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

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This is Tim Ferris. Welcome to another episode of the Tim Ferris 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.

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 past 1 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 to give you these super combo episodes and internally we've been calling these 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.

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. 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.log slash combo. And now without further ado, please enjoy and thank you for listening.

First up, Dr. Gabor Mate, Twitter at Dr. Gabor Mate and Dr. Gabor Mate.com. Gabor is an addiction and trauma expert and bestselling 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.

One of the epiphanies for me in the last very recent year or two has been looking at my coping mechanisms very differently. 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 always applied this loving kindness meditation to other people. 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.

And that's that rage that anger was the fuel that got me out of Long Island. I 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 I call it compassionate inquiry. So inquiry in a compassionate way. Now 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? Ah, it's with my pain. And so what your friends said that it served you. So thank it. Love it. But let go of it is absolutely right. I call it the stupid friend. The stupid friend is the one who helped you in a particular way at a certain time, but it can't learn that that way doesn't function anymore.

That instead of helping now it's hurting. So it's a friend because it's really trying to help, but it's stupid because it's not learning that you no longer that three year old or that five year, although that's 15 year old. You know, so 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.

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. 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. And as a result of these traumatic events, what happens inside you is you get disconnected from your emotions and you disconnect it 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. And these perspectives keep showing up in your life in the present because they're the stupid friends.

And so the issue is not just to recognize what happened 10, 15, 30, however many years ago, but to actually recognize their manifestations in the present moment and to transcend them. And how do you do that by reconnecting with yourself, by restoring the connection with your body primarily and with your emotions that you lost. And what you do when you found these things again, then you have what we call recovery. Because what does it mean to recover something?

It means to find it again. So what does it that people find when they recover, they find themselves. And the loss of self is the essence of trauma. So the real purpose of addiction treatment, mental health treatment, any kind of healing is reconnection. So you 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.

I am 100% sure because I've had people come on and for the very first time on this podcast talk about sexual abuse of the injuries as children and what they did to help recover from that. Many people listening, I am sure have addictions, both traumatic past experiences and trauma. 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. 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 the trauma of a mission.

Trauma of a mission with 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 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, 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? 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 you understand what happened to me.

And so that is a reason for it. So that not 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. 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 generically programmed, so I'm doomed to stay that way. Number one, number two, you have to reconnect with the body.

There are various body therapies, my friend Peter Levine and his somatic experiencing walking tiger. Is that one of the waking the tiger waking the tiger was his first book and he's written many wonderful books since then. So that's the somatic. Somatic experiencing his method is called which he developed brilliant. There is EMDR. Eye movement, decentralization, 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. So it's combined with talk therapy, but it takes you past just a conscious defensive egoic mind. There is emotional freedom tapping that people do. There's various variations on that. There is there is motor sensory integration techniques. Then there is the traditional therapies like yoga. Now yoga was not simply a physical modality when it first developed. Yoga actually means unity.

So the very essence of yoga is to regain that unity not just with ourselves, but also with the larger creation. And so yoga when it's practiced in its intended way, not just the hot yoga where you get to go to work out, 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. Just get it passed for one second. Do you practice yoga and if so, what type do you practice?

So I've always said with my ADHD, I'm not a yoga person. I can't do it until you're not half a go. I met actually a yogi. His name is Sud Guru. He's a Indian yogi with a big following. I was very skeptical, but I met the guy. I now have a 50 minute daily yoga practice, which I did this morning before coming to the end to you. And this made an enormous difference in my life. With my ADHD mind, I really have trouble just sitting there.

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. If you asked me 18 months ago, I would have said no. I supported, but I don't do it. But now I'm actually a very committed practitioner. And it really has made a difference. Is it a particular type of yoga that people could Google or learn more about?

I'm not a yoga expert. And as 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 Sud Guru or his followers. And you can look up Inner Engineering online. When I recommend it to friends and others, everybody has been only been grateful. So I can highly recommend it.

Typically, there's to me what seems to be a cult around the guy, which I don't take too particularly. But he's the genuine article in terms of having it a deep experience, and being able to transmit that experience to others, and creating a practical system around it. So it's worked for me. I'm not here to recruit anybody else, but since you're asking. 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.

Yeah. So it's an Inner Engineering. You can look up online. Great. And it's taught here in the States, and in Canada, internationally, actually. But I did interrupt you. You're about to mention, I think, another technique or modality that can help talk about. For instance, the somatic experience EMDR emotional freedom tapping, motor-centric integration technique or techniques yoga, and then there's something coming up after that. Well, about 10 years ago, I began to work with psychedelics.

Now, if you're 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. But then, to a serious of events, I became aware of the potential role of psychedelics in healing. And I've been doing work with them for 10 years, and there are no other potent methods. They're not for everybody, and I have to emphasize that whatever modality you choose of a psychedelic nature, you have to do it with adapt.

It's not just with deep integrity and deep knowledge and experience, but in such hands and in such a context, it can be like a superhighway to self-awareness. Not in isolation, but it opens doors, but otherwise might take years. And so it's not unusual for me to conduct the 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.

So, again, it's not to be isolated from other kinds of work, and it has to be integrated, but it's not a potent way of working. And of course, 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.

So, Godmore, you mentioned a series of events leading you to psychedelics or to consider psychedelics potentially as a healing or medical modality. If you're able to, could you describe any of those events? Sure. So, in 2008, my book on addiction in the realm of Hungry Ghost, Close and Connoisse with Addiction, was published in Canada, and very quickly became a number one national bestseller.

And I was also currently published in the States as well. And I was in a book tour, and people could ask me, what do you know about addictions and ayahuasca as a treatment? Ayahuasca being a provian or Amazonian vine that's made into a brew that has psychedelic properties, and you're nothing. The next speech or the next event, somebody also asked, what do you know about ayahuasca into addiction?

And if I started getting annoyed with it, like leave me alone, I've used to read in the book, I've spent years researching it, my life experience and all kinds of scientific exploration went into it, asked me what something I know about. 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?

And I was a provian shaman leading some ceremonies up in Vancouver, so who might have said no, when I jumped right in and I sat in this tent with 50 other people? 50. 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 those little baby in the room, mother and dad were there for the experience. Maybe it was in the room, and the baby was cooling away, and tears started flowing down my face.

And these were not tears of sorrow, they were tears of joy, 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. And then I saw in all the ways that I had closed my heart against love in my life, and I'd be trade love in my personal relationship with my spouse and my children and in other ways.

So I just got this experience of love as something profound and universal and life defining, but something from my age being cut off in so many ways. And I got it because I closed my heart against love precisely because when I was vulnerable and small, I'd be so hurt going to my mother's state of mind. She couldn't respond to me, I needed to be responded to not her fault, but she couldn't.

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 explain that for a second. And again, this Buddha Peshchangri, Second World War January, the Russians are circled Buddha Peshch and are fighting the Germans.

