dr bj miller

Dr. BJ Miller on Mettle Health and Improving the Quality of Life While Facing Serious Illnesses (#261)

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Our guest today: Dr. BJ Miller

Dr. Bruce (BJ) Miller Jr. is a hospice and palliative care specialist who treats hospitalized patients with terminal or life-altering illnesses. His expertise includes symptom management for patients with cancer. In his work in end-of-life care, he seeks to connect art, spirituality and medicine.

He has been profiled in the New York Times and interviewed by Oprah Winfrey, Tim Ferriss and Krista Tippett. He was also interviewed on Feisworld Podcast in 2017.

Miller has a grant from the Fetzer Institute to help integrate spirituality as part of the health of mind and body into medical education.

A native of Chicago, Miller studied art history as an undergraduate at Princeton University. He worked at nonprofit organizations for the arts and disability rights for several years before coming to UCSF to earn his medical degree. He completed an internal medicine residency at Santa Barbara Cottage Hospital, where he was chief resident. He completed a fellowship in hospice and palliative medicine at Harvard Medical School, working at Massachusetts General Hospital and the Dana-Farber Cancer Institute.

In our live conversation, we’ll be talking about an exciting new project Dr. Miller is leading with his colleagues called Mettle Health: https://www.mettlehealth.com

What our interview

Transcript

Dr. BJ Miller on Mettle Health and Improving the Quality of Life While Facing Serious Illnesses.mp3 – powered by Happy Scribe

Feisworld podcast helps independent creators live their creative and financial freedom. I’m your host, Fei Wu, and I’ll be taking you through a series of interviews with creators from around the world who are living life on their own terms. Each episode is packed with tactics, nuggets you can implement origin stories to make listening productive and enjoyable. We’re not only focused on the more aspirational stories, but relatable ones as well. We also have none interview based miniseries releasing throughout the year to help Deep dove into topics such as freelancing, marketing, even indie filmmaking that will benefit creators like you.

Show notes, links and ways to connect with the guests are available on Feisworld.com. Now onto the show. Hello, hello, this is Fei Wu from Fei’s World podcast. Thank you so much for joining me. I have a very, very special guest who’s very dear to my heart today, and his name is Dr. B.J. Miller. He is a hospice and palliative care specialist who treats hospitalized patients with terminal or life altering illness. His expertize includes symptom management for patients with cancer.

In his work in end of life care, he seeks to connect art, spirituality and medicine. And he’s been profiled in many, many places, including New York Times. He was interviewed by Oprah Winfrey, Tim Ferriss, Krista Tippett and of course, last but not least, favorite podcast in twenty seventeen. I first met him through Robert Lefferts Memorial Lecture series related to palliative care over the years, and because of this lecture series really introduced me to so many people, in particular palliative care doctors.

You know, I have a personal history also to always try to understand what we can do at the end of our lives if there’s an alternative to how people are often dying these days. You know, my dad, who passed away nearly 11 years ago in December 2009, was treated for cancer. He died of esophageal cancer. And at the time and for the two years he was sick. I was in my 20s, twenty four to twenty six, to be exact.

I remember it was such a chaotic time of my life. I and my mom together who were suffering greatly because we didn’t know if there was any other way to to treat my dad. And he was. And he died as a result at the ICU. If I were to do it all over again, I would have never allow that to happen. And he was also in China, which means there was some level of cultural discrepancy as to what we had access to, what our friends and family wanted it for the end of his life versus what we wanted.

There was a lot of struggle in retrospect. If I knew for a second that palliative care is something that I could have taken advantage of palliative care specialists who offer online consultation to help me through reading these charts and numbers and terms and terminologies I knew nothing about. It would have really changed my life. I would have long, long ago became an advocate of palliative care. Who knows, maybe I’ll start my own palliative care podcast’s to be a non doctor.

But going after specialists in this area, I am beyond the intrigued of these folks. If you are unfamiliar with this practice, definitely look it up. I bet that there are services near you. And if you don’t and if you know someone who is suffering family members and friends, as we always, always do. Right. We have each one of us have hundreds, if not thousands of connections on LinkedIn, on Facebook. And we know that deep down someone is always suffering.

And I know friends and family who have lost their husbands, their wives at a young age. I know friends whose kids are sick, whose kids are diagnosed with cancer, and the parents have to really change their lives forever because of it. Dr. B.J. Miller started a new practice called Mettle Health, M-e-t-t-l-e, MettleHealth.com. And it’s a team led by him with a lot of these qualifying physicians, social workers, psychologists who are ready to take care of your situation, to have an open conversation, to let you know you, meaning whether you’re a patient or a family member or clinician, to help you understand other alternatives that will make your life life better and to see other perspectives.

And I’m just really thrilled as I’m recording this on my own. Mom, who is a master artist, is painting away on the large silk canvas. It’s really 100 percent silk cloth, a portrait of very, very creative portrait of B.J. Miller. And to witness that come alive is just the most surreal and magical experience, one of the most magical experiences I’ve shared with my mom during the pandemic. I cannot even begin to tell you how special it feels.

So if you also want to check out this portrait in progress, we’re about halfway through at this point. But you get to see all the videos and all the still photos that my mom has done, and that is on her Instagram channel called XiangLi Art. That is X-i-a-n-g-L-i A-r-t so without further ado, I really want to welcome you to this very special Live stream I had earlier on with Dr. B.J. Miller. We talk about a variety of topics about his book launch last year in twenty nineteen, a called Beginner’s Guide to the End It.

