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

This episode is a two-for-one, and that’s because the podcast recently hit its 10-year anniversary and passed one billion downloads. To celebrate, I’ve curated some of the best of the best—some of my favorites—from more than 700 episodes over the last decade. I could not be more excited. The episode features segments from episode #298 "Dr. Gabor Maté — New Paradigms, Ayahuasca, and Redefining Addiction" and episode #153 "The Man Who Studied 1,000 Deaths to Learn How to Live." Please enjoy! Sponsors: Vuori Clothing https://vuoriclothing.com/tim high-quality performance apparel: https://vuoriclothing.com/tim (20% off your first purchase) Shopify https://shopify.com/tim global commerce platform, providing tools to start, grow, market, and manage a retail business: https://shopify.com/tim (one-dollar-per-month trial period) LinkedIn Ads http://linkedin.com/tfs marketing platform with 1B+ users: https://linkedin.com/TFS (free $100 LinkedIn ad credit for your first campaign) Timestamps: [00:00] Start [05:37] Notes about this supercombo format. [06:57] Enter Gabor Maté. [07:22] Compassionate inquiry and trauma vs. traumatic. [11:06] Self-reconnection resources. [14:40] How Gabor benefits from yoga. [16:27] Gabor’s thoughts on the therapeutic value of psychedelics. [18:14] What’s been revealed by Gabor’s experiences with ayahuasca? [25:32] Essential intention. [26:30] We don’t respond to what happens, but to our perception of what happens. [32:48] Enter BJ Miller. [33:07] What does BJ do? [35:32] What does the first meeting look like for a new patient at the Zen Hospice Project? [37:18] Defining palliative care. [40:54] What happens when a patient dies in Zen Hospice compared to a regular hospital? [45:03] How many deaths has BJ experienced? [45:42] What has observing hundreds of deaths taught BJ about living? [50:39] On keeping a mindfulness or meditation practice. [55:05] About the Dinky (a terrifying story of electrocution). [1:04:29] The miracle of a snowball in the burn ward. [1:07:48] BJ’s experience as an undergraduate student at Princeton. [1:08:46] On the idea of art. [1:14:46] How BJ would support someone who suffered injuries similar to his own. [1:16:57] What helps people most in hospice care? [1:21:22] Why cookies matter. [1:23:12] Thoughts on the use of psychoactive compounds in end-of-life care and treating existential suffering. [1:33:46] BJ’s secret habit that might surprise most people. [1:38:32] Suggested material for an introverted hospice patient. [1:45:04] What comes to mind when BJ hears the word “successful?” [1:48:13] Daily practices for seeing good in people. [1:51:00] How to ride a motorcycle when missing three limbs. [1:55:01] What purchase of $100 or less has most positively affected BJ’s life? [1:56:53] BJ’s billboard. [1:58:24] BJ’s advice to his 30-year-old-self. [1:59:58] What has BJ changed his mind about in the last few years? [2:01:26] BJ’s requests/asks/suggestions of the audience. * For show notes and past guests on The Tim Ferriss Show https://tim.blog/podcast, please visit tim.blog/podcast https://tim.blog/podcast/?utm_source=podcast&utm_medium=podcast&utm_campaign=podcast-description. For deals from sponsors of The Tim Ferriss Show https://tim.blog/podcast, please visit tim.blog/podcast-sponsors https://tim.blog/podcast-sponsors Sign up for Tim’s email newsletter (5-Bullet Friday) at tim.blog/friday https://go.tim.blog/5-bullet-friday-1/. For transcripts of episodes, go to tim.blog/transcripts https://tim.blog/transcripts. Discover Tim’s books: tim.blog/books https://tim.blog/books. Follow Tim: Twitter: twitter.com/tferriss https://twitter.com/tferriss Instagram: instagram.com/timferriss https://instagram.com/timferriss/ YouTube: youtube.com/timferriss https://www.youtube.com/timferriss Facebook: facebook.com/timferriss https://www.facebook.com/TimFerriss/ LinkedIn: linkedin.com/in/timferriss http://linkedin.com/in/timferriss Past guests on The Tim Ferriss Show http://tim.blog/podcast include Jerry Seinfeld https://tim.blog/2020/12/08/jerry-seinfeld/, Hugh Jackman https://tim.blog/2020/06/26/hugh-jackman/, Dr. Jane Goodall https://tim.blog/2020/04/16/jane-goodall/, LeBron James https://tim.blog/2018/11/27/lebron-james-mike-mancias/, Kevin Hart https://tim.blog/2020/05/20/kevin-hart/, Doris Kearns Goodwin https://tim.blog/2018/09/07/doris-kearns-goodwin-leadership/, Jamie Foxx https://tim.blog/2015/12/06/jamie-foxx/, Matthew McConaughey https://tim.blog/2020/10/19/matthew-mcconaughey/, Esther Perel https://tim.blog/2017/05/21/esther-perel/, Elizabeth Gilbert https://tim.blog/2020/05/08/elizabeth-gilbert/, Terry Crews https://tim.blog/2017/12/20/terry-crews-how-to-have-do-and-be-all-you-want/, Sia https://tim.blog/2020/08/12/sia/, Yuval Noah Harari https://tim.blog/2020/10/27/yuval-noah-harari/, Malcolm Gladwell https://tim.blog/2016/06/21/malcolm-gladwell/, Madeleine Albright https://tim.blog/2020/05/27/secretary-madeleine-albright/, Cheryl Strayed https://tim.blog/2017/03/30/cheryl-strayed/, Jim Collins https://tim.blog/2019/02/18/jim-collins/, Mary Karr, https://tim.blog/2020/11/11/mary-karr/ Maria Popova https://tim.blog/2014/10/21/brain-pickings/, Sam Harris https://tim.blog/2020/05/15/sam-harris-2/, Michael Phelps https://tim.blog/2021/01/21/michael-phelps-grant-hackett/, Bob Iger https://tim.blog/2020/01/16/bob-iger/, Edward Norton https://tim.blog/2019/10/31/edward-norton-motherless-brooklyn/, Arnold Schwarzenegger https://tim.blog/2015/02/02/arnold-schwarzenegger/, Neil Strauss https://tim.blog/2014/06/24/neil-strauss/, Ken Burns https://tim.blog/2019/09/12/ken-burns/, Maria Sharapova https://tim.blog/2017/08/26/maria-sharapova/, Marc Andreessen https://tim.blog/2016/05/29/marc-andreessen/, Neil Gaiman https://tim.blog/2019/03/28/neil-gaiman/, Neil de Grasse Tyson https://tim.blog/2019/10/03/neil-degrasse-tyson/, Jocko Willink https://tim.blog/2016/09/21/jocko-willink-on-discipline-leadership-and-overcoming-doubt/, Daniel Ek https://tim.blog/2020/12/03/daniel-ek/, Kelly Slater https://tim.blog/2020/09/08/kelly-slater/, Dr. Peter Attia https://tim.blog/2019/11/27/peter-attia-fasting-metformin-longevity/, Seth Godin https://tim.blog/2016/02/10/seth-godin/, Howard Marks https://tim.blog/2018/09/25/howard-marks/, Dr. Brené Brown https://tim.blog/2020/02/06/brene-brown-striving-self-acceptance-saving-marriages/, Eric Schmidt https://tim.blog/2019/04/09/eric-schmidt/, Michael Lewis https://tim.blog/2020/05/01/michael-lewis/, Joe Gebbia https://tim.blog/2018/03/08/joe-gebbia-co-founder-of-airbnb/, Michael Pollan https://tim.blog/2018/05/06/michael-pollan-how-to-change-your-mind/, Dr. Jordan Peterson https://tim.blog/2021/03/01/jordan-peterson/, Vince Vaughn https://tim.blog/2017/05/31/vince-vaughn/, Brian Koppelman https://tim.blog/2020/04/23/brian-koppelman/, Ramit Sethi https://tim.blog/2019/05/07/ramit-sethi/, Dax Shepard https://tim.blog/2020/11/18/dax-shepard/, Tony Robbins https://tim.blog/2014/10/15/money-master-the-game/, Jim Dethmer https://tim.blog/2020/05/18/jim-dethmer/, Dan Harris https://tim.blog/2020/11/19/dan-harris/, Ray Dalio https://tim.blog/2017/09/13/ray-dalio/, Naval Ravikant https://tim.blog/2015/08/18/the-evolutionary-angel-naval-ravikant/, Vitalik Buterin https://tim.blog/2021/03/08/vitalik-buterin-naval-ravikant/, Elizabeth Lesser https://tim.blog/2021/03/16/elizabeth-lesser/, Amanda Palmer https://tim.blog/2019/04/18/amanda-palmer-2/, Katie Haun https://tim.blog/2021/02/18/katie-haun/, Sir Richard Branson https://tim.blog/2017/10/09/richard-branson/, Chuck Palahniuk https://tim.blog/2020/09/02/chuck-palahniuk/, Arianna Huffington https://tim.blog/2017/10/18/arianna-huffington/, Reid Hoffman https://tim.blog/2015/08/31/the-oracle-of-silicon-valley-reid-hoffman-plus-michael-mccullough/, Bill Burr https://tim.blog/2017/09/17/bill-burr/, Whitney Cummings https://tim.blog/2015/06/26/whitney-cummings/, Rick Rubin https://tim.blog/2015/05/15/rick-rubin/, Dr. Vivek Murthy https://tim.blog/2020/03/26/vivek-murthy/, Darren Aronofsky https://tim.blog/2017/09/09/darren-aronofsky/, Margaret Atwood https://tim.blog/2022/02/22/margaret-atwood/, Mark Zuckerberg https://tim.blog/2022/03/24/mark-zuckerberg/, Peter Thiel https://tim.blog/2014/09/09/peter-thiel/, Dr. Gabor Maté https://tim.blog/2018/02/20/gabor-mate/, Anne Lamott https://tim.blog/2021/07/09/anne-lamott/, Sarah Silverman https://tim.blog/2022/01/12/sarah-silverman/, Dr. Andrew Huberman https://tim.blog/2021/07/06/andrew-huberman/, and many more. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Tim Ferriss?