The government in power is a right wing fascist, anti-Semitic military force, and even though the deportations of Jews had stopped, the Germans had annihilated half a million Hungarian Jews in three or four months, but not the Hungarian fascists were killing Jews in Buddha Peshch. And including in the house where my mother and her living, so my mother gave me to a stranger in the street, a Christian woman, but she didn't know she'd be there alive next day.

Well, 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 house could I experience it. So my heart closed this against love. And I got all this. And so I got that if this plant that as you say manifest the mind can show me both the ways in which I've closed the off from myself, and that I don't need to because the love is still there. What healing potential it has.

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, they opened the door for me. And I got right away. Now, however the thought that I had was that I had no induction, I had no introduction, I had no processing afterwards.

I was caught as a medicinal plant that has been used in the Amazon basin for hundreds of years, maybe longer in its cultural context in the tribe in a village where people know each other where they know the shaman where they share the same assumptions and the same history. That's not the same as a bunch of Westerners strangers to each other come together for one night drinking the stuff and then going there separate ways. So agreed.

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. So we came up with the idea of a retreat where a small number of people get together with properly trained shaman's who have integrity and experience, deep experience. And with me facilitating people's preparation and their post ceremony integration. 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 to it cold. They come into the preparation in a safe setting where pretty soon that 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. Basically I tell people, guess what you're back and you found your virgin and everything you've heard about your film origin 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. I've had people with multiple suicide attempts, heal from depression. I've seen people get much better with the autoimmune diseases. 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. So that was my personal experience.

Well, can I again give you a quote? Yes, please, which I love. It's one of my, from my one of my favorite teachers and his name is AH Almas. And he says, your conflicts, all the difficult things, the problematic situations in your life are not chance or have hazard. They're actually yours. They're specifically yours, designs 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. You're not going to go in the right direction unless there's something prick 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. 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 mental problems and everything. You've got to see what is the teaching here. 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 two self wants to do. Now, two things. 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. Traditionally, we've had terrible times during holidays. Partly because my workaholism and once I go into a holiday, I just collapse and now my wife is dragging a corpse around. Because I'm a workaholic. You know, I hadn't cleared space. So this time we actually wanted to do a holiday with intention. This is nothing but psychedelics. Just to do that we said an intention. What is an intention?

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 are we going to handle when there's kind of disagreement or conflict? We had a beautiful holiday because it was the first intention of a 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 problem is the upset. So want to do a bit of exercise?

Sure. Okay. You know, if you don't like it, just tell me. 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. And something that they open to sharing. So it doesn't have to be anything stored either or something. But just something out whether it's your spouse partner or the bus driver. I don't care who. Sure. A friend. Okay. So are you willing to go there?

Anything. Okay. I can share anything. Just where you upset with somebody. Okay. Yes. Okay. So what happened to describe it? 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. Yeah. Right. And I had hired someone to do these things while I was gone. Okay. And I came back and done another more fixed. Okay. And your emotional reaction was anger.

Rage. Anger. Okay. Anything else besides anger? I think they're close cousins. Frustration. Frustration is frustration is anger. Yeah. Yeah. I was disappointed. Just disappointed is sadness. Yeah. It's a different feeling. So it's disappointed. I myself also, because I started to look at how maybe... Well, this is not so much an emotion. It's a state of mind. I'm asking what the emotions were. What's inside disappointment? Something didn't happen. I wanted to happen.

How do I feel? Isn't there sadness there? Sure. Yeah. There's sadness. I'm not talking into it. I'm just asking. Well, I might be confusing state of mind and states of mind and emotions. Yeah. I'm not sure how to do it. Yeah. I'm looking at the role emotion. Yeah. Sadness. 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 we've said in angry about?

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. That's what happened. They had made the commitment in the phone. But that doesn't tell me what you were saying in angry about. What does that mean that they didn't fulfill their commitments? Ment that they didn't care about me. They didn't respect me. They didn't care about you didn't respect you.

What kind of person doesn't get care to respect it? I might need a lifeline here. Don't know. Someone who doesn't deserve to be cared for or respected. Exactly. It's going to be unworthy, right? Sure. Overrespect and care. Okay. Now, if two other people here, which there usually are when I do this exercise, I would ask them, okay, we just listened to him tell us about this experience.

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 other reasons might there be? A million in one. A million? Yeah. He could be in the hospital. He could be in hospital. He is part of our cared one could have been in a car accident. Exactly. He had a flight delaying at Codan, Puerto Rico during a hurricane. Yeah. He's got ADHD. Yeah. And he can't follow through.

He's under stress and he couldn't do the email that I was supposed to send to sitting in drafts and I thought I'd sent it, but in fact, he never received it. Okay. Any number of possibilities? Yeah. No. Of all the possibilities that you've just outlined, including they don't care about your respect, which is the worst one? The one I immediately defaulted to. Right. Well, I mean, the worst. The guy's dead. No, no, no, no. It's bad, but no, but internally.

Yeah, internally, the worst assumption is the one that I immediately made. Exactly. So let's notice something. Hey, you, I should say we, because we're all like this, we don't respond to what happens. We respond to a perception of what happens. Right. Okay. That's what the Buddha said. It's with our minds you create the world. So that if you'd fund at ADHD or he was stressed or you know, you might have been sat for him, but we're not of an angry and you will not have been sat.

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, number two, of all the possible interpretations we choose the worst one. The two, thirdly, what I just said isn't true. We didn't choose it. It's not like you went through all these possibilities. Well, the multiple choice that is option D. Oh, no, he doesn't care about me. He doesn't respect me. You didn't do that.

You don't think they're automatically right? The question is why? Now, here's the learning. First, I'm in your life that you felt heard and angry that when you perceived somebody didn't care about you, I didn't respect you. Well, here's what happened before. 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, number one. But you probably agreed. It's not the first time. It's not the first time. Very good.

And most people I talk to, it goes back way back. Yeah, this goes way back into childhood. 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. 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?

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Terms and conditions apply. And now, Dr. BJ Miller, Twitter at BJ Miller MD, 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. BJ, welcome to the show. 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.

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, following on the tails of that, Adam Gisalli, who is an just an incredible neuroscientist at UCSF who's been on the podcast, reached out to me. And that was related to a senior partner at IDEO, who had also reached out to him to suggest that you be on the podcast. 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. But before we get there, and as it was, we'll get there rather quickly, when people ask you what do you do, how do you answer that? I guess I generally say, you know, generically, I'll say, oh, I'm a physician. And people seem like they actually really want to talk things out. I say, well, I'm a palliative care doc. And then people will talk out from there.

I'll say, I work at a remarkable place called the Zenospis project and do some work at UCSF and do increasing amounts of speaking and beating the drum, I like to say. So paying how interested the person asking the question is, that's what they might hear from me. Let's say they're very interested. I don't know if you drink, but let's say the other person said 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? Well, the drum, I suppose, is really is getting society to pay attention to the inevitable of life, helping each other look at hard stuff, helping each other live with hard truths. 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. 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, one is enough, by the way. But let's look at a sample experience. So you have a new patient come into your facility. What does the first meeting look like? What does that first day look like for them? Let me pre-answer your question because it 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 when we're meeting folks for the first time in Zen hospice, they, 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. And there's plenty of work to be done even on the far side of turning that corner. Another way of answering your question is really upstream of hospice.