It’s just so liberating and heartwarming to read that book, believe it or not, I read the book sometimes late at night, even towards the end chapters about the end of life. It was just felt so authentic, soothing. I will include links in the description below, as we can definitely check it out, including Mettle Health. Other than that, we’re just having a very open a friend to friend conversation. Dr. Miller also opened up about sexuality and what it means to what sex means, what intimacy means.

Well, people are going through serious illness. We even talked about that, how these lessons could be very beneficial to people who are not sick because that, you know, as you probably have heard in previous episodes of Feisworld Media talk about sex and intimate lives among couples and beyond and why it’s so important to understand our limitations are the framework of our mindset and how to make our lives better, how to really connect with our census. So, so many hidden gems.

I truly think B.J. Miller is a treasure of the human kind and is such a mensch and has so much to offer. Yet he is a hidden gem. As much as his video on Tadgh received over 12 million views, I highly recommend you check it out. I’ll include a link. But truly, there’s so many people who still have not heard of him or understand his work. Palliative care in itself as a practice in medicine is a hidden gem.

I think once we understand it better, you’ll see a whole new world related to what your body, what death, what life is all about, so cannot wait to see you at the end of the episode. I welcome your feedback as always. Drop me a note, find me everywhere on First World, Dotcom or Face World as a social media handle that is once again of us or world. Without further ado, please welcome Dr. B.J. Miller to the Face World podcast.

Hi, everyone, this is Faye from Feisworld Media, I have a super duper special guest today, Dr. B.J. Miller, who is here with me.

Yeah, I say hello.

I’m really impressed by your covid hair. I think it looks really good.

I’ve been working on it all morning. This is what I came up with.

It’s awesome. So for those of you who have not met Dr. B.J. Miller, he’s appeared everywhere. Farrah’s interview, Krista Tippett on being these are like all my favorite people in New York Times, Oprah Winfrey. And I couldn’t believe in twenty seventeen. I was able to interview you as well. And our episode just became the like literally one of the all time favorite, most downloaded episodes, thanks to Krista Tippett, of course, is just so good to have you back here.

It’s like, amazing.

Thank you. You make me feel so good. It’s really nice to see you. Thank you all. So I’m not sure we knew this. I wanted to mention this because you’re such a humble person, but Tanveer is publish that book. Tribe of Mentors interviewed hundreds of people, though well indexed to everyone he’s been interviewing over the years and then doing one random interview. Somebody said, hey, out of that entire book, if you have to pick one story, what is the most interesting, meaningful and valuable to you?

And he said, oh, definitely. Dr. B.J. Miller, did you know that?

No, no. No. Really? Yes. I did not know that.

I was like, that’s awesome. I’m like, I have to go back to see who actually interviewed. But I we were all so proud. So I just I was wondering, I was like, I’m so glad. Is now back to like normal life. And you have you can finally relax because I remember twenty sixteen, seventeen. You just like one interview after another. Then there’s a Netflix the end game which we all watched. And then and then you were writing this book that is not a 50 page book.

So like what was it like for those years versus now? What’s the difference?

Oh, it has been really quite a ride. I mean, exciting, right? I mean, I didn’t this was not in my game plan and in so much of this just kind of flowed from the TED talk that happened in twenty fifteen. But even that happened sort of circuitously. It’s not like I sought out to give a TED talk. It happened five funny ways. Someone had had nominated me for this thing called the Ted X Prize, which I didn’t get, but I got sort of consolation prize which was you don’t get the million bucks but hey would you give a TED talk?

And at that time when you and I met, I was working at ONOE, actually, when you and I met if I was there still. But any time at the time of the TED talk, I was working at Zen Hospice project. The job there was getting the word out, attracting attention to the organization, raising money. But besides, the organization was just sort of trying to get the world to think and feel about its mortality, about our reality.

Anyway, I’m going on here. But the bottom line is that’s how I got invited into that TED talk and then that TED talk led to all these other things. And so it was a really surprising detour, but in so many ways a very welcome one, because I like anybody else in my field, we’re constantly going, when are people going to start realizing that they’re mortal? When are people going to start talking about this? Because it’s it’s way more death is way more painful than it needs to be.

And so finally, here it was. The world was sort of cracking open and wanted to hear more, wanted to lean into the subject. So it was thrilling for me personally and professionally. And I get to meet people like you and James and Tim Ferriss and all that stuff. But just amazing. Right? But also, as you pointed out, it got a little dizzy, like, I guess a bottom line, I think of a way to put it is I’ve realized there’s there’s talking about something and there’s doing something.

And sometimes those correlate and sometimes they don’t. And I started spending a lot a lot more time talking about or trying to write about this subject than actually being in it, being in it with my patients, with their families, with my own losses. So in the last year or so, I started realizing I was feeling really kind of out of sorts, you know, just kind of just remote from myself in some important ways because I was on some performances, because I had an audience versus I couldn’t hear my own thoughts for myself, something like that.

Wow. So it was really it’s been quite a ride and I feel like I’ve learned a ton and now I’m really, really happy with some of that stuff in the rearview mirror. So glad to have had those opportunities. So glad now to be getting back to direct support. The thing I was trained to do, the thing I love to do and actually caring for people rather than talking about caring for people.

I am so glad you’re reflecting on that. I’m so glad we have the opportunity to catch up after the fact because I just felt like one of my my friends also for my documentary. I think Sarah Cooper is experiencing the same thing. Sarah is the one who had all the Lip-Sync for Trump. And like overnight, she’s everywhere. Every day I wake up The New York Times like she’s she’s on everything now. And I always wonder, how do people cope with that?

