a lot of miles out of a beautiful bottle of wine, not just for the taste and the buzz, but the symbolism of delighting in something that goes away.

01:55:58 Speaker_03
Here, here, I have a practice that some folks might enjoy, which I didn't come up with. I'm pretty sure I borrowed it from some past girlfriend, but I have a

01:56:10 Speaker_03
small glass jar and i keep the corks from bottles that i finished with friends at home and i have each of them write something on the cork.

01:56:23 Speaker_03
So i have this collection the bottles are gone the wine is long gone but there's this vestige right maybe that's not the right word i'm trying to jerry.

01:56:32 Speaker_03
Who is to sound intelligent but the the corks in this said i'm looking at right now it's on this floating shelf on the wall and so i see it as i walk by it.

01:56:41 Speaker_03
Yes and no matter how sort of lonely i might feel at times i think we all do at moments that sort of a reminder of how close by how within reach sort of friends and that type of experience are.

01:56:53 Speaker_03
If you could put one billboard anywhere with anything on it, what would it say? Oh boy. That's a doozy.

01:57:00 Speaker_02
Let's see here, man. Well, it makes me think of. His biggest billboards are you cannot we can only put so much on a minute makes me think of my favorite bumper sticker.

01:57:11 Speaker_02
I guess it seems like such a potent i just love i love it and so i would love to see it on a billboard which and and the basic bumper sticker i'm sure you seen it is don't believe everything you think.

01:57:23 Speaker_02
Actually never seen that that's a really good one what's what is the sweet hilarious. true reminder to not take yourself so dang seriously. Anyway, that's probably my choice. Don't believe everything you think.

01:57:37 Speaker_03
Don't believe everything you think. I was really waiting for what this was going to be. I was really wondering. I saw one.

01:57:45 Speaker_03
I'm really going to lose any shred of respect that people have for me by saying this, but I saw one recently that it was not a bumper sticker. It was surrounding the license plate. I'm not sure what the license plate casing, I guess. It said,

01:57:59 Speaker_03
Um, if you're on my ass, you better be pulling my hair.

01:58:02 Speaker_04
I thought that was pretty clever.

01:58:05 Speaker_03
Uh, but it shows you where my level of emotional maturity is in any case. Don't you're I, you know, I thought I might, I might lose you with that one. That's okay. I'll try to really reel you back in with the next few questions.

01:58:17 Speaker_03
So yeah, don't believe everything you think. That's awesome. I'm astonished I've never seen that. What advice would you give your 30-year-old self? And if you could place us with where you were, what you were doing, that'd be helpful also.

01:58:33 Speaker_02
Wow, that was a particularly poignant time for me actually. I was deep in med school. It was my last year of med school. Boy, I had a really experimental tour of my 20s. I was settling into a new rhythm.

01:58:50 Speaker_02
I had finally let go of a fair amount of guilt around my own accident and the effect on my friends. I was pretty,

01:59:01 Speaker_02
neurotic at that time, and my sister had just died, so this may not be the intention of your question, but 30 happened to be a really sort of heady, heavy time for me.

01:59:11 Speaker_02
But I'll still roll with the question, and I think I guess I would have helped myself get, you know, this sounds way too tidy, but I might have said something like, hey man, don't believe everything you think. Don't, you know. Let it go.

01:59:27 Speaker_02
Don't take it all. I do mean to take life very seriously, but I mean to take things like playfulness and purposelessness very seriously.

01:59:36 Speaker_02
I don't mean this is not meant to be light, but I think I would have somehow encouraged myself to let go a little bit more and hang in there and don't pretend to know where this is all going and you don't need to know where it's all going.

01:59:52 Speaker_02
Yeah, you don't need to know where it's all going.

01:59:54 Speaker_03
And you can't. And you can't. What have you changed your mind about in the last few years?

02:00:02 Speaker_02
Well, for all my talk of purposelessness and all this stuff, I have in the last several years allowed myself to feel that I have a true vocation in this work around palliative care. helping us as a species deal with our, and dance with our mortality.

02:00:20 Speaker_02
I had convinced myself that, hey man, I had gotten very loose and I was whatever, I didn't feel the need to accomplish so much per se. But in these last few years, I've let myself, I think in a way man, I think I've let myself,

02:00:37 Speaker_02
get more ambitious in a way and to take my work even extra seriously, more seriously than perhaps I had been and letting myself feel like this could all work and letting myself feel like actually the healthcare system could be fixed.

02:00:57 Speaker_02
So in other words, I guess in a word, is to re-equate myself with something I hadn't talked myself out of, which was ambition. I still think of that word in negative, with negative connotations. I see bad behavior on behalf of ambition a lot.

02:01:11 Speaker_02
And I'm sure you have too, and around where we live, and places like Princeton, and people stepping all over each other to get ahead, and that's not what I'm talking about.