When folks are struggling, going to war with their disease, engaged in that fight, whether it's chemotherapy or whatever. That's the kind of personnel meet in clinic at UCSF. 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.

The cancer center wanted us to call it the Symptom Management Service because it felt that the Pout of Care phrase had too much baggage around it. And his palliative care, I'm just going to plead ignorance here, is that synonymous with hospice care or is that, are those different things? They are, they're related but different. And thank you for asking that question Tim. I mean, this is part of the drum beat. So hospice is that portion of palliative care that's at the end of the road.

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. You can see folks in palliative care for many, many years. Far and advance of their death. So yeah, all hospice is palliative care, but not all palliative care is hospice. Got it.

All right, so palliative care, just to kind of make it do it is basically the, you know, 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. You know, are you suffering in some intractable way more than you struggling more than you need to? And if so, then, you know, come see us in palliative care will help.

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. Whereas once rendering 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 can spend a lot of time on this.

There are a lot of wonky details, but does that sort of make sense to you? It totally makes sense. And the first thing that led to mine 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, and we'll dig into the learnings and philosophies and so on that you've cultivated.

But so let's say they have gone through the paperwork and the process to get to the Zen hospice project. Uh-huh. What does their first day look like? So first day of Zen hospice is usually there's always the folks by almost by definition are in pretty fragile state. So just the ride getting to the house and into the house is often plenty overwhelming. 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, the kitchen crews are swarming around that resident and their family and just getting to know them. That's where all the potency comes is. It's inherently a relationship. So there's some details around medications and so on, but most of the early work is just getting to know people and making them feel that this is their home now. This is their come to live here.

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. In the first day, it doesn't feel anything like being admitted to a hospital. And pretty soon, as you get to know someone within the first day, invariably questions get asked, like, tell us what's most important to you now. You know, you want something neat. We can whip you up something in the kitchen or we'll tend to the family. It's very casual.

It's meant to be, if you feel like you're entering a warm and bright set of familiar setting. And what does the, just to highlight also the differences, can you describe upon the patient's death, what happens in Zenn hospice project versus in a conventional hospital setting? And you can present either first. Yeah. Well, so in hospice and palliative care in general, but certainly places like Zenn hospice project, in many ways, they were created as antidotes to the hospital.

So in some ways, they're really, you'll feel like opposites. That's to some degree by design. But a death in a place like Zenn hospice project is usually very peaceful because we've gotten to know that person. We've been living with that person. We've 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.

So for the most part, people can enjoy and expect a much more comfortable and peaceful death at Zenn hospice project and places like it. That's what the all of the expertise is geared towards. You're not distracted by beeping machines and other things and other agendas happening, research agendas, whatever it is.

And to your question, how Tim, you know, so when the person dies, invariably the morgue sure it needs to come and retrieve the body and we have this ritual that we offer people, which is on their way out the building. You know, 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 it, we'll all gather on the porch 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. And then we'll sprinkle the body with flower petals.

You know, it's just a very simple, gorgeous moment. And then the body bag is zipped up as it has to be by law and the body heads out the door. But you know, it's just very stunning, poignant, gorgeous, simple moment. And you can feel everyone entering into this sort of grieving phase more fully, especially of course, the family. 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 and easing into the grief process because they're space forward 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. So counter that with the typical hospital deaths. And by the way, Tim, I'm talking about all sorts of things to get out of, I hope you do.

But you know, no knock on hospitals, 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. And you feel that mismatch. So I've worked on a lot of work in hospitals as a patient, but also as a physician. And you know, a typical hospital death is is in a more sterile room, usually lined with a bunch of machinery and all the sounds and lights emitted. 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. And there's no ushering in of grief. There's a sort of a stuffing 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. It's just kind of on to the next.

And it's a stark, stark contrast. You begin 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, but under your care or in your periphery, how many deaths have you experienced? You know, my guess now, 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.

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. What, this is a huge question, so we can certainly find, slice it and feel free to tackle it anyway you like, but what has observing that many deaths and the march towards death taught you about living in specifically your own life? 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, you know, we can feel like you're sitting on a secret because I think the assumption is that, oh, wow, that's got to be very morbid. You know, it is. I mean, you've 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.

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, it's very nurturing. This 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, you know, aware of the clock, you know, and of sure that can make you anxious as well. But we, you know, we know we're aware of our finitude.

And so 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 sort of remarkable vicarious deathbed moments with our patients and their families. And you can learn a lot. And one of the things I love thinking about a real organizing theme for me is, is avoiding regret, essentially.

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. So in the 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.

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? Well, there's 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.

Without 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 commissant that we die. That's part of this drumbeat. 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?

One thing, you know, caveat is, I'm, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, like anybody else, I'm 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. So, you know, I got all sorts of work to do with myself. But as we all do, yeah, yeah, Amen, brother. So, but I do think I've gotten a lot better at, I'm pretty good as a hyper educated person in rationalizing all sorts of things and behaviors.

And I can convince myself to stay in relationship, sort of situations that don't necessarily feed me or that aren't working very well. And I, I think I've gotten a lot better at calling that for everybody's sake, you know, so I might be, I think I'm a little bit better these days at 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, I feel these lessons in my relationship to nature. So that's a great stab 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. And I get thrilled that I can feel anything. Because even pain, I can, if way I deal with my own pain is I just, I remind myself that I'm glad to, to feel anything at all.

So my relationships, I think are impacted by, sort of orientation to mother nature's impacted. I've got a lot, 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. So to drill into that, I apologize for interrupting, but yeah, yeah, not because this is a particular Achilles heel of mine.

And I've improved, 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 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. And 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? Well, this is where meditation, mindfulness, self-awareness, whatever you want to call it can be so helpful because one thing is to get better at realizing you're doing it in the first place. Definitely. Well, even before you're able to change it at all, there's great potency just being aware that you're doing it. I used to be much where I could walk around for months with grudges and chips and bitterness and so on and so on.

Before I even realized that, I would just be really moody or whatever else. So, you know, job one, I guess, is just paying attention yourself and seeing it for what it is. And then the next step is actually, that's the hard part, I think, at least for me. I mean, the next step is actually kind of easy because then as you watch yourself spinning out, then you can kind of call it the silly, useless thing that it is and you kind of take the wind out of its sales. You know, you disempower the anger.

And for me, you know, my life, man, the absurdity, the being in touch with absurdity has been very, very helpful. Yeah. So that's my next step. So, the awareness and then is sort of watching the silliness of it all. And then that anger and maybe with some deep breaths or whatever else or a walk to sort of bleed off the physical anxieties of it, but then I can sort of unspool, unwind and maybe even quickly kind of laugh at myself.

And that's great because, hey, you've let go of the junk and be, it's an exercise in humility and forgiveness, which is always pretty dang useful. 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 Brock that I found very, very particularly helpful to me in this instance. You mentioned mindfulness meditation. Do you have a regular meditation or mindfulness practice?