And you do talk about a coping mechanism a lot in your book. And OK, I must confess, last night I started reading towards the end of the book. So for people who don’t know this, you don’t have to be the you don’t have to be a caretaker. You don’t you can just be a regular person to read this book. And it was I could just feel so much of your spirit in it. And I went till the end and I start reading about what it’s like to be dying.

And for some really strange reason, I was reading this first of it, like around 11 p.m. I said, do I want to read this before I go to sleep? But I just felt so calm because it was everything I did not know about dying and all these assumptions that we had. And I ended I run out that my my mom isn’t someone who fears her mortality. I was later on might bring up a story where she was diagnosed with something that was not cancer, but like at the beginning of the year and I came home.

Her primary care doctor is like, it’s probably cancer and she had the surgery is good. I can tell you the moment I came home, I had to cry on my own and I literally cry on I could I have to just hide from her and I have to, like, put on makeup and pretend nothing happened, you know, came out. She was sitting there being a bad ass. But I was like, but where’s the speed dial?

I have to, like, make this phone call right now to be OK. But it was just so calming to read your book and to be educated about this. What what is it that people are like, fearing or stepping away from it to say like, let me now deal with it? Like, what do you think? Is that breakthrough?

Yeah, I think there’s so much to say about that. I mean, you know, some of it sort of inborn and some of it sort of learned, like so many of life’s human like stuff, you know, because we don’t talk about it much or don’t know how to talk about it, because when we do talk about death, the language we’ve chosen, we’ve cultivated, we say things like she succumbed to her illness or she lost the battle, you know, or even worse, like she gave up, you know, or something death represents if you just follow the words we choose, death represents this.

Ugly, gnarly thief that comes and robs you of life as though death and life are opposed. And from a physiologic individualize point of view, I suppose I can see that death is the thing that ends your life in some, but in only some very narrow, narrow sense. The truth is, of course, it doesn’t take long to step back. And you realize that death is a part of life. It is. It’s the package deal. In fact, you don’t get to have life without death.

It’s so the sooner that we as a body of culture, as a nation, as a people can really grok that death is part of the deal, then it’s not so scary. It’s not this mysterious thing that’s going to rob you of your life. It can feel gnarly, can feel hard and many, many things. But if you set this sort of right, if you set your framework of reality to include this event, then it just starts feeling very different.

It starts feeling part of your life, even something to celebrate or even something to navigate with your eyes wide open, even to get into work with, et cetera, versus cower in the corner and hope it doesn’t see you. So that’s, I think a lot of the answer to your question is just sort of how we as people have structured this this piece of nature. And you could say, I think and I’ll shut up, I’ll go on and on about this one.

No worries. I think the subject matter, doesn’t it it doesn’t get much bigger than death, death and life. If it if there’s anything sort of bigger, I would say it’s our relationship to nature or to creation. And there’s another flaw in how we kind of time where we talk about man versus nature, you know, as though we’re not natural beings ourself and it’s the same kind of idea once we kind of rope ourselves into nature. We’re not at war with nature.

We are part of nature. We’re working with right against it. It’s the same kind of idea. So it may feel like a subtle shift, but if we can make that shift, everything else starts to look a little different and a little bit more interesting and a lot more navigable. Yeah, I got an answer.

Yeah. Yeah, I, I don’t know. I was so fascinating with the end chapters. I just, I couldn’t help kept reading it and to think that I always thought that death is like I’m totally conscious, fully aware of the situation and then I’m gone. And then I realize you said Oh the liver and the function doesn’t work that way. So you are going to kind know, kind of slowly fade out process and and then the food hurts is in certain cultures you mentioned, then you always, you know, family members and trying to feed the patients.

But then if you know you’re leaving, that actually will hurt you. And this is how you deal with side of the culture. It was so Eye-Opening to me and I can tell by your facial expression, isn’t it just fascinating to me? I mean, these are all very consequential and I don’t want to get giddy and one past the hard emotions that go with death. Let’s be clear. Death is hard in a lot of ways. And it’s also fascinating and it’s also interesting how humans have come up with various ways to deal with it.

And your point about some cultures wanting to have food in the belly for the journey, for the journey after death. So wherever we’re going, wouldn’t it be nice to have a belly full of food? And so it’s such a beautiful notion. But from a physiological medical point of view, we can actually cause pain by putting food into a belly when that belly can no longer process the food as a body shutting down. We actually cause pain and not promote life in any way with that.

So just to stick with this example, one of the things we’ve learned to do in hospital settings is to acknowledge the the cultural significance of that food. And maybe it is to give a snack or a small amount of food, or maybe it is to put food with the body so that wherever they’re going to have a snack with them. So so if once we start opening our eyes and looking at these things, it becomes very interesting. You can sort of start parsing the meaning of it and you can still protect the meaning of this of these rituals without accidentally hurting somebody.

So these are the kinds of things you can see once you’re in there and look at. But if you’re not looking, if you’re running away, you’re not going to see this little bit.

So, yeah. So I don’t think I’ve listened to so many of your interviews with some of my favorite people, but I don’t remember if somebody asked you when you were a younger doctor, you’re still young doctor. When you’re when you start your practice and when you first faced your patients who are near death, where they’re dying. And what I’ve witnessed later on, you’re holding their hand. Make me think is like, you know, when it’s my time, I would love for someone to hold my hand.