02:01:20 Speaker_03
But- Maybe it's aspiration. Yeah, yeah. Mm-hmm. Yeah, I think that's right. Well, on that point, do you have any last requests, asks, suggestions, or otherwise for the people listening?

02:01:38 Speaker_02
Oh, thanks, man. That's such a great invitation. I mean, one is, folks, hey, everyone, I hope we can start seeing the remarkable amount that we all have in common.

02:01:48 Speaker_02
by virtue of being the same species on the same planet, et cetera, and mortal beings at that. And I guess I would ask that we start looking to make that real. I would ask that we prize kindness. I would ask that we learn to forgive in a daily way.

02:02:08 Speaker_02
But more strategic, I would ask you guys, if you're so moved, to get involved reifying and supporting hospice and palliative care. If you're in and around the Bay Area or just so moved, we would love your support at Zen Hospice Project.

02:02:22 Speaker_02
These places rely heavily on philanthropy. So if you're moved, please come check us out, zenhospice.org. Otherwise, think about what's going on in your own geography. Support hospice and palliative care. It's work that needs to be developed and built.

02:02:37 Speaker_02
Yeah, I'll leave it at that.

02:02:38 Speaker_03
That's plenty. I've been so excited to chat with you for so long, and I've had so much fun in part because it's exciting to me to think that In studying and refining how to die, we can study and refine how to live. And that, like you said, with the

02:03:02 Speaker_03
foot in the door, the wedge that is palliative care, you have the ability in this laboratory called Zen Hospice Project to do a lot of experimentation that could actually translate much more broadly to life, not just at the end of life, but throughout life.

02:03:21 Speaker_03
And I find that very, very inspiring and exciting. So I think it's a real Tremendous opportunity and potential point of leverage that you have and so people can find you at zen hospice dot org. Zen host spice dot org zen hospice.

02:03:43 Speaker_03
Facebook is zen hospice project twitter at zen hospice. And i'll put all this in the show notes of course for everybody listening.

02:03:53 Speaker_02
Can I also on that note, Tim, can I just give a shout out to the work that's also the great work that's being done at UCSF? Absolutely, of course.

02:04:00 Speaker_02
The symptom management service in the UCSF Cancer Center, the outpatient palliative care program there, Mike Rabo and all the work going on around there is gorgeous.

02:04:09 Speaker_02
And that's another thing to consider supporting, but that's another place to find my work too.

02:04:14 Speaker_03
Definitely. Yeah, UCSF is just spectacular. I've also been involved with the Ghazali Lab and other folks at UCSF. I'm just continually impressed.

02:04:27 Speaker_03
BJ, hopefully we'll get to do a round two, maybe with some wine sometime, but I really appreciate, number one, first and foremost, the work that you're doing and how you've dedicated your life. It's tremendously important. and tremendously impactful.

02:04:40 Speaker_03
And also on a smaller level, of course, the time that you carved out today for this.

02:04:46 Speaker_02
It's such a pleasure, Tim. And that went really fast, man. And thank you so much for having me on the show. It's such a joy.

02:04:52 Speaker_03
And to everyone listening, you can find the show notes, links to everything we discussed at fourhourworkweek.com forward slash podcast all spelled out or just search Tim Ferriss and podcast. And as always, until next time, thank you for listening.

02:05:11 Speaker_03
Hey guys, this is Tim again. Just one more thing before you take off, and that is Five Bullet Friday. Would you enjoy getting a short email from me every Friday that provides a little fun before the weekend?

02:05:22 Speaker_03
Between one and a half and two million people subscribe to my free newsletter, my super short newsletter called Five Bullet Friday. Easy to sign up, easy to cancel. It is basically a half page

02:05:33 Speaker_03
that I send out every Friday to share the coolest things I've found or discovered or have started exploring over that week. It's kind of like my diary of cool things.

02:05:41 Speaker_03
It often includes articles I'm reading, books I'm reading, albums perhaps, gadgets, gizmos, all sorts of tech tricks and so on that get sent to me by my friends, including a lot of podcast guests.

02:05:54 Speaker_03
And these strange, esoteric things end up in my field, and then I test them, and then I share them with you. So, if that sounds fun, again, it's very short, a little tiny bite of goodness before you head off for the weekend, something to think about.

02:06:08 Speaker_03
If you'd like to try it out, just go to tim.blog slash friday, type that into your browser, tim.blog slash friday, drop in your email, and you'll get the very next one. Thanks for listening.

02:06:20 Speaker_03
This episode is brought to you by Shopify, one of my absolute favorite companies, and they make some of my favorite products.

02:06:26 Speaker_03
Shopify is the commerce platform revolutionizing millions of businesses worldwide, and I've known the team since 2008 or 2009. But prior to that, I wish I had personally had Shopify in the early 2000s when I was running my own e-commerce business.