You know, not really. Well, I guess your whole job in a way is a mindfulness practice. So I think that perhaps might be overkill. So just add another session on top of anything else you're doing. Thank you for that way out, brother. You're welcome.

But, yeah, I mean, it's, you know, there's some truth that it actually, this is where it's 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 just being aware is listening, is paying attention and bearing witness and coming to terms with all the stuff you can't control, whether it's on my, for my sake, all on sake or my page to say.

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. I mean, I do, 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 or something ever since I became disabled, you know, I think I'm particularly primed to appreciate movement. So I like a walking or bike ride and it feels like meditation, but 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, being truly have a meditation practice. And that is really its own discipline. So I don't really have that, but I got those other things.

Well, I think they're all present state mindfulness practices, right? And 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. Could you tell us about the dinky? Yeah. I'm sorry, I love speaking of absurdity, the dinky. What a, I mean, I lost three limbs to a thing called the dinky. Sorry, I'm laughing, but your search lab, I mean, I laughed. No, please laugh.

I mean, it is kind of silly, but anyway. 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. Yeah, it's called the dinky, which affection to some. And the dinky runs from Princeton to Princeton junction and commuters can take the trains into failure, New York or whatever else. That's what the dinky is.

But why it's significant in my life in particular is, you know, one night it was November. I was just after Thanksgiving vacation sophomore year, November 27, 1990, a couple of friends of mine and I were out just hanging out having fun, not a crazy night, but we were walking, well, you remember the wall wall market, Tim? I do. I was at Forbes, so I walked by the dinky and the wall wall every single day multiple times. Right.

So you know, so a late night visit to the wall wall market was pretty common. And so we were heading over to get a sandwich, whatever. You know, and we were just walking by the dinky. It was just parked there. So it was not operating hours and you know, it has a ladder on the back and we just walked by and just decided to climb it, you know, like you would climb a tree.

We really did not think we were doing anything that daring, but put it this way, we'd 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 that those trains run, 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. It's this big metal pole.

So when I stood up on top of the train, I had a metal watch on and I happened to be close enough to the power source and the electricity art to the watch and, yeah, entered my arm and then blew down the feet. How was that? What happened at that point?

Well, I should say I don't really remember anything about that night, but my friends were with me, I pieced it back together, but there was, 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 I think I 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 that couldn't possibly understood and just electrified their friend and yet they got up on top of the train to help me. I mean, I just ever a daily shout out to my friends Jonathan and Pete and Tommy too for all they did for me that night and all God and so many nights.

But yeah, so Pete held me down because I guess I guess at some point I came too. And I was just thrashing about and you have electricity enters your body and so you've got all this heat you burn from the inside out and apparently it's very common that people wake with extreme energy. I mean, you are electrified. So I mean, I'm just flailing, punching him through. I'm just a wild tear apparently. So Pete who was very particularly large, strong and sturdy heroic friend of mine held me down.

I pull off the top of the train and make things worse 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. But between my friends and Princeton police officer by the name of Officer Dawson, I believe his name was who went on to become promoted, I think, after that to Sergeant Dawson.

But anyway, Sergeant Dawson got up on the train with Pete and together with Jonathan, they got me to the stretcher and handed me down to the ambulance. Guys and the ambulance whist me off to the local hospital and the local hospital did of 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. Barnabas Hospital in Livington, New Jersey, which is New Jersey's one and only burn unit, at least it was at the time. And that was that. And flash forward to when you became fully cognizant of what had happened. You open your eyes. What does the scene look like? It's interesting. It's like I was conscious. I was awake throughout the ordeal and it's this more the sleepiness of memory.

So it was not like coming out of a coma where I was asleep and then awake. So there was not a sort of a singular moment reprisal, you know, but I tell you the first memory, which I actually some freakish reason I love this story. Just I don't know why I do like the story so I will tell it to you anyway. So you're blood pressure is unstable. You're just a hot mess. 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 surgical amputation of the dead tissue. And also in part because it's not totally clear what tissues viable and what tissues not. So anyway, it was maybe day five or day six for the first amputations and I woke up the night before. I remember this very, very well. You know that feeling where you wake up from a dream and it's been a bad dream and you there's a moment of sort of panic and then you sort of orient yourself.

You look around you or yourself and you're like, oh, thank God. That was that was just a dream. You know that sensation and it's an incredible somatic. You know, it's a beautiful feeling of relief that washes over you. So anyway, I somehow I looked around a burn unit, which is a particular environment. It's not like our guest house. And I was just describing a moment ago at Zenospis. It's a very technical sterile intense environment.

And somehow in my stupor I looked around and saw all these machines 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. I extubated myself, which is not easy to do. Oh, my G-Stretch. So I extubate myself. I pull out, have all these lines running into my jugular veins in my neck. I pull those out.

I just decouple myself from all these machines and get out of bed on my crispy little feet and start heading for the door to go to the bathroom. You know, I just obviously out of it. But in my mind, very clear, everything's fine. And then the, you know what a Foley catheter is, Tim? I don't know what a Foley catheter is, but a catheter I would understand is something is probably in your rethrough. There you go, pal. You got it. So, yeah. 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 rethrough into your bladder. And the catheter just is there to spontaneously drain your bladder. But the way that thing stays in there is that 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 this, you know, small ping pong ball at the end of it. It's now inflated.

So I'm walking the door and they usually clip the catheter in the bag onto the side of it. So you know where this is going. So anyway, some walking to the door and the thing runs out of slack. And it's the day catheter, of course. And it comes not all the way out, but like partially out. Sorry to you and all you know. This is like a, we're talking like a small python that ate a golf ball kind of situation. No, no offense. I mean, large pythons that ate a golf ball. No, small python.

Yeah. So no, that's right. I mean, so I mean, this is hot. I said, so. Oh, God. And the total reverse that total warm bath of relief that you experienced thinking it was a dream. So that just goes totally in reverse. And in a millisecond, I realized that all of this was not a dream. I'm fall down to the floor because all of a sudden I really can't walk either. Just fall the floor and I'm screaming. I'm pulling on that.

I'm trying to break the rubber tubing of the catheter, which is no way I could somehow relieve the pain. And anyway, finally a nurse comes running in and gets me back in bed. And that was that. But so anyway, that's my first real memory. Oh, my God. I can see why it's a bit. Oh, yeah. I'm sort of bent over as I'm talking to you. Oh, God. 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? Uh-huh.

Could you tell the snowball story? So a burn unit is, I guess I don't really know, 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. 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, as my understanding of certain medical history, that the way burns off and 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've survived the initial trauma is infection. So burning, it's our incredibly sterile environment. So everyone's gowned up, masked, bluived.

For the first maybe several weeks, I could only have one person I'm room at a time. You know, it's just like you're in a bubble. In other words, 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. So there's no relationship to the natural world you can touch nothing.