Like, I would be feeling really satisfied and at ease. And the way you talk to them and the in the documentary, I love what you said, which is all based on what I know where we’re going. It’s not so bad. It’s and. But were you ever scared or you know, I don’t know what’s the right word when you first face these folks, like at the beginning where you nervous. How did you feel differently compared to how you feel now?

As a physician working with families and patients, yeah, I was nervous as all get out because, you know, where where where’s the language for this? What do I say? How do I make how do I possibly make any of this better? Because from a medical point of view, when you’re dealing with the end of life, very often what you’re dealing with, practically speaking, is the are the failures of medicine or the limitations of your craft.

So as a clinician, you’re sitting there kind of helping someone see that that you, doctor person, don’t have the power to change this. And that’s hard. And on those sort of clinical ego and how we’re trained, but just an even if never mind my ego, me wanting to be a thoughtful, helpful person, what do I turn to? I don’t have what tricks to I have here. How do I deal with this? And of course, the answer is it’s very simple answer and very complicated.

And the answer is you just be a human being. You drop the veneer of your white coat and your medications and all the things that used to work. But here do not. And you strip you get stripped down with your patients and your families to a degree. If you’re in an empathetic zone, you let yourself get sort of taken down to the studs, too. And then and then we’re two human beings just sharing a really mysterious, huge moment.

And that’s where the holding the hand, sitting in silence, touch, not pretending to know things you don’t. There’s no need. And so that’s but that was very hard to learn to get to, because what it really means, Faye, is what you what you need to do to do this work, to be a full human being, you need to be able to sit with pain that you can’t change. You need to be able to not run away from suffering yours or somebody else’s.

And it’s that easy and it’s that hard.

Yeah. And if I knew mental health existed at the beginning of the year, I would have scheduled my phone calls right away. And it was so necessary there. So like you said, there is just so much unknown and we happen to be all living in this pandemic together. I couldn’t believe that started with an article a friend sent over to me as a text message in late December. And I was like, oh, I feel so bad for people living in China.

That’s where I’m from. But I never thought in a million years that we’ll be experiencing this at large here in the US. So I definitely I’m so excited about mental health. When I saw your email talking about this new project initiative, my first reaction was like, oh my God, how are you going to have the time for this? But let me know if there’s anything I can do to help. So I had to look up metal to to get a definition from Google today.

And it says it’s a person’s ability to cope well with difficulties or to face a demanding situation in a spirited and resilient way.

Yeah, it’s a great word. I underuse. I mean, what a beautiful concept, construct concept. And so that’s a metal metal. So we started metal health. My my partner, Sonya and I, we just unveiled this thing a month or two ago. It’s brand new. We had been wanting to do something like this as part of a different effort. We were going to try to build out a digital library of resources and have office hours as part of it.

But covid hit and made it clear that there was really that really what the world would need it right now is direct support. That’s what we all needed. And so we pivoted, as they say in the business world, to to this direct online counseling format. So that’s that’s how mental health was born. And it’s up and running. We’re just now building it. It’s basically a place you can go for extra support. It’s it’s palliative care. So we’re doctors, chaplains, nurses, social workers.

And but we’re just delivering it through this sort of digital portal. We’re not coming people’s doctors. So I’m not prescribing medications. I’m not usurping anybody’s doctor. I’m we’re here to kind of counsel and coach people through difficult situations and really to coach folks to use their health care wisely because the health care system is powerful. But it also can hurt you if you’re not careful. It’s kind of a dumb system. You need to you need to engage it.

So there’s so we feel there’s a real need for us to help people use what they have a little bit better than to come in and try to fix everything ourselves. We’re more coaching folks through these situations and so far so good. I love the sessions. It’s so good. Like the beginning of our conversation. It feels so nice to be back in this direct supportive communication, this direct exchange. And so, yeah, we’re thrilled. We’ll see where it goes.

Wow.

So it must be so busy. And there are about four of you that I could see on the page. Do you take calls in turns or depending on the patient’s needs and they they are kind of filtered channels to different people.

Great question. We’re playing with this model now. We we decided because of the need being huge to sort of, as I said, build the fly the plane while you’re building it. So we just got this thing up there and didn’t want to overthink it. Just get out of the way of ourselves and start talking with folks. So the early thinking was, you know, you as a as a consumer, a customer, patient client would just sign up for a session and then we would assign you a counselor.

But now it’s starting to feel we’re starting to wonder if the folks would rather having to have that choice picking their counselor or at least picking the discipline. Would you rather talk with a nurse? Would you rather talk with the doctor, even though we’re all trained in the same sort of interdisciplinary care? So we’re now experimenting with giving the client’s choice there. That’s probably where we’ll land, is my guess. But this is all this is all a work in progress as we speak.

Wow.

What? This is amazing. So what are some of the things that if people are watching this, a lot of people who are watching those in my world are entrepreneurs. Some are creative entrepreneurs, some work for corporations. And of course, as you know, there are a lot of podcasters, some YouTube ers as well. What are some of the things that maybe people from my network or through my introduction introductions can do? For mental health, you know.

Well, that’s a lovely question. I mean, a couple of thoughts. One is just to understand, I mean, the things that people come to us with so you can kind of many folks don’t really know what the heck palliative care is probably pays to define that out of care is basically within the context of serious illness. Palliative care is the multidisciplinary pursuit of quality of life. Our job in part of care is to make you feel as well as possible or help you feel as well as you can be, whatever your circumstances.