  This episode is brought to you by Vuori Clothing, spelled V U O R I, Vuori. I've been wearing Vuori at least one item per day for the last few months and you can use it for everything. It's performance apparel, but it can be used for working out, it can be used for going out to dinner, at least in my case, I feel very comfortable with it. Super comfortable, super stylish. And I just want to read something that one of my employees said. She is an athlete, she is quite technical, although she would never say that. I asked her if she had ever used or heard of Vuori, and this was her response. "I do love their stuff. Been using them for about a year. I think I found them at REI,

• 0:43Tim Ferriss?

  first for my partner, t-shirts that are super soft but somehow last as he's hard on stuff. And then I got into the super soft cotton yoga pants and jogger sweatpants. I live in them and they too have lasted. They're stylish enough, I can wear them out and about. The material is just super soft and durable. I just got their clementine running shorts for summer and loved them. The brand seems pretty popular, constantly sold out. In closing, and I'm abbreviating here, but in closing, with the exception of when I need technical outdoor gear, they're the only brand I've bought in the last year or so for yoga, running, loungewear that lasts and that I think look good also. I like the discreet logo." So that gives you some idea. That was not intended for the sponsor read. That was just

• 1:24Tim Ferriss?

  her response via text. Vuori, again spelled V U O R I, is designed for maximum comfort and versatility. You can wear it running, you can wear their stuff training, doing yoga, lounging, weekend errands, or in my case, again, going out to dinner. It really doesn't matter what you're doing. Their clothing is so comfortable and looks so good. And it's not offensive that you don't have a huge brand logo on your face. You'll just want to be in them all the time. Their men's KORE short, K O R E, the most comfortable lined athletic short, is your one short for every sport. I've been using it for kettlebell swings, for runs, you name it. The banks short, this is their go to land to sea short, is the ultimate in versatility. It's made from recycled plastic bottles. And what I'm wearing right

• 2:10Tim Ferriss?

  Right now, which if I had to pick one to recommend to folks out there, or at least to men out there, is the Ponto Performance Pant. And you'll find these at the link I'm going to give you guys. You can check out what I'm talking about, but I'm wearing them right now. They're thin, performance sweatpants, but that doesn't do them justice. So you've got to check it out. P-O-N-T-O, Ponto Performance Pant. For you ladies, the women's performance jogger is the softest jogger you'll ever own. Vuori isn't just an investment in your clothing, it's an investment in your happiness. And for you, my dear listeners, they're offering 20% off your first purchase. So get yourself some of the most comfortable and versatile clothing on the planet. It's super popular. A lot of my friends have now noticed are

• 2:51Tim Ferriss?

  wearing this. And so am I. vuoriclothing.com/Tim. That's V-U-O-R-I Clothing.com/Tim. Not only will you receive 20% off your first purchase, but you'll also enjoy free shipping on any US orders over $75 and free returns. So check it out. vuoriclothing.com/Tim. That's V-U-O-R-I Clothing.com/Tim. And discover the versatility of Vuori Clothing. This episode is brought to you by Shopify, one of my absolute favorite companies, and they make some of my favorite products. Shopify is the commerce platform revolutionizing

• 3:33Tim Ferriss?

  millions of businesses worldwide. And I've known the team since 2008 or 2009. But prior to that, I wish I had personally had Shopify in the early 2000s when I was running my own e-commerce business. I tell that story in The 4-Hour Work Week, but the tools then were absolutely atrocious. And I could only dream of a platform like Shopify. In fact, it was you guys, my dear readers, who introduced me to Shopify when I polled all of you about best e-commerce platforms around 2009. And they've only become better and better since. Whether you're a garage entrepreneur or getting ready for your IPO, Shopify is the only tool you need to start, run and grow your business without the struggle. Shopify puts you in control of every sales channel.

• 4:15Tim Ferriss?

  Doesn't matter if you're selling satin sheets from Shopify's in-person POS system or offering organic olive oil on Shopify's all-in-one e-commerce platform. However you interact with your customers, you're covered. And once you've reached your audience, Shopify has the internet's best converting checkout to help you turn browsers into buyers. Shopify powers 10% of all e-commerce in the United States. And Shopify is truly a global force as the e-commerce solution behind Allbirds, Rothy's, Brooklinen and millions of other entrepreneurs of every size across more than 170 countries. Plus Shopify's award-winning help is there to support your success every step of the way if you have questions. This is possibility powered by Shopify. So check it out. Sign up for a $1 per month trial period at Shopify.

• 5:00Tim Ferriss?

  That's S-H-O-P-I-F-Y. Shopify.com/Tim. Go to Shopify.com/Tim to take your business to the next level today. One more time, all lowercase, Shopify.com/Tim. At this altitude, I can run flat out for a half mile before my hands start to shake.

• 5:19Speaker 01

  Can I answer your personal question?

• 5:21Speaker 02

  No, we're sitting at a pretty time.

• 5:25Speaker 01

  I'm a cybernetic organism living this year over metal endoskeleton.

• 5:37Tim Ferriss?

  Hello, boys and girls, ladies and germs. This is Tim Ferriss. Welcome to another episode of The Tim Ferriss Show where it is my job to sit down with world-class performers from every field imaginable to tease out the habits, routines, favorite books and so on that you can apply and test in your own lives. This episode is a two-for-one, and that's because the podcast recently hit its 10th year anniversary, which is insane to think about, and passed 1 billion downloads. 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. These super combo episodes, and internally, we've been calling these the super combo episodes because my goal is to encourage you to, yes, enjoy the household names, the

• 6:22Tim Ferriss?

  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.blog/combo. And now, without further ado, please enjoy and thank you for listening.

• 6:56Speaker 02

  First up, Dr. Gabor Maté, Twitter @DrGaborMaté and DrGaborMaté.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."

• 7:22Tim Ferriss?

  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.

• 7:44Gabor Maté?

  That's right.

• 7:44Tim Ferriss?

  And that included anger, rage responses, use of stimulants, you name it. I always applied this loving kindness meditation to other people.

• 7:52Gabor Maté?

  Right.

• 7:53Tim Ferriss?

  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. For instance, that rage, that anger, was the fuel that got me out of Long Island. I'd just love to hear, and we can take it anywhere we want, of course, but once you have shifted the focus from why the addiction to why the pain, and you start to work with someone, what approaches have you found to help? What tools?

• 8:24Gabor Maté?

  I call it compassionate inquiry. So inquire in a compassionate way. Now, "Why did I do this?" But, "Hmm, 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 soothe my pain." And so what your friend said that it served you, so thank it, love it, but let go of it, is absolutely right. I call it the stupid friend. 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. Right. 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're no longer that three-year-old, or that five-year-old, or that fifteen-year-old.

• 9:09Gabor Maté?

  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.

• 9:54Gabor Maté?

  And as a result of these traumatic events, what happens inside you is you get disconnected from your emotions, and you're disconnected from your body, and you have difficulty being in the present moment, and you develop a negative view of your world, and a negative view of yourself, and a defensive view of other people. And these perspectives keep showing up in your life in the present. Because they had the stupid friends. And so the issue is not just to recognize what happened at ten, fifteen, thirty, 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

• 10:38Gabor Maté?

  with your emotions that you lost. And once 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 is 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.

• 11:06Tim Ferriss?

  For people who are listening and want to reconnect with themselves, with their bodies, for instance, what recommendations might you have? Whether that's things they can do or resources they can look to or both or something else? What recommendations? Because I'm sure, I am a hundred percent sure, because I've had people come on and for the very first time on this podcast, talk about sexual abuse that they endured as children and what they did to help recover from that. Many people listening, I am sure, have addictions, both traumatic past experiences and trauma. What recommendations could you make for them?

• 11:46Gabor Maté?

  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 the bad things happened that shouldn't have. We've talked about those. But the other way to get traumatized is when good things happened that should have happened. Good things didn't happen that should have happened.

• 12:02Tim Ferriss?

  The trauma of omission.

• 12:04Gabor Maté?

  Trauma of omission 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.

• 12:47Gabor Maté?

  I've needed a lot of help in terms of therapy. That helps you understand what happened to me and so that there's 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 genetically 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 his books? Waking the Tiger. Waking the Tiger. Waking the Tiger was his first book and he's written many wonderful books since then.