And also you're in a fair amount of pain, of course, which does not necessarily reward your paying attention to anything. So it's just, it's not fun. So this is November. At some point in December, maybe is early January. And honestly, I can't remember who brought me the dang snowball. I can't remember. There were two nurses in particular that I was felt very close to. And it may have been one of them. I think it was. It may have been her name was Joy of our card of poem.

And 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, I could feel snow. And man, it was so, man, it was just stunning. You know, what a simple little thing, right?

But to put it in my hand 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. 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, we are feeling machines. And if we're caught off and 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 have guessed this, but just holding that snowball first of all, the sensation, but also the implied inherent perspective that it helped me make, right? That everything changes. Snow becomes water. It's beautiful because it changes. Things are fleeting. And it just felt so beautiful to be part of this weird world in that moment. You know, I just felt part of the world again, rather than remove from it. It was potent.

BJ, what did you study undergrad or what were you planning on studying or studying at the time? I always forget when people had decisions in undergrad, even though I went through it myself. Yeah, well, like you, I mean, I started out, you know, ten, I was at Princeton 89 to 93 and I started out, I went there really high on the idea of learning things that were a foreign to me, you know, totally seeing a different world view and really delighting in the liberal arts education.

So with that, I can't on men's square had just happened before freshman year and I was sort of China was on my mind. I started studying Chinese language and was heading for a major in East Asian studies. But when I was out with this injury, art, which I'd always been interested in, especially music, I became much more interested in art, not just listening to it or looking at it, but the idea of art. So I switched my major to art history and that's what I ended up studying.

Would you mean by the idea of art? What is this art stuff? Right? I mean, why do humans, 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. So either in our center daily lives or those of us who make art, we use it to make art. What's the purpose of making art? Art is inherently kind of useless and that seems to be part of its charm.

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? Like, my less human because I have less fewer body parts, you know, am I? Is that the measure of what it means to be a human being? 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 kinds of questions I was trying to kind of wade through.

Like, essentially, questions of identity. So, so study. Art, the hunch was, well, well, this seems to be a peculiar, the situation I'm in was sort of peculiar to being a human being. 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. And it seemed to me 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. And that's what art really helps you exercise that muscle 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. And when I looked at my body, I would have loved to change so much about it, but I couldn't. Well, I could change it with this knowledge. I could change my perspective. I could change how I saw myself.

That's what art helped me learn and where to focus my energies. And it really paid off, I had to say, it's very helpful. 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 care about music, create music, like a compulsion and dance every group of humans on the planet.

It just seems so peculiar, yet unsurprising if you look at, say, bird song and animal mating calls and mating dances and all this, that and the other thing. But there seems to be many layers. 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?

Actually so much of, I mean, 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. 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 in my ear. And that was great. But on the 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. And there was one of my dearest friends, a guy named Justin Burke, who is, he is a philosopher and art historian. I mean, that's what he studied to his doctorate.

And frankly, lots of work talking about right now to him and the benefits I had reaped from it was really in, from conversations with Justin fed the backdrop by this pounds of artwork that I got to spend time with, but 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.

And even this day, I'm in 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. So there's no one work I could point to. Although I would say probably the painting of Mark Rothko has proven to be very poignant and potent for me. I just, any chance I get to stand in front of a Rothko, I will, I will do. Have you spelled that last name? I'm ignorant.

Ross when it comes to this type of thing. Oh, Rothko, R-O-T-H-K-O, Mark Rothko, abstract expressionist mid-20th century guy. Made these big, beautiful color form paintings, non-representational, quick, random anecdote that might be entertaining. So I grew up on Eastern Long Island where Jackson Pollock basically turned himself into one of his paintings by driving a car into a tree. 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 nine o'clock and this man and his wife would say to themselves, oh no, it's fucking Jackson. And again, and they would pretend to be going out to dinner no matter what time it was.

And they'd go, oh, we're so sorry we can't stay or just on our way to dinner because what would happen is he would stay, he would forget about the dogs, they would 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. So anyway, related but totally unrelated.

But if we're talking about abstract, if you were, this is an awkward transition, but here we go, that's kind of my mo. If you were brought in as a position 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 were reading or otherwise would you point them to?

I find myself every once in a while, I'll get called by friends in the hospital, come visit with someone who isn't similar shoes. And actually, I wish I remembered his name, but someone did that for me when I was in the burn unit. He had had a similar accident. I think he lost two legs below the knee. I should say both legs.

And I learned a lot from how I gained from his visits to me, I have just sort of reproduced, which is 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. My early questions when I was in the bed was like, what do I look like? What's it going to feel like to walk on prostheses?

That's kind of, you know, it was that nuts and bolts, he kind of stuff will, will anyone want to date me again? You know, I mean, I don't know. It was on that level. And so when this guy would come visit me, he 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.

Then just seeing him look me the eye with some kinship, that was the therapy of it. I think I've gone in trouble when I've tried to come in with some predetermined idea of advice giving, oftentimes that's not really what's needed. It is 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'll avail myself to any questions I have.

But I think most of the power of this is just visiting, just being together and sharing this awkward body. From what I've heard in red 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. The snowball. Could you talk about the things you've noticed that most help people in hospice care.

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. So you're right. I mean, I think one of the joys about one of the up shots or sober linings about the end of life is that if you want it to, if you'll let it, you can let a lot of the rules that gobbin our daily lives fly out the window.

As you realize, 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. That is the work day to 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 our facing the end of your life, oftentimes that becomes crystal clear.

Like where you've been hanging out and spending so much of your time and energy and worry, it's like living in someone else's dream. You know, it's not sure. I mean, society and what we've structured, there's a lot of importance to it. I don't mean to dismiss it. But we inherited that. We don't spend a lot of time creating our realities in a cop, you know, 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.

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. Right. And that's part of the trick of checking yourself and, you know, over time, you know, in a daily way, am I doing things I really care about, etc. So back to your question, to just point about simple things.

I mean, the simple things, the small things ain't so small, you know, 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. That is so profound, it's so potent. And yet I think most of us take that for granted, you know. So as a clinician and as a person, I love looking for moments where the rules get to go out the window.

I love when I have, you know, I love having residents at the guest house at Zenospos who smoke, frankly, you know, or, you know, anything that just kind of gets to that kind of reorient us and puts things in proper proportion relationship to the natural world. And rejiggers our 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.

I think about this most nights, every night, depending on where you are, of course, but you can look up and usually find a star. 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, you realize that the lights at hitting your eye is ancient and that the stars that you're seeing may no longer exist by the time the light gets to you and just sort of mulling the bare naked facts of the cosmos for me is enough to just thrill me, all me, freak me out, and kind of put all my neurotic anxieties in their proper place. Right.

So yeah, and a lot of people when you're standing at your horizon on death's door, you know, you can be much more in tune with that cosmos than you are with what the body is doing. You know, in a day to day kind of way. Does that make sense? I know, it makes perfect sense. 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?