That’s my job. And so that means there’s practical support, there’s emotional support, this spiritual and philosophical support. There’s all sorts of ways where human suffering is spectacularly elaborate in the way we quell our suffering together is also pretty exquisite. So a lot of it is just listening, being a trustworthy sounding board. So more specifically, clients will come to us and say, gosh, I have to make some decisions about treatment. Do I go into chemo?

Do I do surgery? I don’t know how. And so we’d sit with them and help them work through, like, OK, what’s important to you? What what are your goals here? Here’s how to ask. Here’s what you should ask your oncologist to get clear on this or that. This is sort of what we call goals of care conversation. And that is that’s a way to guide someone through treatment decisions. People come to us for grief support.

Either someone has just died or they’re with someone who’s going to die or they’re going to die and having what we call anticipatory grief. And so there’s a lot of work to support folks through that. There’s basics, of course, of coping with symptoms, just the feelings that go with illness. So those are some of the there’s existential distress, sort of how do you find meaning in your life? There’s how to communicate with your doctor and with your family.

That’s the sort of smattering of subjects that we cover. And you can imagine it can go many, many places. So we’ll start with a client with one question. Recently, I had a client who was interested in regaining some physical intimacy with his spouse who had cancer. And so basically we’re talking about sex. And that was it was a beautiful conversation because that’s one that a lot of folks don’t feel safe having in their doctor’s office. And yet what an important critical aspect of human experience.

So it was felt really it was a wonderful conversation, not medical in nature. And one they couldn’t get in the health care system, persay, but so dramatically affected their take on illness and their experience of illness as a couple. So anyway, there’s a sort of a some of the kind of ground we cover. Palliative care as a service is growing within medicine very rapidly, but not quickly enough. There are a lot of reasons for that. We could go off on that tangent if it’s helpful.

So one of the problems is part of care is very accessible for the most part in big hospitals, but not outside the hospital. It’s really available on the coasts, not so much in the southeast, for example, but the magic of the Internet through telehealth, we can reach a lot more people and be a lot more accessible. We’re starting and mental health is direct to consumer, so it’s out of pocket costs. That’s not ideal. But the client pays out of pocket for this, not as a company.

That’s how we’re going to get started. So we don’t have to be beholden to the medical industry. But over time we will work to start taking and we’ll have a sliding scale. We’ll start bundling our services with our packages. That’s how I would like to grow so that we be more accessible. We certainly don’t want to have services for people of means over here and services for people with no means over here. Death, suffering happens to all of us.

We need to have structures that accommodate all of us. So that’s our plan as a business to get there. So back to your lovely question for your audience. We are looking for angel investors to help build this out. We do want to scale this, but we also were sort of, I think, in a healthy way, suspicious of scale. A lot of good ideas turn kind of funky when they get too big. So we’ll want to creep onto that scale carefully and thoughtfully.

But the need is huge, so we need to get bigger. So help around early or early funding, business planning, that kind of thing, contacts in the world to bundle this into packages, et cetera, that kind of stuff. Wow.

It’s definitely notated. So fascinating. I’ve been in conversations with a number of people actually related to palliative care as well. I think it’s a as an area there. It’s interesting. Some people jump in it usually because they clearly understand there’s a need. But I definitely have seen people who are very business driven as well without the understanding or the expertize to really understand how it works. So, yeah, yes, that’s a huge issue, because especially when it comes to navigating the health care system, not all of this stuff is intuitive, but much of it is not a systems.

Issues are profound and. Experience and as health care as a sector is extremely complicated, people even within health care, don’t understand it. So there’s a lot about this whole experience, either from as a business or just navigating the health care system or being a human being these days. That is not intuitive and hence the need for coaching and counseling and support.

Yeah, awesome.

Things are so bad when I say one more thing that our customers, our clients, our patients, caregivers, but also clinicians, clinicians are burning out at an alarming rate. So being a safe place for clinicians to get some counseling to be heard and feel seen, that’s on our list. Most of our clients so far, our caregivers, family members, caring for somebody second up would be patients themselves. And then the third would be clinicians. But we’d like to address all the all of those audiences.

Awesome. I am so excited for you. And yeah, this is just I don’t know why it just so it’s so exciting. And believe it or not, I, I was so proud of one of my friends reach out to me about a year ago and he wanted to fund the project. We talked and then he was he reached out again last weekend and so very much at the beginning. So I have nothing to really talk about just yet. But it’s about childhood cancer and how it only I believe it’s compared to what adulthood?

Cancer. I guess it’s such a small percentage. And he has two healthy young kids, but he wants to really advocate for these family siblings and they’re passionate about it. And he’s like, I think you are going to be the one to build a website. I was like, really, really me. And but I realize I have a lot of access to so many people, so I can just see so many dots connecting and I am super excited and have fun to connect and lead in and foster these kinds of relationships.

So much of this work is about relationships and communication, your capacity to link folks and bring people together. So it’s so much about I mean, there’s so much good stuff happen in the world. It’s just hard to find it hard to access it. Yeah.

Yeah, exactly. And and I’m not going to skip over since you said sex. And I also I feel like I’m on this quest of I interviewed Dr. Jessica Zitter, Vicky Jackson, Ryan, David, David Reineke. I can never tell. So the head of oncology oncology at my age. So there was a chapter in their book as well talking about sex, because I realized there was such there’s boogeymen like I have a friend. She was her husband was diagnosed with cancer.