• 13:32Gabor Maté?

  That's the somatic. Somatic Experiencing, his method is called, which he developed, is 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 the conscious, defensive, egoic mind. There is emotional freedom tapping that people do. There's various variations on that. There is motor sensory integration techniques. Then there is the traditional therapies like yoga. Now, yoga was not simply a physical modality when it first developed. Yoga actually means unity.

• 14:17Gabor Maté?

  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 a good workout, that's great, I'm not against it. But I'm talking about intentional yoga with a meditative aspect to it, which is taught by a number of disciplines, bodywork of all kinds.

• 14:39Tim Ferriss?

  Just gonna hit pause for one second. Do you practice yoga? And if so, what type do you practice?

• 14:43Gabor Maté?

  So, I've always said that with my ADHD, I'm not a yoga person, I can't do it. Until a year and a half ago, I met actually a yogi, his name is Sadhguru. He's an Indian yogi with a big following, I was very skeptical. But I met the guy, I now have a 50-minute daily yoga practice, which I did this morning before coming to the interview. And this made an enormous difference in my life. With my ADHD mind, I really have trouble just sitting there. 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 had asked me 18 months ago, I would have said no. I support it, but I don't do it. But now I'm actually a very committed practitioner,

• 15:28Gabor Maté?

  and it really has made a difference.

• 15:30Tim Ferriss?

  Is it a particular type of yoga that people could Google or learn more about?

• 15:36Gabor Maté?

  So I'm not a yoga expert, and there's many forms of yoga that other people more knowledgeable than I am could recommend. But the one I learned is called Inner Engineering, and it's taught by either Sadhguru or his followers, and you can look up Inner Engineering online. When I recommended it to friends and others, everybody's been only been grateful, so I can highly recommend it. Typically, there is 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 a deep experience and being able to try and 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.

• 16:16Tim Ferriss?

  No, no, it's just my fans appreciate. Well, you know, I'm not gonna blame it on my fans, I like specifics.

• 16:21Gabor Maté?

  Yeah, so Inner Engineering, you can look up online. And it's taught here in the States and in Canada internationally, actually.

• 16:27Tim Ferriss?

  But I did interrupt you, you're about to mention, I think, another technique or modality that can help. Talked about. For instance, the somatic experience, EMDR, emotional freedom tapping, motor sensory integration technique or techniques, yoga, and then there's something coming up after that.

• 16:44Gabor Maté?

  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 through a series of events, I became aware of the potential role of psychedelics in healing. And I've been doing work with them now for 10 years. And they're another potent method. And 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 adept practitioners with deep integrity and deep knowledge and experience. But in such hands and in such a context,

• 17:25Gabor Maté?

  it can be like a superhighway to self-awareness. Not in isolation, but it opens doors that otherwise might take years. And so it's not unusual for me to conduct a psychedelic session with somebody or a series of sessions, either in a group or individual setting, and have them say, that was like 10 years of psychotherapy in one day. And I've had the same experience myself. 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 personally, where there's an increasing movement amongst psychologists, therapists, psychiatrists, medical doctors,

• 18:07Gabor Maté?

  other healers to find ways of incorporating psychedelic healing in the larger therapeutic scheme.

• 18:13Tim Ferriss?

  So Gabor, 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?

• 18:29Gabor Maté?

  Sure. So in 2008, my book on addiction, In the Realm of Hungry Ghosts: Close Encounters with Addiction, was published in Canada and very quickly it became a number one national bestseller, subsequently published in the States as well. And I was on a book tour. And people kept asking me, what do you know about addictions and ayahuasca as a treatment? Ayahuasca being a Peruvian or Amazonian vine that's made into a brew that has psychedelic properties. I knew nothing. The next speech, the next event, somebody else would ask, what do you know about ayahuasca in the treatment of addiction? I finally started getting annoyed with it, like, leave me alone. I've just written a book, I've spent years researching it.

• 19:11Gabor Maté?

  My life experience and all kinds of scientific exploration went into it, ask me about something I know about.

• 19:19Gabor Maté?

  And then I realized that maybe the universe was knocking on my door. And somebody said, did you know you could experience it here in Vancouver? There was a Peruvian shaman leading some ceremonies up in Vancouver. So who am I to say no? And I jumped right in and I sat in this tent with fifty other people.

• 19:37Tim Ferriss?

  Fifty?

• 19:38Gabor Maté?

  Yeah, it was, that's how they set it up. It's not what, it's not what I recommend, but that's how they set it up. They played beautiful music. And there was a little baby in the room. The mother and dad were there for the experience. The baby was in the room and the baby was cooing away. And tears started flowing down my face. And these were not tears of sorrow, they were tears of joy. 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 else 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.

• 20:23Gabor Maté?

  And how I had betrayed 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, and universal and life-defining, but something from which I'd been 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 been so hurt owing to my mother's states of mind. She couldn't respond to me where 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...

• 21:04Tim Ferriss?

  Explain that for a second?

• 21:05Gabor Maté?

  So again, it's Budapest, Hungary, Second World War, January, the Russians have circled...

• 21:12Gabor Maté?

  Budapest and are fighting the Germans. The government in power is a right-wing fascist antisemitic 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 now the Hungarian fascists were killing Jews in Budapest. And including in the house where my mother and I were living. So my mother gave me to a stranger in the street, a Christian woman, because she didn't know if she'd be dead or alive next day. Wow. Or that I would be. And I was quite sick, so I didn't see her for a month, which I experienced as a deep abandonment. How else could I experience it? So my heart closes against love. And I got all this.

• 21:54Gabor Maté?

  And so I got that if this plant that, as you say, manifests the mind, can show me both the ways in which I've closed off from myself and that I don't need to because the love is still there, what healing potential it has. Now, I wish I could say that after that experience, I became a loving husband and a loving human being. I didn't. It's not that simple, you know? As my wife could tell you. Nevertheless, it opened the door for me. And I got right away. Now, however, the thought that I had was that I had no induction, I had no introduction, I had no processing afterwards. Ayahuasca is a medicinal plant

• 22:37Gabor Maté?

  that has been used in the Amazon basin for hundreds of years, maybe longer, in its cultural context. In a tribe, in a village where people know each other, where they know the shaman, where they share the same assumptions and the same history. That's not the same as a bunch of Westerners, strangers to each other, coming together for one night, drinking the stuff and then going their separate ways. 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? Así que nos propusimos la idea de una retiro donde un pequeño número de personas se unen con shamans adecuadamente entrenados que tienen integridad y experiencia, experiencia profunda

• 23:20Gabor Maté?

  y conmigo facilitando la preparación de la gente y su integración posterior a la ceremonia. Así que he estado haciendo eso ahora durante diez años. Se involucró mucho el aprendizaje. cometimos errores, pero evolucionó. Y la esencia de ello es que la gente no viene a esto frío. Venen con la preparación en un entorno seguro donde pronto el grupo se convierte en una familia entre sí, lo que significa que no solo les aman y apoyan, sino que también se estimulan. Es decir, básicamente les digo a la gente: "¿Adivinas qué? Estás de vuelta en tu familia de origen. Y todo lo que has odiado sobre tu familia es que va a aparecer aquí, pero en el contexto en el que es seguro que eso suceda." Correcto. Así que he visto un montón de gran curación.

• 24:03Gabor Maté?

  He visto a personas con múltiples intentos de suicidio que se curan de depresión. He visto a la gente mejorar mucho con las enfermedades autoinmunes. He visto a la gente lidiar con todo tipo de adicciones y problemas de vida, problemas de relación, salir de eso mucho más que ellos mismos, mucho más capaces de lidiar con estos problemas mientras se realiza la integración adecuada posterior. Así que esa fue mi experiencia personal. Bueno, ¿puedo darle una cita? Sí, por favor. Que me encanta. Es uno de mis maestros favoritos. Y su nombre es A. H. Almas. Y él dice: "Tus conflictos, todas las cosas difíciles, las situaciones problemáticas en tu vida no son casualidad o casualidad. Son realmente tuyos. Son específicamente tuyos, diseñados específicamente para ti por una parte de ti que te ama más que cualquier otra.

• 24:49Gabor Maté?

  La parte de ti que te ama más que cualquier otra ha creado obstáculos para llevarte a ti mismo. No vas a ir en la dirección correcta a menos que haya algo que te esté poniendo en el lado diciendo, diciendo: "Mira aquí, hacia este lado". "Esa parte de ti te ama tanto que no quiere que pierdas la oportunidad. Va a tomar medidas extremas para despertarte. Te hará sufrir mucho si no te escuchas. ¿Qué más puede hacer?" Ese es su propósito. Y he encontrado esto ser verdad. En enfermedades físicas y problemas mentales y todo eso, tienes que ver qué es la enseñanza aquí. Así que podemos ver todas estas cosas como problemas para deshacernos, que es lo que la personalidad quiere hacer, o podemos verlas como oportunidades de aprendizaje, que es lo que tu propio ser quiere hacer. Now, two things.

• 25:33Gabor Maté?