Yeah. Yeah. Yeah. Well, you know, I mean, the smell of fresh brand are for most of us, the smell of a chocolate chip cookie does magical things, you know, first of all, food is primal. You know, our sense of smell. I mean, the shortest, I mean, it is, it is one of our oldest senses. It is primal. You know, you can walk by someone who may be wearing a colon or perfume of someone you knew 30 years ago.

I still out there's, 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. Louis when I was in preschool. And it would throw me back there instantaneously. Sense of smell is potent. In food is primal and potent. I mean, it's nourishment, it's nutrition, it's how we live in some ways, right? So there's all this symbolic stuff happening too. But there's also just a 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, smelling the cookies, 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. Art as part of its poignancy and music and the dance is its purposelessness. And just delighting in the wacky fact of perhaps a meaningless universe and how remarkable that is, that's kind of 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. Just to prize those little moments. You guys, I might be fabricating this, but make cookies at the Zenospocenter. Because it's a big size reason, right? And so you mentioned absurdity a few times. This is something I've been thinking about a lot.

I mean, and for reasons that may inferentially become super clear in a second, but just the being able to try to laugh at the cosmic joke, so to speak, I mean, like the meaningless miss, 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. But the question I was going to ask is to get your opinion on a modality, we'll call it, or a tool.

And to 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. 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 insurance policies and vagaries of our healthcare 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. The only difference is they come back to life.

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 York family about the use of a belief specifically psilocybin for those people not familiar, which is extracted or the psychoactive compound in 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.

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

So it's not folks who are just with a week trying to justify their own recreational use of these. You see a few UCLA Johns Hopkins, you got it right. NYU friends at the River Sticks Foundation have been funding some of this work. The people I know were involved in this work are deeply thoughtful, caring, loving people. Anyway, so that's a sort of a preamble. But you know, to get to your question, I am thrilled for this for a number of reasons.

One is just the counterculture fund kind of things coming out of the closet. Another is a whole generation, IE 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, a lot of folks of that generation have experienced what 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 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. And basically existential distress is a crisis of meaning in some way or another.

So it's particularly potent at the end of life where people don't have much time left to make meaning and they realize they haven't been making living a very meaningful life or haven't thought much about it. It can be really traumatizing to realize, oh gosh, to take all of a sudden to 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, 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. 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 as a diagnosis of exclusion. So no one knows what the hell to do about this. So diagnosis of exclusion.

Yeah. So you just rule out everything else that you understand and then whatever you're left with, you just call it this bucket term. And in this case that bucket term is an existential suffering. Not a particularly inspired. But this is where it also gets thrilling. 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. So that's total ubiquity, absolutely on esoteric field, absolutely relevant. No one I know has not suffered. It seems to be elemental to being human being. And this is our full command palliative care.

And what's more, we have named this thing existential suffering, which is so mysterious, 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. 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.

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. I always is. I love this subject. So we have the leverage now that palliative care is accepted in 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 and to keep them to make them relevant.

This is where it gets thrilling, meaning you have a channel because you've wedged your foot in the door of palliative care 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, you name it. There's, I mean, what field isn't relevant in somewhere or other to the human condition, right?

So all of a sudden there's this huge invitation, or at least possible invitation to the rest of the world besides the medical, sort of narrow medical sciences, per se. That's really exciting. So we 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.

We're aware that we've talked, as we've talked, like bearing witness and non-abandonment accompanying people in their struggles as itself a great saviour, and that's beautiful work. But what else can we do?

Well, I often find myself prescribing people for their existential suffering, you know, to remember what it is that they love, to keep an eye out for aesthetic moments in their days where they feel something, anything, and just whether it's that snowball or sun on their skin, some just to note when you feel happy to be alive. And there's our little toe hole to work from. 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 may be radically helpful in fostering a meaning-making moment for someone, 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.

So this is just thrilling for all those reasons. 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, I think, that they're really well organized and comprised of very good MDs and PhDs called the Hefter Research Institute, HEF-T-E-R, it's just hefter.org.

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 psychedelics, whether you call them in theogens or psychoactive, psychotropics, whatever it might be. So it's a very, very, a lot of interesting work.

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. So if we look at, and by the way, Tim, can I just interrupt? I've also had some really fascinating conversations with other folks in this study. And I think that's the space in another organization of polyglistensis too is a group called Compass. Compass? I think they're Compass.

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. 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. Just another group in this space that's doing cool stuff.

Cool. And you know, I'll throw one more in their maps, which is doing a lot of investigation, interesting work related to policy and the legal side of things as well and that that's worth checking out. And for people wondering, these will all be links to all these things will be in the show notes at for our workweek.com forward slash podcast. I'll spell that.

But coming back to your story and your life, I mean, I really have so much I would love to ask and we'll dig into some of them, but we're not going to have time for all of them, which is fine. 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, people in general because I don't want to make it exclusively professional. Yeah. 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. Yeah. Well, let's see here my friend. I have two answers to that question.

So the one is we know we've touched on a little bit, but I find myself increasingly interested in the aesthetic domain 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. And one of the reasons I'm particularly interested in the aesthetic domain besides just delighting and having a body to feel anything like we've talked is it's how it prizes purpose listeners. So I am all for meaning.

I see human beings as meaning making machines and we talked about this a little bit like 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. And I'm okay if there's meaning in a grand scale or not, frankly. I think it's a very different way to make sense of our lives. 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. 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 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.

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. 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. And let's get really good at honoring just the joy of smelling of 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. So anyway, I think that's one answer to your question. I don't know how many of us are out there, pricing purposelessness, but I do. Well, it made me think of this might be a strange connection, but made me think of Kurt Vonnegut, the writer who actually consider a fantastic philosopher in a lot of ways if you read his fiction.

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. Don't let anyone tell you different. And there's a story. I think it's actually in a dialogue 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 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, you don't get it. I didn't waste time because, and he runs through all of these seemingly meaningless, seemingly trivial, but to him, very important, kind of 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 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. 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 what one to three books would you suggest I read? So funny because I mean, I'm laughing because I am probably the least well-read person you will ever need. And especially one with like degrees, college and stuff. I, if I am, or if they said give me one to three things that I can watch, do, absorb, look at, et cetera, without even interaction.

What would your answer be? Thank you. That's better. For me, I mean, hey, I'm all for books too. Those are apparently are cool. But for me, you know, I love film. I love music. I love art. I love doing nothing. That's for me to live me. But I would put big picture books in front of people. I mentioned Mark Rothko, staring at Mark Rothko, where it is just a gorgeous splendor. But you know, suit your taste. So for me, I guess I put some picture book of Mark Rothko paintings in front of them.

I would put probably any music from Beethoven into their ears. And I probably would reserve that third thing for staring into space. Before they stared into space, they wanted to watch a movie. What would you put in front of them? Man, there's so many good ones. Ratatouille. No. I think, you know, I have a real soft spot for waiting for Guffman. Not that it has this great meaning per se, but by speaking of absurdity, I just think it's hilarious. Meeting for Guffman. I've never heard of it.