It was fairly late stage, but they’re both she was only in her early forties. And I just remember how intimate they always were. They were like the, you know, kind of the model couple, very intimate, like with each other and something that just I felt really sad for her because I you know, I just immediately thought that that I just somehow it was so romantic of me, was like, OK, that maybe isn’t happening because he’s always in and out of treatments.

So and I really realize it’s not just cancer because people go through illness, all kinds of illness, psychological issues all the time. So how do people rethink sex, sexuality? And and last night I somehow watched this YouTube video about this guy who decided that he was not going to there’s a thing like he he has not orgasm like sixty five days. And because each time you orgasm, there’s like a dopamine or something and then all these things. So like how we don’t talk about it, but how do people go about a different way of intimacy and connecting with each other?

Well, I’m very grateful for this question. This is why the magic of sort of starting with reframing how you see the world and yourself in it and reframing reality to you need a really big framework for reality to accommodate all the things that happen to you in a life. I think of a lot of us human beings, life is overwhelming in good and hard ways. It’s an amazing proposition to be alive. But it can be it’s a lot to handle as a human being, especially with our memory.

We have to deal with the past. We’ve got to deal with the future. We got to present. It’s a lot. So one of the ways I think humans generally make sense of it is we narrow our focus. We sort of put structures around it and limitations or boundaries. So we with a narrow or smaller view, it feels more manageable. The problem with that approach is then things that don’t fit in that narrow aperture still come into your life and then there’s no place for them and you feel out of sorts with yourself.

It’s a very common human experience. So that’s why it’s so important to take another route, which is to really blow out the build your capacity as a human being to handle all the stuff that happens in a life. So you’re not at odds with reality. That’s the bottom line. So if you can get there, then you’re in a creative space so that now sex like sexuality, for example, if you had a narrow aperture around what a body should do and can do what’s supposed to feel good and what’s hot.

That’s narrow framework. When you’re sick, certainly when you’re dying, when your body is falling apart, you don’t you don’t feel welcome in that world. Although the limit, the boundaries we put around it, the standards we put around it don’t seem to include you. And so very often I see people letting go of their sexuality. And it’s there’s a there’s a French phrase for this flippity more that little death. It’s one of the major ways that we humans die before we need to die just because we don’t feel like we’re I don’t get to be a sexual being anymore because I have a colostomy.

That’s so sex is gone for me. That’s what I’ll hear patients say all the time. It’s kind of stunning. And we just sort of willfully say, oh, I guess this is how it is. I don’t. But of course, as long as you have a body, as long as you have senses, you have access to sensuality and sensuousness. And then from there, of course, you can tag on other layers of meaning and make it a sexual meaning persay.

But ultimately it’s about human contact and touch and feeling connected, whether that’s through intercourse or that’s just touching, combing your hair or whatever it is, you know. So once you get in there, you allow yourself to feel welcome as a sexual being any more. Then it becomes a matter of exploration when I’m as if I’m sick and dying, my body sort of not what it used to be. Well, I might need to revisit with my partner what feels good to me.

Now, the old things may not work or may not even feel good. If I’ve had surgery on my pelvis, it may not be possible to have sex in the normal conventional way, but any body part can be erogenous. You know, sex is 90 percent mental. We can layer on. We are meaning making beasts so we can take these senses and add significances to them. So that’s that’s a little bit how you do it. First you find a world view that welcomes you into it.

Then you dare to explore what might be a new terrain and that could be very exciting and very intimate because what else what’s more intimate than vulnerability and know that’s when you learn new things.

And I think you’ll I think, you know, if somebody I hope whoever’s listening to that is not feeling well once you recover. I think now when it comes to sexuality and feeling sexy and sexual, all of a sudden there’s a whole new toolbox that you’ve never explored before. And I’ve had so many guests who are not physicians who come on, many of whom are men, to say it’s OK to talk about sex on your shows, like go ahead.

And and I notice these these men are really researching all these things on their own. And then I just I realize that, wow, it’s really true that we never talked about it. You never learn. And then even they said how you change their relationships with their girlfriends, with their wives, with their partners. And it just it’s just incredible that, you know, of so many things that we put on ourselves as a label to say until I have these things checked off, you know, like this video is like orgasm is the destination.

Like if you don’t hit it, then as bad sex. And so I feel like we got to just remove all of that from it. Yeah.

Yeah. Why would we why why we set up why we invent structures that include other people or more to the point that include parts of ourselves that starts feeling, I don’t know, that starts feeling a little bit cruel. And the fact is we human beings are way more creative. We get to name the context, we get to name the structure. So so this is where this work can start feeling really creative and generative and the context is still death.

That’s what’s sort of fascinating. Once you get in there, it’s not all bad, it’s not all bleak. It’s not all down there and other ways to see.

So well, I’m going to do like one eighty here because I’ve been fascinated by watching the way you work, even though I was never really in person. I, I, I would love to do that someday. It’s still like my dream to do a documentary to kind of follow you and see how you work. And and I feel like it’s so educational for doctors to see that, as you know, from the left for family, from the youngest of the family, you know, after meeting you.

And he’s like, I know what I want to do. He’s applying to medical school and is super excited about learning palliative care. And and I just I feel like all of a sudden palliative care is finding me. I think I will be going to China because the doctor, he’s like, oh, did you know that? Whoa, that is incredible. You guys must be pioneers. And he’s like, oh, not really. To a. a WeChat group.

And then. Like hundreds of doctors and that we had group, I was just blown away, I would send your interview to them and many of them understand English pretty well and they’re all studying is fascinating. But there’s a long side of saying, I see you were kind of very physically always there in person, hugging, touching and but now we’re in this pandemic together and we’re on Zoom lot like we are right now. Like, do you find challenges, difficulties in consulting or advising your patients?