  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 of my workaholism, and once I go into a holiday, I just collapse. And now, my wife is dragging a corpse around on holiday, you know? Because I'm a workaholic, you know, and I had unclear space. So this time, we actually went into the holiday with intention. This is not to do with psychedelics, just to do that we said, an intention. What is our intention? And if we have an intention, I've learned from a couple of very wise teachers, what structures do we want to set up to support our intention? And how are we going to handle when there's kind of disagreement or conflict?

• 26:17Gabor Maté?

  We had a beautiful holiday, because it was the first intentional holiday that we've had. So that intention in life in general is absolutely essential. Like, every morning, what is my actual intention? So the problems, the upset. So, wanna do a bit of an exercise?

• 26:32Tim Ferriss?

  Sure.

• 26:33Gabor Maté?

  Okay, and then, 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 salon, 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're open to sharing. So it doesn't have to be anything sordid or something, but just something, you know, whether it's your spouse, partner, the bus driver, I don't care who.

• 26:52Tim Ferriss?

  Sure.

• 26:53Gabor Maté?

  A friend.

• 26:54Tim Ferriss?

  Okay.

• 26:54Gabor Maté?

  So are you willing to go there?

• 26:55Tim Ferriss?

  Anything.

• 26:56Gabor Maté?

  Okay.

• 26:56Tim Ferriss?

  I can share anything?

• 26:57Gabor Maté?

  Just where you're upset with somebody.

• 26:59Tim Ferriss?

  Okay, yes.

• 27:00Gabor Maté?

  Okay, so what happened?

• 27:01Tim Ferriss?

  Describe it.

• 27:02Gabor Maté?

  What happened, yeah?

• 27:02Tim Ferriss?

  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.

• 27:13Gabor Maté?

  Physically?

• 27:14Tim Ferriss?

  Physically.

• 27:14Gabor Maté?

  Yeah, yeah.

• 27:15Tim Ferriss?

  Right, and I had hired someone to do these things.

• 27:17Gabor Maté?

  Right.

• 27:18Tim Ferriss?

  While I was gone.

• 27:18Gabor Maté?

  Okay.

• 27:19Tim Ferriss?

  And I came back and none of them were fixed.

• 27:20Gabor Maté?

  Okay, and your emotional reaction was?

• 27:23Tim Ferriss?

  Anger.

• 27:23Gabor Maté?

  Rage. Anger, okay. Anything else besides anger?

• 27:27Tim Ferriss?

  I think they're close cousins. Frustration.

• 27:31Gabor Maté?

  Frustration is anger, yeah?

• 27:33Tim Ferriss?

  Yeah, I was disappointed.

• 27:37Gabor Maté?

  Disappointed is sadness.

• 27:39Tim Ferriss?

  Yeah, it's a different feeling. So I was disappointed, myself also, because I started to look at how maybe...

• 27:44Gabor Maté?

  Well, disappointed is not so much an emotion as a state of mind. I'm asking what the emotions were. What's inside disappointment? Something didn't happen, I want it to happen, how do I feel? Isn't there sadness there?

• 27:57Tim Ferriss?

  Sure, yeah, there's sadness.

• 27:58Gabor Maté?

  I'm not talking into it, I'm just asking.

• 28:00Tim Ferriss?

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

• 28:06Gabor Maté?

  Yeah, so I'm looking at the raw emotion.

• 28:08Tim Ferriss?

  Yeah, sadness.

• 28:10Gabor Maté?

  So there's anger and sadness, those are the emotions.

• 28:12Tim Ferriss?

  Let's go with that.

• 28:13Gabor Maté?

  Okay, so I'm gonna ask you a silly question. What were you sad and angry about?

• 28:17Tim Ferriss?

  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.

• 28:29Gabor Maté?

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

• 28:37Tim Ferriss?

  Meant that they didn't care about me, they didn't respect me.

• 28:45Gabor Maté?

  So they didn't care about you and didn't respect you. What kind of person doesn't get cared or respected?

• 28:49Tim Ferriss?

  I might need a lifeline here. Don't know, someone who doesn't deserve to be cared for or respected.

• 28:53Gabor Maté?

  Exactly, somebody unworthy, right?

• 28:56Tim Ferriss?

  Sure.

• 28:56Gabor Maté?

  Or respect and care, okay? Now, if there are other people here, which there usually are when I do this exercise, I would ask them, okay, we just listened to Tim 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?

• 29:18Tim Ferriss?

  A million and one.

• 29:19Gabor Maté?

  Name one.

• 29:20Tim Ferriss?

  Yeah, he could have, he could be in the hospital.

• 29:23Gabor Maté?

  He could be in the hospital, what else?

• 29:25Tim Ferriss?

  Part of her cared one, could have been in a car accident.

• 29:27Gabor Maté?

  Exactly.

• 29:27Tim Ferriss?

  Uh, he had a flight delay and got caught on Puerto Rico during a hurricane.

• 29:32Gabor Maté?

  Yeah, he's got ADHD.

• 29:34Tim Ferriss?

  Yeah.

• 29:34Gabor Maté?

  Uh, and he can't follow through. He's under stress and he couldn't...

• 29:39Tim Ferriss?

  Right.

• 29:40Gabor Maté?

  Okay, okay, now...

• 29:41Tim Ferriss?

  The email that I was supposed to send is sitting in drafts and I thought I'd sent it, but in fact he never received it, I mean...

• 29:45Gabor Maté?

  Okay, and any number of possibilities.

• 29:47Tim Ferriss?

  Yeah.

• 29:47Gabor Maté?

  Now, of all the possibilities that you've just outlined, including they don't care about you or respect you, which is the worst one?

• 29:57Tim Ferriss?

  The one I immediately defaulted to.

• 29:59Gabor Maté?

  Right.

• 29:59Tim Ferriss?

  Well, I mean, the worst.

• 30:02Gabor Maté?

  Well, no, no, no, no.

• 30:03Tim Ferriss?

  If the guy's dead, then it's bad.

• 30:04Gabor Maté?

  No, no, but internally.

• 30:05Tim Ferriss?

  Yeah, internally, the worst assumption is the one that I immediately made.

• 30:08Gabor Maté?

  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 our perception of what happens.

• 30:18Tim Ferriss?

  Right.

• 30:19Gabor Maté?

  Okay, that's what the Buddha said. It's with our minds you create the world. So that if you'd found out he had ADHD, or he was stressed, or, you know, you might have been sad for him, but would not have been angry, and you would not have been sad. 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 and you said.

• 30:51Tim Ferriss?

  Was it multiple choice? I chose option D.

• 30:53Gabor Maté?

  Oh, no, he doesn't care about me. He doesn't respect me. You didn't do that. Your brain jumped there automatically, right? The question is why? Now, here's the learning. First time in your life that you felt hurt and angry that when you perceived somebody didn't care about you or didn't respect you? Or has it happened before?

• 31:09Tim Ferriss?

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

• 31:15Gabor Maté?

  But you'd probably agree it's not the first time.

• 31:16Tim Ferriss?

  It's not the first time.

• 31:17Gabor Maté?

  Very good. And most people I talk to, it goes back way back.

• 31:21Tim Ferriss?

  Yeah, this goes way back.

• 31:22Gabor Maté?

  Into childhood.

• 31:27Tim Ferriss?

  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? LinkedIn Ads allows you to build the right relationships, drive results, and reach your customers in a respectful environment. You'll have direct access to and build relationships with decision-makers. One billion members, 180 million senior-level executives, and 10 million C-level executives. You'll be able to drive results with targeting and measurement tools. Built specifically for B2B.

• 32:09Tim Ferriss?

  In technology specifically, LinkedIn generated a 2 to 5x higher return on ad spend than other social media platforms, based on an assessment by analytic partners. 79% of B2B content marketers said LinkedIn produces the best results for paid media. So make B2B marketing everything it can be and get a $100 credit on your next campaign. Check it out. Go to LinkedIn.com/TFS to claim your credit. That is LinkedIn.com/TFS, as in Tim Ferriss Show. One more time, LinkedIn.com/TFS. Terms and conditions apply.

• 32:48Speaker 02

  And now, Dr. BJ Miller, Twitter @BJMillerMD, a hospice and palliative care specialist, author and speaker, whose TED Talk, "What Really Matters at the End of Life," has been viewed more than 17 million times.

• 33:06Tim Ferriss?

  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 to 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 Gazali, who is just an incredible neuroscientist at UCSF, who's been on the podcast, reached out to me.

• 33:47Tim Ferriss?

  And that was related to, I think, 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...

• 34:05Tim Ferriss?

  Death and the the value of meditating on death, among other things. But before we get there, and I suppose we'll get there rather quickly. When people ask you, what do you do? How do you answer that?

• 34:22Speaker 04

  I guess I generally say, you know, generically, I'll say, oh, I'm a physician. And if people seem like they actually really want to talk things out, I'll say, well, I'm a palliative care doc. And then people won't talk up from there. I'll say, I work at a remarkable place called the Zen Hospice Project and do some work at UCSF. And do increasing amounts of speaking and beating the drum, I like to say. So depending on how interested the person asking the question is, that's what they might hear from me.

• 34:52Tim Ferriss?