02:06:40 Speaker_03
I tell that story in 4-Hour Workweek, but the tools then were absolutely atrocious, and I could only dream of a platform like Shopify.

02:06:48 Speaker_03
In fact, it was you guys, my dear readers, who introduced me to Shopify when I polled all of you about best e-commerce platforms around 2009, and they've only become better and better since.

02:06:59 Speaker_03
Whether you're a garage entrepreneur or getting ready for your IPO, Shopify is the only tool you need to start, run, and grow your business without the struggle. Shopify puts you in control of every sales channel.

02:07:11 Speaker_03
It doesn't matter if you're selling satin sheets from Shopify's in-person POS system or offering organic olive oil on Shopify's all-in-one ecommerce platform. However you interact with your customers, you're covered.

02:07:22 Speaker_03
And once you've reached your audience, Shopify has the internet's best converting checkout to help you turn browsers into buyers. Shopify powers 10% of all e-commerce in the United States.

02:07:33 Speaker_03
And Shopify is truly a global force as the e-commerce solution behind Allbirds, Rothy's, Brooklyn and millions of other entrepreneurs of every size across more than 170 countries.

02:07:43 Speaker_03
Plus, Shopify's award-winning help is there to support your success every step of the way if you have questions. This is Possibility, powered by Shopify. So check it out. Sign up for a $1 per month trial period at Shopify. That's S-H-O-P-I-F-Y.

02:07:58 Speaker_03
Shopify.com slash Tim. Go to Shopify.com slash Tim to take your business to the next level today. One more time, all lowercase, Shopify.com slash Tim. This episode is brought to you by Viori Clothing, spelled V-U-O-R-I, Viori.

02:08:15 Speaker_03
I've been wearing Viori at least one item per day for the last few months, and you can use it for everything. It's performance apparel.

02:08:26 Speaker_03
but it can be used for working out it can be used for going out to dinner at least in my case i feel very comfortable with it super comfortable super stylish and i just want to read something that one of my employees said she is an athlete she is quite technical although she would never say that i asked her if she had ever

02:08:45 Speaker_03
used or heard of Viore and this was her response. I do love their stuff. Been using them for about a year. I think I found them at REI. First for my partner, t-shirts that are super soft but somehow last as he's hard on stuff.

02:08:57 Speaker_03
And then I got into the super soft cotton yoga pants and jogger sweatpants. I live in them and they too have lasted. They're stylish enough I can wear them out and about. The material is just super soft and durable.

02:09:09 Speaker_03
I just got their Clementine running shorts for summer and loved them. The brand seems pretty popular, constantly sold out.

02:09:14 Speaker_03
In closing, with the exception of when I need technical outdoor gear, they're the only brand I've bought in the last year or so for yoga, running, lounge wear that lasts and that I think look good also. I like the discreet logo."

02:09:28 Speaker_03
So that gives you some idea. That was not intended for the sponsor read. That was just her response via text. Viori, again spelled V-U-O-R-I, is designed for maximum comfort and versatility. You can wear it running.

02:09:42 Speaker_03
You can wear their stuff training, doing yoga, lounging, weekend errands, or in my case, again, going out to dinner. It really doesn't matter what you're doing. Their clothing is so comfortable and look so good, and it's non-offensive.

02:09:56 Speaker_03
You don't have a huge brand logo on your face. You'll just want to be in them all the time. Their men's core short, K-O-R-E, the most comfortable lined athletic short, is your one short for every sport.

02:10:08 Speaker_03
I've been using it for kettlebell swings, for runs, you name it. The Banks short, this is their go-to-land-to-sea short, is the ultimate in versatility. It's made from recycled plastic bottles. And what I'm wearing right now,

02:10:20 Speaker_03
which I had to pick one to recommend to folks out there, or at least to men out there, is the Ponto Performance Pants. And you'll find these at the link I'm going to give you guys.

02:10:30 Speaker_03
You can check out what I'm talking about, but I'm wearing them right now. They're thin performance sweat pants, but that doesn't do them justice. So you got to check it out. P-O-N-T-O, Ponto Performance Pant.

02:10:40 Speaker_03
For you ladies, the Women's Performance Jogger is the softest jogger you'll ever own. Fiori isn't just an investment in your clothing, it's an investment in your happiness. And for you, my dear listeners, they're offering 20% off your first purchase.

02:10:53 Speaker_03
So get yourself some of the most comfortable and versatile clothing on the planet. It's super popular. A lot of my friends I've now noticed are wearing this. And so am I. VioriClothing.com forward slash Tim. That's V-U-O-R-I Clothing.com slash Tim.

02:11:11 Speaker_03
Not only will you receive 20% off your first purchase, but you'll also enjoy free shipping on any US orders over $75 and free returns. So check it out. VioriClothing.com slash Tim. That's V-U-O-R-I Clothing.com slash Tim.

02:11:27 Speaker_03
And discover the versatility of Viori Clothing.