And maybe not just, um, referring to doctors as a whole to connect with your patients?

Absolutely. These are really weird and trying times. I mean, the first response is we shouldn’t pretend otherwise. I think there’s a there’s a good corollary when people are dealing with serious illness and they get a diagnosis and you watch them try to pretend nothing’s different, everything’s the same, that can be a very enlightened point of view if you’ve really had this huge world view that does accommodate illness like we’re talking about. But for the most part, people are trying to force themselves to stay in this normal plane when it’s not normal, when things are.

So that’s a way that patients we can start becoming, again, at odds with ourselves. So I think job one right now is for us to say, no, this is different or something importantly different happening right now. And you’re naming it with a lot of it is we are removed from human touch Zoom go to meeting these sort of web portals like we’re on now. The Internet. You know, it’s really shining right now and a lot of ways.

Thank the gods for the digital space. Right? I mean, I’m very grateful for it. Without it, I wouldn’t be able to see you at all. But I think it’s really and and so let’s appreciate this technology, but it’s also understand its limitations. This should not I will struggle if I pretend that this is the same thing as giving you a hug or looking you in the eye or feeling your presence or smelling each other, what the animals sort of understand being in someone’s presence.

We don’t have any of those cues right now. So let’s not pretend this is the same thing. This is really great that they got for it, but it ain’t the same thing as you and I being in the same room together. So that’s job one is just to frame it. So we’re not confusing ourselves. And that. So to your question, more specifically, clinically with patients and clients, I’m hearing I’m starting a Web based business where I’m talking with folks on the phone or in video conference.

And so here I am trying to promote a practice through this portal. But so much of my practice will be talking with folks just like we’re saying now. Go touch someone, go be touch where you can. Now go hug a tree, use your esthetic, use your senses. You may be cut off from some of them, but find where they’re still alive and go there and protect and love that space very much because otherwise you start feeling useless to why do I even have a body?

I should just be a disembodied brain on a on a sitting at the table talking, no, no, no. So don’t. So part of it is I really is I can’t do that with my clients. I can’t touch them. I can still love them. We can say really important things and that’s really, really great. But ultimately, I’m walking them up to an edge of some zone and I say, now you’ve got to go. Let’s hang up the phone and you’ve got to go touch your dog.

You’ve got to go eat something and really experience it. So I need it’s on me to protect that analog esthetic because it’s really, really powerful and really, really potent. And if we let it the digital space. Helps us experience why the analog space is so amazing. The world needs we need both.

I do feel I understand it’s not the same. I’ve been in the same room with you. And I was jokingly said to my mom that I remember three years ago seeing you in the room at that time. To be honest, I don’t think many people my age necessarily said, oh, because of Oprah Winfrey, because it years many of them didn’t even know it happened. But you had this presence that people genuinely or just drawn towards you to a degree where I remember doing dinner at the end of dinner, I was going to invite you to my podcast.

But then I saw this long line of men and women just hugging you. And it each took a long time. I was like, oh, man, this is might not happen. I just got to send an email and said, but, you know, what are some of the advice or things that maybe you have learned to maybe just connect digitally a little bit better? And the reason is my primary care doctor. I think clinically he’s good.

He’s also my mom’s doctor. But I saw the pressure. I try not to laugh about it. He’s not on social media anywhere near me. But I saw the way that you showed up on Zoom. He looked even more nervous and reserved than he was in person. He’s like, so is like shaking of the leg. You good? You good. It lasted like five minutes and it was. So what are some of the things as doctors and everyone need to do this?

Well, I think owning the clumpiness, you know, if that doctor said caffé, I don’t know, I’m a little awkward with this stuff, wouldn’t that have felt different? That would have been a human moment. That would have been him being a little bit vulnerable. So I think the key is in some ways, like awareness, aware of what this technology can do and what it can do and speaking to both so saying things like, I’m so glad to see you today before you tell me what’s going on in your life, I’m just pretending to be your doctor, not to say how nice it is to see you.

I miss you. I wish we could see each other in person. It’s not the same, but I’m glad we get this. Wouldn’t that feel different? If you kind of caveat it, set it up a little bit differently and then own the clumsiness that that’s very that can be a really sweet point of connection. Actually, a lot of doctors were trained that we have to have this sort of composure. And when, in fact, as human beings, what we crave as patients is for our doctor to be real human beings, that is, have desires of their own, have disappointments of their own just to be real.

And so here’s a moment to say, oh, gosh, I don’t know how to use this computer thing, which would be kind of tender and sweet. So that would be very, very helpful. And I think and I think beyond that, just even saying I miss you, I look forward to the post covid days when we can see each other again. Yeah. Wouldn’t that have been different. I think is doing is you’re just surfacing what’s actually happening.

You’re just naming it.

Yeah. Yeah. So here’s the thing. For example, when you say that I feel probably genuinely feel like, wow. I mean, you know, as you know, like I have this I haven’t told anybody, but I’m buying this new home. I love to host you here. I generally really want to see you. Do you think for people who may be lacking that love of emotions or doctors who truly deep down like I’m not like you, Vijay, I actually don’t want to see my patients.

Like, do you think they can? It’s still better to say that or.

I think there are ways to say that. I mean, I don’t know that every thought or feeling we have inside needs to be or should be serviced, especially in a professional exchange. So I’m sure there are limitations here, but I don’t think I think that’s where teamwork is so beautiful. And if health care is really working well and where palliative care really, really thrives, it’s because it’s a team. So maybe you are just the way you’re wired is actually being in person with people.