  Let's say they're very interested. I don't know if you drank, but let's say the the other person's had two drinks. So pleasantly drunkenly curious. And they say, what drum are you beating? I'm really interested to hear more. What is the drum?

• 35:07Speaker 04

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

• 35:32Tim Ferriss?

  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.

• 35:40Speaker 04

  Just one, yeah.

• 35:42Tim Ferriss?

  Which is, and one is enough, by the way.

• 35:44Speaker 04

  No kidding.

• 35:47Tim Ferriss?

  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? And what does that first day look like for them?

• 36:03Speaker 04

  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.

• 36:46Speaker 04

  When folks are struggling, gone to war with their disease, engaged in that fight, whether it's chemotherapy or whatever, that's the kind of person I'll meet in clinic at UCSF. So part of my job is I'm 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 palliative care phrase had too much baggage around it.

• 37:17Tim Ferriss?

  And is palliative care, I'm just going to plead ignorance here, is that synonymous with hospice care? Or are those different things?

• 37:25Speaker 04

  They are related but different. And thank you for asking that question, Tim. I mean, this is part of the drumbeat. So hospice is that portion of palliative care that's at the end of the road. 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 in advance of their death. So yeah, all hospice is palliative care, but not all palliative care is hospice.

• 37:58Tim Ferriss?

  Got it.

• 37:59Speaker 04

  All right. So palliative care, just to kind of make it, is basically the, 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. We'll 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.

• 38:44Speaker 04

  Whereas once you're entering hospice because of its insurance details and vagaries, you do have to, in general, you have to give up curative intended care to qualify for hospice. And we could spend a lot of time on this, there are a lot of wonky details. But does that sort of make sense to you?

• 39:00Tim Ferriss?

  It totally makes sense. And the first thing that leapt to mind for me, and that will lead to a lot of tangents, I apologize in advance, but was that the way that you define palliative care would seem to include almost everyone on the planet in some respect, suffering more than they need to. And we'll, we'll dig into the learnings and philosophies and so on that, 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.

• 39:32Speaker 04

  Uh huh.

• 39:33Tim Ferriss?

  What does their first day look like?

• 39:35Speaker 04

  So first day at Zen Hospice is usually, there's always the folks by, almost by definition, are in a pretty fragile state. So just the ride, getting to the house and into the house is often plenty overwhelming. 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. It's inherently a relationship. So.

• 40:13Speaker 04

  There's some details around medications, et cetera, but most of the early work is just getting to know people and making them feel that this is their home now. This is, they've come to live here. Yeah, they're gonna be dying soon, but they're here to live until they die. So it's a very non-medical establishment. And the first day doesn't feel anything like being admitted to a hospital. You know, and pretty soon, as you get to know someone within the first day, invariably questions get asked like, you know, 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 feel like you're entering a warm embrace of a familiar setting.

• 40:53Tim Ferriss?

  And what does the, just to highlight also the differences, can you describe upon the patient's death? What happens in Zen Hospice Project versus in a conventional hospital setting? And you can present either first.

• 41:13Speaker 04

  Yeah, well, so in hospice and palliative care in general, but certainly places like Zen Hospice Project, in many ways, they were created as antidotes to the hospital. So in some ways, they're really, you'll feel like opposites. That's to some degree by design. But a death in a place like Zen Hospice Project is usually very peaceful because we've gotten to know that person, we've been living with that person, we know what they want, what their idiosyncrasies are, and we work with, you know, local teams of hospice agencies who come in and provide the medical care.

• 41:53Speaker 04

  So for the most part, people can enjoy and expect a much more comfortable and peaceful death at Zen Hospice Project and places like it. That's what all the expertise is geared towards, you're not distracted by beeping machines and other things and other agendas happening, research agendas, whatever it is. And to your question, Tim, you know, so when the person dies, invariably the mortuary needs to come and retrieve the body. And we have this ritual that we offer people, which is on their way out the building, 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, and we'll all gather

• 42:38Speaker 04

  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 this 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, it's this very stunning, poignant, gorgeous, simple moment. And you can feel everyone entering into this sort of grieving phase more fully,

• 43:23Speaker 04

  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 there's space for it, and there's this sweet segue. And you can just feel that something's been completed there, and then the family now have to live on, but can do so with some imagery that's sweet and beautiful to remember, rather than traumatic. So, counter that with a typical hospital death. And by the way, Tim, and we can talk about all sorts of things together, I hope we do, but, you know, no knock on hospitals. They're incredible places.

• 44:07Speaker 04

  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.

• 44:32Speaker 04

  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 snuffing of it. And it's very disorienting for everybody involved, including the clinicians, because there's no pause moment to reflect on the experience you've just had with this person. It's just kind of on to the next. And it's a stark, stark contrast.

• 45:02Tim Ferriss?

  Since you began your work with palliative care and hospice care,

• 45:08Speaker 04

  Thank you.

• 45:09Tim Ferriss?

  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?

• 45:24Speaker 04

  You know, my guess now, I mean, I 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 1,000 people, it's approaching 1,000. I don't know that for sure, but it's certainly many, many hundreds.

• 45:42Tim Ferriss?

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

• 46:06Speaker 04

  Well, that's the perfect question, man. I mean, you know, there's like a, those of us who work in the field of hospice and palliative care, you know, we, it 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, it's got to be very morbid work or very depressing work. And sure, it is loaded. I mean, it is emotionally laden work without a doubt. 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, hmm, it's a lot, it's very nurturing. This sort of, this sort of secret is that paying attention to the fact that you die.

• 46:51Speaker 04

  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. 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.

• 47:32Speaker 04

  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 a sense, we're exercising these muscles on behalf of others that all of us need to exercise on behalf of ourselves. At some point, we just get pretty well practiced at it. 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, there's some systems issues, there's some economic issues. But there's these, these beautiful civil issues on behalf of kindness, on behalf of justice and equality. The fact that we all die.

• 48:15Speaker 04

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

• 48:28Tim Ferriss?

  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?

• 48:43Speaker 04

  One thing, you know, caveat is I'm, I, like anybody else, am flawed and I'm a work in progress. And I forget all the lessons that I've learned a million, I have to learn them over and over again. So, you know, I got all sorts of work to do it myself, but.

• 48:57Tim Ferriss?

  As, as we all do.

• 48:58Speaker 04

  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 relationships or in 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.

• 49:42Speaker 04

  I feel these lessons in my relationship to nature. So that's a great salve for me is being out on Mount Tam out here in Marin County or just about anywhere. And feeling, letting myself really delight and bask in the, the crazy grandeur of being alive at all. And I get thrilled that I can feel anything, sometimes even pain. I can, if the way I deal with my own pain is I'm 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.

• 50:24Speaker 04

  I've got a lot, 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, on letting go of certain things.

• 50:37Tim Ferriss?

  So to, to drill into that, I apologize for interrupting, but

• 50:39Speaker 04

  Yeah, yeah, no.

• 50:40Tim Ferriss?

  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. When you find yourself, when you catch yourself angry with someone or not letting go. What is the internal dialogue? What do you say to yourself? How do you ameliorate that?

• 51:18Speaker 04

  Well, this is where, you know, meditation, mindfulness, self-awareness, whatever you want to call it, can be so helpful because one thing to, is to just get better at realizing you're doing it in the first place.

• 51:30Tim Ferriss?

  Definitely.

• 51:31Speaker 04

  You know, even before you're able to change it at all, is there's great potency in just being aware that you're doing it. I used to be much more, I could walk around for months with grudges and chips and bitternesses, et cetera, before I really even realized it. I would just be really moody or whatever else. You know, job one, I guess, is just paying attention to yourself and seeing it for what it is. And then the next step's 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 sails. You know, you disempower the anger.

• 52:10Speaker 04

  And for me, you know, in my life, man, I, the absurdity, the being in touch with absurdity has been very, very helpful.

• 52:20Tim Ferriss?

  Yeah.

• 52:21Speaker 04

  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 A, you've let go of the junk, and B, it's an exercise in humility and forgiveness, which is always pretty dang useful.

• 52:52Tim Ferriss?

  And for those people listening who 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, in this instance. You mentioned mindfulness, meditation. Do you have a regular meditation or mindfulness practice?

• 53:15Speaker 04

  No, not really.

• 53:19Tim Ferriss?

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

• 53:29Speaker 04

  Thank you for that way out, brother. Man, you're welcome. But, no, I mean, it's, you know, there is some truth in 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 come to terms with all the stuff you can't control. Whether it's on my, for my own sake or my patient's sake. So there is some real truth that I, 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.

• 54:14Speaker 04

  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 in meditation. I like movement, 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 then 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. You truly have a meditation practice and that is really its own discipline. So I, I don't really have that, but I got those other things.

• 54:58Tim Ferriss?

  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?

• 55:16Speaker 04

  Yeah. I'm sorry, I love, speaking of absurdity, you know, the dinky, this, what a, I mean, I lost three limbs to a thing called the dinky.

• 55:29Tim Ferriss?

  Sorry, I'm laughing, but.