I've never heard of waiting for Guffman. No. Wow. Just a string of ignorance on my part in this conversation. Although you don't read books. I feel that evens us out. Oh, yeah. But this is good news because, man, you have so much to look forward to. I mean, so this movie is by Christopher Guest and company, the guys who did spinal tap. Oh, wow. You know, best in show. Sure, sir. Glad you say Guffman. Or how do you spell Guffman? I think it's G-U-F-F-M-A-N. Okay. Got it. Come on.

It is friggin' hilarious. So that I was just always a long-term favorite. I mean, as a kid growing up, Kentucky Fried movie. Well, I haven't thought about that in decades. Wow. That was like really an important movie in my childhood. We watched it probably, I don't know, a hundred times. I mean, every day, I mean, that and groove tube. I mean, it was, you know, formatives for us.

And I heard, you asked another question specifically about documentary film of other guests and I was thinking about that. And you know, one that leads to mine, I don't love you to really even consider a documentary, but I guess it is. It's, you know, the movie Grizzly Man. Oh, man, oh man. Yeah, that's one of that documentary. You can consider that one. Yeah, sure. It's called a documentary. So yeah, of course it is.

I mean, it is, I find any piece of art where I simultaneously, or I'm not sure whether it's to sob or laugh hysterically, that I love that feeling where you just can go either direction. You're not even sure which is the correct emotion. You're simultaneously attracted and repulsed to something. That was my experience watching that film. And I saw just sitting as a beautiful, like an amazing piece of filmmaking.

And I also particularly like its poignancy around our humans, silly dance around nature and how we humans think of ourselves and somehow opposed to nature. And yet when we try to reinsert ourselves into the wild, it doesn't necessarily go very well. Right. And how we romanticize mother nature can coddle us. And you know, I spend a lot of time in a desert in southern Utah as much time as I can.

I just love that landscape and speaking of perspective making, you know, thinking on geologic time and making myself feel very, very small and inconsequential is really deeply therapeutic for me. When I go out in Utah and I got lost twice walking around this particular area. And it's the same feeling I had watching grizzly men, which is mother nature as far as I can tell is pretty indifferent to us. You know, yeah, I would say so. So anyway, there's my answer for you.

So that brings to my two things. The first, as 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 emotion, like a singular emotion in a way.

When, for instance, if 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, 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.

The second is just to tie it together a few things you've said, related to sort of the meaninglessness, which may be too loaded in term for some people, and might come off as very negative, but seeming inconsequential or small and meditating on that, or not even meditating or experiencing it in a very visceral way by being in the desert or looking up the sky. 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. And if that is true, it makes perfect sense that focusing on this expansive geological timeline, which puts our shitty week into a just hilarious, diminutive perspective, makes a lot of sense. This is unrelated, but what do you think of or who do you think of when you hear the word successful?

Well, you know, you just pointed to something, the relationship of self and the silliness of self and the power of the self. And I think we do ourselves disservices by playing into polemics around, you know, selfishness or self-lessness. So there's a lot to say about that. But to segway 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 self-actualization. Someone who has realized has played themselves all the way out.

And that might be seen in a appreciated by practically no one. And therefore not make the measure of some external success. But someone who has sort of become themselves, delighted in themselves, including their quirks and awkwardness, and played that self out, you know, insisted on itself all the way to the end. To me, that may be a version of success. So I guess one part of my answer to questions, 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. 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.

And so I think probably success may be 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. And this is another reason I love our mortality, as the potential to be this equalizing, uniting force. So 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 consonants with the world around you, that seems like great success. Is there anyone who embodies that for you or comes closest? 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. It's a remarkable life's work and it's just a name we all know. But I'm also interested in all the gazillion successful people we walk by every day and don't even know it.

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 in others that I walk by on the street. In a way, you find yourself kind of imbuing others with an idea of success and it changes how you look at them and how you keep them. That's a sweet, favorite daily exercise of mine. 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 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. How I did up in the day to start the day? No, what you just talked about, sort of assuming the presence of this type of success. You said to it, it's morning exercise of yours. Oh. I don't know.

I didn't remember saying morning. That's what tripped me out. That's sort of a daily exercise, perhaps. Oh, there we go. Yeah, I could have made up the morning part. Who knows, but sure. But at sort of any time of day or night, it's just as useful. It's kind of like just the power of meaning of meaning well, of wanting well of others. And when there's a choice in the matter to see, to choose to see good. And if you can't know, assume good, and this kind of builds an argument.

So your day of gratitude and happiness and some amount of comfort. So I'll catch myself being bitter or I get kind of road rage. I'm very aggressive on my motorcycle and car. And actually just today, I was really annoying someone by falling them too close and whatever. I get in my bullshit zone pretty quickly. But when I'll catch myself, and then so when I walk by, you know, particularly here, the Bayer, the homeless epidemic is enormous.

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. 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 all right with who they are.

Maybe they're way more all right with who they are than a lot of people I see striving and otherwise looking successful. So it's really just simply that I actually learned this. My mother took me to a Deepak Chopra conference when I was pretty young and was a long, long time ago.

And the one thing I heard that stuck, it was really interesting to me was, is getting in the habit of saying, you know, when anyone when you hear anyone sneeze, either say it out loud or to yourself, say bless you, it's just a, it's like a neural, like a neural loop of goodness. And it just means in that quick second, you meant well towards somebody. And even if you don't say it out loud, even if you don't share it, say it to yourself.

And I got to believe that that resonates in registers somewhere, you know, that that land somewhere, that that landed something to a vibe. So that's the kind of stuff you walk around and you see people and you just project well wishing onto them. Now I hate to focus on something maybe superficial, but you said riding your motorcycle. I know, I apologize if this sounds like a weird question, but you have three limbs that have been damaged. How do you ride a motorcycle?

So yeah, so you know, this is, this was a sort of long dream that recently came true. Congratulations. I mean, it's awesome. I'm just curious about the logistics. Thank you. You ask is right now there's the man who helped make this dream come true. Randy, he ended up being my patient and our resident at Zenospis project not long after he converted my motorcycle. So there's a lot to this story, my friend. So cheers to Randy and his family and his wife.

I mean, in his mother, Melanie, whom I'll be seeing next week actually. So that's one piece of the story. But the other is this I'd always, I love two wheels. I love gyroscopic gyroscopic lifestyle. I love the feeling of it. I've always loved riding bicycles. And then I'd always wanted to get on a motorcycle, but I kept going to shops and, you know, people would sort of look at me and no one got into it. I could never find a mechanic who was willing to take it on and try to help make it happen.

A fellow named Maul Will who's an old motorcycle racer champion, sort of legendary in that world. He has his live around here. He lives in Timuron. And he built a prosthetic component. And I don't know what the story that inspired Merb to do this, but he's a machinist himself in a Handy fellow. And in his retirement, he got him in his business of building this prosthetic component that lends itself very well to mounting an arm onto a bicycle or a motorcycle.

So the first piece of this puzzle was discovering Merb'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. You have throttle rear brake and then typically front brake on the left. How are those controls modified?