Just really it doesn’t work for you. You know, just it’s just not just your constitution or maybe you’ve had trauma of your own or whatever it is. There’s no shame in that. Like, the shame is when we don’t know ourselves and start pretending and then that’s where the trouble comes in. We know ourselves, know our limitations. Then we can work with teams and say, like, maybe I’ll go into radiology and I work with images, not so much with human being, or I would just only do telehealth, but then I would be aware, I’d be cognizant that that’s not the whole enchilada.

And I would see myself as part of a team to, hey, if I’m doing this digital piece, the work here, but I work with X, Y and Z, and I think you should see them. And it’s working through others, working as a team, not pretending that any one of us has to be all of these things and be good at touch as well as communications. Just does that make sense? So I think if you see yourself in the ecosystem, support your teammates so that altogether you’re promoting you’re fostering a profound experience together and you don’t have to be everything yourself that period.

Yeah.

I love it, I love it, I definitely want to respect your time, I know that how precious this time is to you and you’re super busy. That’s why I was hesitant to kind of announce to the whole world, like, I think there’s a good chance this is going to be canceled or if we reschedule, which is totally understandable. I’m so glad to make it happen. And what are some of maybe a general advice for people right now?

We’re living in covid, and I am I guess I’m very lucky to be a content creator. And I guess there’s a really introverted side of me. I actually like staying at home, recording YouTube videos, helping people, writing constantly. But I can also see young people getting extremely frustrated, really young people, but also people in their twenties. And I have friends with really young kids because the kids want to go back to school, find their friends, and the parents are going crazy and depressed almost to a degree.

Like what? What are some of the advice that we can give to them?

Yeah, it’s it’s a tricky time, especially for young folks to imagine graduating college right now and stepping out of the world into this really tricky. I think, again, like we said, job one is to acknowledge it. Yeah. It’s just not pretend it’s otherwise. And of course, the sooner we acknowledge it, the sooner we deal with it in a concerted way as a nation and the sooner will be on the far side of it. That’s what we’re seeing play out right now is not happening or is happening in a herky jerky fashion.

And what we’re doing with all that is we’re not avoiding the pain, we’re just perpetuating it. So if we just ignored all this and pretended otherwise, if that could work, that somehow if we just could hold our breath and be postcoital soon enough, great through this, that doesn’t work. And more of a shame, it actually perpetuates the pain and extends the pain. That’s that’s the that’s the crazy making part of it. So I think, again, to sort of how you frame this is really important, I think for a younger person.

I think we folks who have been around have been on the planet longer, need to make sure to protect these things that are otherwise could be too subtle. Like we’re talking about the importance of touch, the esthetic domain, the analog domain. We need to name it, protect it, foster it, and make sure it doesn’t somehow go away, because then we’re just really doing ourselves a disservice. I think beyond that, other counsel to to to young, young, young folks would be to see this as part of a whether it’s covid or the next thing or climate change or whatever else is.

I think we are all experiencing something of an existential crisis, not just as individuals, but as a species. That’s a big deal, you know, and let it be a big deal. Let this if I were like sitting with a young person right now, I’d say let this hurt, feel it, feel it, don’t pretend otherwise and don’t make summary statements yet. Be in it. Be here now. And to be in this now means to be lost, discombobulated, feel out of sorts, feel that you will.

One of the great things that come out of this is we’re all going to have to gone through something together and it’s like no one wants to go to war. But if you’ve been to war and if you make it through, it can be a profound, life altering experience. Similarly here, no one wants to be doing this, but since the force bigger than ourselves affecting us, let it let it take you down to the studs, feel it, then the sooner we’ll start seeing who we are, like, what’s the essential piece of us?

I think so many conveniences had started to feel like essentials, and I think we’re now reacquainting ourselves with how little stuff we actually need to survive. That’s really profound. That’s wonderful. It’s painful. But if we let ourselves feel this pain, we will learn so much from it. And so if we can kind of roll around with this existential crisis, find who we are, find what’s really important to us, find what we can let go of, then we can learn a bunch of stuff and we can pop out this back side better for it altered.

We have learned a lot of things so that that would be my counsel. First things first, feel the pain, then we’ll then we’ll deal with it.

This is so wonderful. And for everyone was watching still. This is Dr. Viju Miller. I am so thrilled. We spoke in twenty seventeen. Still one of my favorite interviews. Definitely welcome you to check it out. And this one is going to be produced and edited and will be published through Apple, Google, Spotify, along with eighteen other channels and MetroHealth can be found at MetroHealth dot com. So M e e health dot com and it’s really all there for everyone.

It’s such a such a privilege. So thank you so much. I’m so glad we we did this.

Thank you, Faith. It’s really nice to see you again. I do look forward to that day where we can hug each other again. Please give my best to your family, your amazing family and all the crew out in Boston. And thanks for having me back on, it’s really nice to see you and especially.

This episode of the First World podcast is brought to you by Fey’s World LLC, our marketing service agency created for independent creators and businesses. We offer website development, video production, marketing, mentorship to people who want to tell better stories, level up and create a profitable brand. These were a podcast team. Our chief editor and producer, Herman Silvio’s associate producer, Adam Lefort, social media and content manager Rose de Leon, transcript editor Allena Almodovar. And lastly, myself, the creator and host of Face World.

Thank you so much for listening.

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