• 55:30Speaker 04

  You should laugh, I mean, this, I laugh, no, please laugh. I mean, it is kind of silly, but anyway. So as you know, fellow Tiger, you know, 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. You know, it's called the dinky with affection to some. And the, the dinky runs from Princeton to Princeton Junction and commuters can take the trains into Philly or New York or whatever else. That's what the dinky is. The why it's significant in my life in particular is, you know, one night it was November. It was just after Thanksgiving vacation sophomore year. November 27th, 1990.

• 56:14Speaker 04

  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 Wawa market, Tim?

• 56:22Tim Ferriss?

  I do. I was at Forbes. So I walked by the dinky and the Wawa every single day, multiple times.

• 56:28Speaker 04

  Right. So you know, so a late night visit to the Wawa market was pretty common. And so we were heading over to get a sandwich, whatever, you know, and so when we were just walking by the dinky. It was just parked there. This is not operating hours and, you know, it has a ladder on the back and we just walked by it 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 pantograph, I think it's what it's called. And that connects the train itself to the power source.

• 57:13Speaker 04

  And 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 arced to the watch and, uh, yeah, entered my arm and then blew down the feet. That was that.

• 57:30Tim Ferriss?

  So what happened at that point?

• 57:33Speaker 04

  Well, I should say, I don't really remember anything about that night, but my friends who were with me, uh, pieced it back together, but there's, you know, it's a big explosion and I was thrown some distance. And one friend came up on top of the train while the other friend ran and called 911.

• 57:52Speaker 04

  And if you can imagine, I mean, both of my friends were freaking out and right into action mode and, you know, getting up on top of the train that had just, in ways they couldn't have possibly understood, had just electrified their friend, and yet they got up on top of the train to help me. I mean, just ever a daily shout out to my friends Jonathan and Pete and Tommy too, for all they did for me that night and oh god, and so many nights. But yeah, so Pete held me down because I guess, I guess at some point I came to and I was just thrashing about and you have, you know, electricity enters your body and so you've got all this heat, you burn from the inside out and apparently

• 58:32Speaker 04

  it's very common that people wake with extreme energy. I mean, you are, you are electrified. So I mean, I'm just flailing, punching him through, I'm just a wild tear, apparently. So Pete, who was a very particularly large, strong and sturdy heroic friend of mine, held me down so I didn't roll off the top of the train and make things worse. 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, as they should have. But between my friends and a, and a Princeton police officer by the name of Officer Dawson, I believe his name was, who went on to become, who was promoted, I think after that to Sergeant Dawson. But anyway, Sergeant

• 59:16Speaker 04

  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 whisked me off to the local hospital. And the local hospital did these things where they basically just slice open the skin to allow the heat out. It's called this fasciotomy so that you stop burning yourself essentially. And then I was flown to the burn unit at St. Barnabas Hospital in Livingston, New Jersey, which is New Jersey's one and only burn unit, at least it was at the time. And that was that.

• 59:47Tim Ferriss?

  And flash forward to when you became fully cognizant of what had happened. You open your eyes. What does the scene look like?

• 59:59Speaker 04

  It's interesting. It's like I was conscious, I was awake throughout the ordeal. And it's just more the sleepiness of memory. So there really, it's not, 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. It just, I don't know why. I do like the story, so I will tell it to you. Anyway.

• 1:00:26Tim Ferriss?

  Please do.

• 1:00:29Speaker 04

  So your 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 it's also in part because it's not totally clear what tissue is viable and what tissue's not. So anyway, it was maybe day five or day six before the first amputations. And I woke up the night before. I remember this very, very well. 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 orient yourself and you realize, oh, thank God.

• 1:01:13Speaker 04

  That was, that was just a dream.

• 1:01:15Tim Ferriss?

  Mm hmm.

• 1:01:16Speaker 04

  You know that sensation?

• 1:01:17Tim Ferriss?

  Sure.

• 1:01:18Speaker 04

  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 that I was just describing a moment ago at Zen Hospice. 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 the sensation I had to use the bathroom. I said, oh, I don't want to get out of bed and go to the bathroom. And in this state, I was intubated on a ventilator. I extubated myself.

• 1:02:00Tim Ferriss?

  Oh, Jesus.

• 1:02:01Speaker 04

  Not easy to do. By he stretch. So I extubate myself, I pull out, I have all these lines running into my jugular veins in my neck. I pull those out. I just decouple myself from all these machines. 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. Um, but in my mind, very clear, everything's fine. And then the, you know what a Foley catheter is, Tim?

• 1:02:30Tim Ferriss?

  Uh, I don't know what a Foley catheter is, but a catheter I would understand as something is probably in your urethra.

• 1:02:38Speaker 04

  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 urethra into your bladder. And the catheter just is there to spontaneously drain your bladder. But the way that thing stays in there is they, 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. That's now inflated. So I'm walking the door and they usually clip the catheter in the bag onto the side of the. So you know, you know where this is going. So anyways, I'm walking to the door and the thing runs out of slack. And yikes, the dang catheter, of course, and it comes not all the way out, but like partially out.

• 1:03:26Speaker 04

  Sorry to you and all your.

• 1:03:27Tim Ferriss?

  Oh, so this is like a, wait, are we talking like a small python that ate a golf ball kind of situation? No, no offense, I mean, large python that ate a golf ball.

• 1:03:36Speaker 04

  No, no, no, that's small python.

• 1:03:39Speaker 04

  Yeah, so no, that's right, man. So I mean, this is hot.

• 1:03:42Tim Ferriss?

  Oh, God.

• 1:03:43Speaker 04

  And the total reverse, that total warm bath of relief that you experienced thinking it was a dream. But that just goes totally in reverse. And in a millisecond, I realized that all of this was not a dream. I fall down to the floor because all of a sudden I really can't walk either. I just fall on the floor and I'm screaming and I'm pulling on the, I'm trying to break the rubber tubing of the catheter, which is no way I could

• 1:04:08Tim Ferriss?

  Oh.

• 1:04:08Speaker 04

  to 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.

• 1:04:18Tim Ferriss?

  Oh, my God. I can see why it's vivid.

• 1:04:21Speaker 04

  Oh, yeah. I'm, I'm sort of bent over as I'm talking to you.

• 1:04:25Tim Ferriss?

  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?

• 1:04:38Speaker 04

  Uh huh.

• 1:04:39Tim Ferriss?

  Could you tell the Snowball story?

• 1:04:41Speaker 04

  So a burn unit is, like I said earlier, a particular place. They're gruesome places. They're very difficult environments. The pain that the patients are going through is gut wrenching. And so working in a burn unit is very difficult. People often don't last in a burn unit very long as a clinician. It's incredibly difficult work. And we learn from wars over time, is my understanding of certain medical history, that that the way burns often kill people is indirectly through infection. So once you've disrupted the integrity of your skin, you're much more vulnerable to infection. And so the thing that often kills burn victims after they've survived the initial trauma is infection. So burn units are incredibly sterile environments. So everyone's gowned up, masked, gloved.

• 1:05:26Speaker 04

  For the first maybe several weeks, I could only have one person in my 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 know, you're in a whole cell. And even when people are at your bedside, there, there's all this garb in between you and them. So there's no relationship to the natural world. You can touch nothing.

• 1:05:55Speaker 04

  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 was November. At some point in December, maybe it was 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. And I think it was, it may have been, her name was Joy Varcardapone. 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, so

• 1:06:35Speaker 04

  I could feel snow. And man, it was so, oh, 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 cut off, we can't take, if our senses are choked off, we are choked off.

• 1:07:18Speaker 04

  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 removed from it. It was potent.

• 1:07:47Tim Ferriss?

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

• 1:07:58Speaker 04

  Yeah, well, like you, I mean, I started out, you know, ten, I started, I was at Princeton eighty-nine and ninety-three. And I started out, I went there. Really high on the idea of learning things that were foreign to me, you know, totally seeing a different worldview and really delighting in the liberal arts education. So with that, Tiananmen 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.

• 1:08:41Speaker 04

  So I switched my major to art history and that's what I ended up studying. What do 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 sort of daily lives or those of us who make art, you know, we use it to make art. You know, what's the purpose of making art? Art is inherently kind of useless and that seems to be part of its charm. The fact that we as a species make art and care about it

• 1:09:25Speaker 04

  seemed to me really important because I was trying to figure out, well, who am I now? Like, am I less human because I have less, fewer body parts? You know, and like, is that the measure of what it means to be a human being? Or, no, but I couldn't really answer the question, what was my humanity? What did it mean to be a human being? Why was I happy to be still alive? Those are the kinds of questions I was trying to kind of wade through, like essentially questions of identity. So, so studying art, the hunch was, well, hmm, well, this seems to be a peculiar, the situation I'm in was sort of peculiar to being a human being, that one could survive injuries like that and go back out into the world in this damaged way

• 1:10:09Speaker 04

  and make their way again and return ostensibly to some sense of wholeness in themselves. And it seemed to be rightly placed to focus on something like art as a guide to help me get creative with the reality I was now facing. In a way, it was, the thing I was trying to learn how to do was make perspective. And that's what art really helps you exercise that muscle. It helps you learn how to see, how to listen. And that was really empowering because I, there's so much I would have loved to change about what I was seeing. You know, when I looked at my body, I would have loved to change so much about it, but I couldn't. Well, I could change with this knowledge.