Okay. So Randy, what he figured out, so first was to get the arm piece and then what Randy figured out was, well, then a Prilya, and I know Honda had made a version of this as well, but Prilya makes a model, the Monna M-A-N-A, that is clutchless. So that was a huge piece to get out of the way. So this is essentially an automatic transmission. 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. So I'm doing nothing with my prosthetic feet, except hold onto the bike. I'm doing nothing with my prosthetic arm, except for holding on the bike. So all the actions in my right hand, brakes 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.

So I have throttle, brake lever, and then the turn signal box all going with one hand. And that's awesome. That's it. That's a way to go. Okay. I just have to pause here for a second and just ask everyone listening. Bullshit excuses you have for not going after whatever you want. Like please write in, tell us on social media why these are really 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. Thank you. And thanks, Randy, and thanks to the folks at Scooteria, the bike shop, and the city. I mean, 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. Amen to that. Just a few more questions.

When we were spectral for your time, but I'm having them blast here, what $100 or less purchase has most positively impacted your life in recent memory? I'm guessing not the motorcycle. No, I was a little more than a nutbuck. Holy cow, man. Wow. You know, I would probably point us to a beautiful Pino noir from Joseph Swan up in Sonoma County.

It's like the artwork of Andy Goldsworthy or anyone who delights in anything of Femmele, the charm and a bottle of wine, the craft, all the work that goes into it. And actually, deliding in the fact that it's perishable and goes away, I find really helpful. 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 deliding in something that goes away.

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 small glass jar, and I keep the corks from bottles that I've finished with friends at home. And I have each of them write something on the cork. So I have this collection, the bottles we're on, the wine is long gone, but there's this vestige. Right, maybe that's not the right word.

I'm trying to gerry to sound intelligent, but the corks in this sit, I'm looking at right now. It's on this floating shelf on the wall. So I see it as I walk by it. No matter how lonely I might feel at times, I think we all do at moments. It's a reminder of how close by, how with the in reach, friends and that type of experience are. If you could put one billboard anywhere with anything on it, what would it say? Oh boy, that's a doozy. Let's say, there, man.

Well, it makes me think of as big as billboards are, it cannot be. It only puts so much on them and it makes me think of the, my favorite bumper sticker. I guess it seems like such a potent, I just love it. And so I would love to see it on a billboard which and the basic bumper sticker I'm sure you've seen it is don't believe everything you think. That's actually never seen that. That's a really good one. Well, what's, what?

It isn't a sweet hilarious, true reminder to not take ourselves so dang seriously. You know, it's anyway, that's probably my choice. Don't believe everything you think. Don't believe everything you think. I was really waiting for what this was going to be. I was really wondering. I saw one, this is, I'm really going to lose any shred of respect that people have for me by saying this, but I saw one recently that was a, it was not a bumper sticker. It was surrounding the license plate.

I'm not sure with the license plate casing, I guess. It said, if you're on my ass, you better be pulling my hair. I thought that was pretty clever, but it shows you where my level of emotional maturity is. In any case, Paul, you're, I, you know, I thought I might, I might lose you with that one. That's okay. I'll try to really, really back in with the next few questions. So yeah, don't believe everything you think. That's awesome. I'm, I'm astonished at never seen that.

Dude, 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. Ooh, wow. That was a particularly poignant time for me, actually. So there's a lot of, I was in, I was a, a deep in med school. It was my last year med school. Boy, I had kind of really a sort of experimental tour of my 20s. And I was sort of settling into a new rhythm.

I had finally let go of a fair amount of guilt around my own accident and the effect on my friends. And I was pretty neurotic at that time and my sister had just died. So it's, this may not be the intention of a question, but 30 happened to be a really sort of heady, heavy time for me. But I'll, I'll still roll with the question.

And I think I guess I would have helped myself get, you know, I, this sounds way too tidy, but I might have said something like, hey man, you don't believe everything you think. Don't, you know, let it go. Don't take it all. Don't, I do mean to take life very seriously, but I mean to take things like playfulness and purposelessness very seriously.

So I want to take, so I don't mean this, this is not meant to be light, but I think I would have somehow encouraged myself to let go a little bit more and, and hang in there and don't pretend to know where it's all going and you don't need to know where it's all going. Yeah, you don't need to know where it's all going. And you can't, and you can't. Yeah. What have you changed your mind about in the last few years?

Well, for all my talk of purposelessness and all this stuff, you know, I have in the last several years allowed myself to feel that I have a true vocation in this work around palliative care and helping us as a species deal with our, and dance with our mortality. I had convinced myself that, you know, hey man, I had gotten to very loose and I was whatever. I didn't feel the need to accomplish so much per se.

But in his last few years, I've let myself, I think in a way, man, I think I've let myself get more ambitious in a way and to take my work even extra seriously, more seriously than, and perhaps I had been, and letting myself feel like this could all work and letting myself feel like actually the healthcare system couldn't be fixed. So in other words, I guess it'll word is to re-equate myself with something I 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. And I'm sure you have to in a way 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. But maybe it's aspiration. Yeah. Yeah. I think that's right. Well on that point, do you have any last requests asks suggestions or otherwise for the people listening? Well, thanks. That's such a great invitation.

I mean, one is folks, hey, everyone, I hope we could start seeing the remarkable amount that we all have in common by virtue of being the same species on the same planet, et cetera, 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. We would ask that we learn to forgive in a daily way. 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 as an hospice project. These places rely heavily on philanthropy. So if you're moved, please come check us out at zanhospice.org. Otherwise, think about what's going on in your own geography, support hospice and palliative care. It's worth it needs to be developed and built. Yeah. I'll leave it at that.

That's plenty. And I've really, 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 foot in the door, the wedge that is palliative care, you have the ability in this laboratory called zanhospice 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. And I find that very, very inspiring and exciting. So I think it's a real tremendous opportunity and a potential point of leverage that you have.

So I can find you at zanhospice.org, zanhospice.org, zanhospice.org, zanhospice.org, Facebook is zanhospice project, Twitter at zanhospice. And I'll put all of this in the show notes, of course, for everybody listening. 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.

And the Symptom Management Service in the UCSF Cancer Center, the outpatient palliative care program there, Mike Reibo, and all the work going on around there is gorgeous. And that's another thing to consider supporting, but that's another place to find my work, too. Definitely. Yeah, UCSF is just spectacular. And I've done, I've also been involved with, well, the gazali lab and other folks at UCSF. I'm just continually impressed.

DJ, hopefully we'll get to do around, too, 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 to life, it's tremendously important and tremendously impactful. And also on a smaller level, of course, the time that you carved out today for this. 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.

And to everyone listening, you can find the show notes, links to everything we discussed at fourhourworkweek.com forward slash podcast. I'll spell it out or just search Tim Veris and podcast. And as always, and until next time, thank you for listening. 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?

And one and a half and two million people subscribed 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 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. It often includes articles on reading, books on reading, albums perhaps gadgets, gizmos, all sorts of tech tricks and so on.

Like it's sent to me by my friends, including a lot of podcasts, guests 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. 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.

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