• 1:10:54Speaker 04

  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, you know, it really paid off, I have to say, it's very helpful.

• 1:11:05Tim Ferriss?

  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, every group of humans on the planet? And 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.

• 1:11:45Tim Ferriss?

  But were there any particular classes, teachers, books, pieces of art that really influenced you?

• 1:11:55Speaker 04

  Really 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 and my ear. And that was great. But on this sort of identity, sort of philosophical front, like the existential, like, why do we do this? What's the meaning of this? That was actually kind of left up to me as an individual and in my relationships. 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.

• 1:12:40Speaker 04

  And frankly, a lot of stuff we're talking about right now, Tim, and the benefits I reaped from it was really 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 mean, I love going to museums, but I just like being around art. Sometimes I don't even look at it. I just like that it exists and I like to reward places to help it exist. So there's no one work I can point to, although I would say probably the, the painting of Mark Rothko has proven to be very poignant and

• 1:13:23Speaker 04

  potent for me. I just, any chance I get to stand in front of a Rothko, I will, I will do.

• 1:13:27Tim Ferriss?

  How do you spell that last name? I'm ignorant when it comes to this type of thing.

• 1:13:31Speaker 04

  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.

• 1:13:43Tim Ferriss?

  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 shitfaced 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 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. We're just on our way to dinner. Because what would happen is he would stay, he

• 1:14:26Tim Ferriss?

  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, the, 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 physician slash, let's just say mentor, guide to someone who had just suffered nearly identical injuries to yourself, 20 some years old, what would your conversation be like with them?

• 1:15:09Tim Ferriss?

  Or what resources or reading or otherwise would you point them to?

• 1:15:14Speaker 04

  I find myself every once in a while, I'll get called by friends in the hospital, come visit with someone who is in similar shoes, you know? And actually, I wish I remembered his name, but someone did that for me when I was in the burn unit. He'd had a similar accident. I think he lost two legs below the knee. I should say both legs. Anyway, 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 am I going to look like?

• 1:15:57Speaker 04

  What's it going to feel like to walk on prostheses? And that's kind of what, you know, it was that nuts and bolts 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. And just seeing him look me in the eye with some kinship, that was the therapy of it. I think I've gotten in trouble when I've tried to come in with some predetermined idea of advice giving. Oftentimes, that's not really what's needed. It's more just the camaraderie.

• 1:16:43Speaker 04

  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 visit is just visiting, just being together and sharing this awkward body.

• 1:16:56Tim Ferriss?

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

• 1:17:20Speaker 04

  Yeah.

• 1:17:21Tim Ferriss?

  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.

• 1:17:33Speaker 04

  Is it any?

• 1:17:34Tim Ferriss?

  Which maybe you could talk about, but I'd be curious to hear sort of what really brings the most peace to these people.

• 1:17:42Speaker 04

  So you're right. I mean, I think one of the joys about, one of the upshots or silver linings about the end of life is that if you want it to, if you let it, you can let a lot of the rules that govern our daily lives fly out the window. Because you realize that we're walking around in systems and society, and much of what consumes most of our days is not some natural order. We're all navigating some superstructure that we humans created. That is the work day, the work week, whatever it is. I think part of the trick is if when you're dealing with serious illness or some unnatural trauma, or are facing the end of your life, oftentimes that becomes crystal clear.

• 1:18:26Speaker 04

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

• 1:19:11Speaker 04

  on a daily way, am I doing things that I really care about, et cetera. So, back to your question, to this point about simple things, I mean, the simple things, the small things ain't so small, you know, actually. The, 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 Zen Hospice who smoke, frankly, you know, or, you know, anything

• 1:19:54Speaker 04

  that just kind of gets to, that kind of reorients us and puts things in proper proportion relationship to the natural world, and rejiggers our priorities. I, I, I love that, I love that reorienting feeling. And, and, and again, it does seem to be one of the silver linings for folks in this zone. Like, 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, 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

• 1:20:35Speaker 04

  with life like ours on it, anywhere nearby. And then you start looking at the stars and you realize that the lights that are hitting your eye is ancient, and that the stars that you're seeing may no longer exist by the time the light gets to you. And just, just sort of mulling the, the bare naked facts of the cosmos, for me, is enough to just thrill me. Aw me, freak me out and kind of put all my neurotic anxieties in their proper place. Though.

• 1:21:06Tim Ferriss?

  Right.

• 1:21:07Speaker 04

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

• 1:21:21Tim Ferriss?

  Oh, no, 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?

• 1:21:30Speaker 04

  Yeah. Yeah, well, you know, I mean, the smell of fresh bread or 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 cologne or perfume of someone you knew 30 years ago. Like I still, 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 and food is primal and potent. I mean, it's nourishment, it's nutrition,

• 1:22:13Speaker 04

  it's how we live in some ways, right? So there's all this symbolic stuff happening too. But there's also just the basic joy of smelling a cookie. It smells friggin great. And it's like the snowball, like in that moment, I am rewarded for being alive and in the moment. Smelling the cookie is not on behalf of some future state. It's great in the moment by itself on behalf of nothing, you know, and this is another thing back to art, art for its own sake. Art is 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.

• 1:22:54Speaker 04

  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, is to prize those little moments.

• 1:23:03Tim Ferriss?

  You guys, I might be fabricating this, but make cookies at the Zen Hospice Center. Because of this precise 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 the meaninglessness, if it is in fact meaningless, of things as opposed to taking all things so damn seriously, which in a way prevents you from doing a lot of the serious work you'd like to do. But the question I was gonna ask is to get your opinion on a modality, we'll call it, or a tool.

• 1:23:48Tim Ferriss?

  And I'm gonna explain this vis a vis a friend I'll keep anonymous. So this is a female, young woman who used to work in hospice care. 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.

• 1:24:30Tim Ferriss?

  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 Journal about the use of, I believe, 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.

• 1:25:14Speaker 04

  Yeah, well, I'm so glad you're asking this question. I mean, this isn't 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, you know, toxic and 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 wig trying to justify their own recreational use of these.

• 1:25:50Tim Ferriss?

  UCSF, UCLA, Johns Hopkins.

• 1:25:52Speaker 04

  Johns Hopkins, you got it right. NYU, friends at the River Styx Foundation have been funding some of this work. The people I know who are involved in this work are deeply thoughtful, caring, loving people. Anyway, so that's a preamble. But, you know, to get to your question, I am thrilled for this for a number of reasons. One is just the counterculture fun kind of things coming out of the closet. Another is a whole generation, i.e. 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 experience with these compounds. And now they get to sort of be above board potentially. So anyway,

• 1:26:35Speaker 04

  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 when 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

• 1:27:18Speaker 04

  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 them as in a diagnosis of exclusion. So, and no one knows what the hell to do about this. Diagnosis of exclusion. Yeah. So you just rule out everything else that you understand.

• 1:28:02Speaker 04

  And if you're, then, then whatever you're left with, you just call it this bucket term. And in this case, that bucket term is existential suffering. Not, not particularly inspired, right? 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 unesoteric field, absolutely relevant, you know? No one I know has not suffered. It seems to be elemental to being a human being. And this is our fulcrum in palliative care. And what's more, we have named this thing existential suffering, which is so mysterious, right?

• 1:28:46Speaker 04

  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, this is my favorite sort of strategic zone to upload into healthcare, all these otherwise non-medical issues. So that was 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. Always is. Good, good, because I love this subject. So, so we have the leverage now that palliative care is accepted and part of healthcare and has, 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.

• 1:29:32Speaker 04

  And to keep them, to make them relevant. So this is where it gets thrilling.

• 1:29:35Tim Ferriss?

  Meaning you have a channel, because you've wedged your foot in the door with palliative care.

• 1:29:39Speaker 04

  Yeah.

• 1:29:39Tim Ferriss?

  Through which you can insert other things that wouldn't otherwise have an easy gateway.

• 1:29:44Speaker 04

  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 some way 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, that sort of narrow medical sciences per se. That's really exciting. So back to psychedelics. Well, so we can call out this existential suffering, but today, as clinicians, we don't really have much to offer it. We're aware that we've talked, as we've talked, like bearing witness and non-abandonment, accompanying people in their struggles is itself a great salve, and that's beautiful work.

• 1:30:29Speaker 04

  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, man, 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 toehold 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 then other things

• 1:31:12Speaker 04

  may be radically helpful in fostering a meaning-making moment for someone, of fostering a sense of belonging in this sort of cosmic way. And so in other words, we have potentially with these compounds, a way to respond to this wacky thing called existential suffering. So this is just thrilling for all those reasons.

• 1:31:37Tim Ferriss?

  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 they're really well organized and comprised of very good M.D.s and P.H.D.s called the Hefter Research Institute. H E F F 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 FMRI's and different types of neuroimaging to look at the specific effects of different types of psychedelics, whether you call them entheogens or psychoactive psychotropics, whatever it might be. So it's a very, very, a lot of interesting, interesting work. And you can

• 1:32:22Tim Ferriss?

  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

• 1:32:35Speaker 04

  And by the way, Tim, can I just interrupt?

• 1:32:37Tim Ferriss?

  Absolutely.

• 1:32:37Speaker 04

  I've also had some really fascinating conversations with other folks in this space. And another organization to pull your listeners to is a group called Compass.

• 1:32:45Tim Ferriss?

  Compass?

• 1:32:46Speaker 04

  Compass. And they are beginning to do 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. So just another group in this space that's doing cool stuff.

• 1:33:11Tim Ferriss?

  Cool. And you know what? I'll throw one more in there. Maps.

• 1:33:14Speaker 04

  Yeah.

• 1:33:15Tim Ferriss?

  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, for people wondering, these will all be, links to all these things will be in the show notes at fourhourworkweek.com/podcast, all spelled out. 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?

• 1:34:01Speaker 04

  Different from other physicians or just people in general?

• 1:34:04Tim Ferriss?

  People in general, because I don't want to make it exclusively professional.

• 1:34:08Speaker 04

  Yeah.

• 1:34:08Tim Ferriss?

  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.

• 1:34:23Speaker 04

  Well, let's see here, my friend. I have two answers to that question. So the one is, you 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 in having a body to feel anything like we've talked, is it's how it prizes purposelessness. 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.

• 1:35:08Speaker 04

  And frankly, I'm fine not knowing. I enjoy the mystery of it. And I'm okay if there's meaning on a grand scale or not, frankly. But meanwhile, I am aware of our talent as a species to make meaning for ourselves and to string together narratives and stories and to make sense of our lives. 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,

• 1:35:53Speaker 04

  we could all benefit from letting ourselves delight in things that don't necessarily have any meaning, but just feel good that don't, you know, 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 its 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.

• 1:36:37Speaker 04

  Just the joy of smelling a cookie and that can be enough. Watching a ballgame, that can be enough. It doesn't have to be big. It doesn't have to be a means to an end. So anyway, I think that's so that's one answer to your question. I don't know how many of us are out there prizing purposelessness, but I do.

• 1:36:56Tim Ferriss?

  Well, I it made me think of, this might be a strange connection, but made me think of Kurt Vonnegut, the writer, who I 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.

• 1:37:38Tim Ferriss?

  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, uh, 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.

• 1:38:23Tim Ferriss?

  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.

• 1:38:42Tim Ferriss?

  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?

• 1:38:57Speaker 04

  So funny because, I mean, I'm laughing because I am probably the least well-read person you will ever meet. And especially one with like degrees, college and stuff. I, I, if I, I am.

• 1:39:12Tim Ferriss?

  All right. If they said, give me one to three things that I can watch, do, absorb, look at, et cetera, without human interaction, what would your answer be?

• 1:39:23Speaker 04

  Thank you. That's better for me. I mean, hey, I'm all for books too. Those apparently are cool. But for me, you know, I love film. I love music. I love art. I love doing nothing. I love being outside. So that's for me to let me, but I would put big picture books in front of people. And I mentioned Mark Rothko. Staring at Mark Rothko work is just a gorgeous splendor, but it, you know, it suits your taste. So for me, I guess I put some, a picture book of, of Mark Rothko paintings in front of them. I would put probably any music from Beethoven into their ears.

• 1:40:05Speaker 04

  And I probably would reserve that third thing for staring into space.

• 1:40:09Tim Ferriss?

  Before they stared into space, they wanted to watch a movie. What would you put in front of them?

• 1:40:16Speaker 04

  Man, there's so many good ones.

• 1:40:19Tim Ferriss?

  Ratatouille. No.

• 1:40:23Speaker 04

  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.

• 1:40:33Tim Ferriss?

  Waiting for Guffman? I've never even heard of it.

• 1:40:35Speaker 04

  Was never heard of Waiting for Guffman?

• 1:40:37Tim Ferriss?

  No.

• 1:40:38Speaker 04

  Wow, wow.

• 1:40:38Tim Ferriss?

  Just a string of ignorance on my part in this conversation, although you don't read books. So I feel that evens us out.

• 1:40:45Speaker 04

  So, oh yeah. But this is good news because man, you have so much to look forward to. I mean, so this, this movie is by Christopher Guest and company, the guys who did Spinal Tap.

• 1:40:54Tim Ferriss?

  Oh, wow.

• 1:40:55Speaker 04

  You know, Best in Show.

• 1:40:56Tim Ferriss?

  Sure, sure. How do you say Guffman? Or how do you spell Guffman?

• 1:40:59Speaker 04

  I think it's G U F F M A N. It's friggin hilarious. So that I just always a long-term favorite. I mean, as a kid growing up, Kentucky Fried Movie. My God, I haven't thought about that in decades. Yeah, 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, formative for us. And I heard that you asked another question specifically about documentary film of other guests. And I was thinking about that. And, you know, one that leaps to mind, I don't

• 1:41:42Speaker 04

  know if you'd really even consider it a documentary, but I guess it is. It's, you know, the movie Grizzly Man. Oh, man. Oh, man. Yeah, I consider that a documentary. Yeah, sure. It's called a documentary. So yeah, of course it is. I mean, and it is, I, any piece of art where I simultaneously, or I'm not sure whether 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 said, I think it's a beautiful, like an amazing piece of filmmaking. And I also particularly like its poignancy around our humans' silly dance around nature.

• 1:42:28Speaker 04

  And how we humans think of ourselves as somehow opposed to nature. And yet, when we try to reinsert ourselves into the wild, it doesn't necessarily go very well. And how we romanticize Mother Nature can coddle us. And, you know, I spent a lot of time in the desert in Southern Utah, as much time as I can. I just love that landscape. And speaking of perspective making, you know, and 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 gotten lost twice walking around this particular area. And it's the same feeling I had watching Grizzly Man, which is Mother Nature, as far as I can tell, is pretty indifferent to us. You know?

• 1:43:12Tim Ferriss?

  Yeah, I would say so.

• 1:43:14Speaker 04

  So anyway, there's my answer for you.

• 1:43:16Tim Ferriss?

  So that brings to my two things. The first is you mentioned that feeling, which is two sides of the same coin, almost that of being simultaneously repulsed, but wanting to laugh and unsure of which way to go. That seems to me to be a very primal emotion, like a singular emotion in a way. When, for instance, I've watched nature footage of chimpanzee troops when one of them is torn to pieces by a jaguar or some such on the ground. And the response tends to be breaking out into what would be considered by primatologists hysterical laughter.

• 1:43:55Tim Ferriss?

  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 together a few things you've said related to sort of the meaninglessness, which may be too loaded a term for some people. It might come off as very negative, but it seeming inconsequential or small and meditating on that, or not even meditating, experiencing it in a very visceral way by being in the desert or looking up at 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.

• 1:44:33Tim Ferriss?

  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 hilariously 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?

• 1:45:08Speaker 04

  I think of, well, you know, you just pointed to something, the relationship of self and the silliness of the self and the power of the self. And I think we do ourselves disservices by playing into polemics around selfishness or selflessness. So there's a lot to say about that. But to segue to your question about success, on one hand, I sort of think of it in terms, I guess, I think of it as a sort of a self-actualization. Someone who has realized has played themselves all the way out. And that might be seen and appreciated by practically no one, and therefore not make the measure of some external success.

• 1:45:50Speaker 04

  But someone who has sort of become themselves delighted in themselves, including their quirks and awkwardness, and played that self out, insisted on itself all the way to the end, to me, that may be a version of success. So I guess one part of my answer to your 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

• 1:46:33Speaker 04

  between the self and the other. And so I think probably success may be, or the second half of it, has to do with, in any 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, is it has 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 consonance with the world around you, that seems like great success.

• 1:47:11Tim Ferriss?

  Is there anyone who embodies that for you or comes closest?

• 1:47:17Speaker 04

  Well, I recently had the joy of sitting with Oprah Winfrey and watching her make use of her life and now point and also point her energies to promoting and helping others. This is a very, I mean, a remarkable life's work and it's just a name we all know and wow. But, you know, I'm also interested in all the gazillion successful people we walk by every day and don't even know it, you know? This kind of happiness, this kind of success doesn't necessarily brag about itself and I love presuming it when I'm unaware of it and assuming it exists in others that I walk by on the street.

• 1:47:56Speaker 04

  In a way, you find yourself kind of imbuing others with an idea of success that changes how you look at them and how you treat them.

• 1:48:04Tim Ferriss?

  Definitely.

• 1:48:05Speaker 04

  And that's a sort of 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 embodying all this.

• 1:48:13Tim Ferriss?

  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.

• 1:48:31Speaker 04

  How I get up in the day to start the day?

• 1:48:34Tim Ferriss?

  No, what you just talked about, sort of assuming the presence of this type of success. You said it's morning exercise of yours.

• 1:48:42Speaker 04

  Oh.

• 1:48:42Tim Ferriss?

  I'd love to just hear you elaborate on that.

• 1:48:44Speaker 04

  Oh, I don't know. I didn't remember saying morning. That's what tripped me up.

• 1:48:48Tim Ferriss?

  Ah, sorry.

• 1:48:49Speaker 04

  That's sort of a daily, daily exercise perhaps.

• 1:48:51Tim Ferriss?

  Ah, there we go. Yeah, I could have made up the morning part.

• 1:48:52Speaker 04

  Who knows? But sure, but it's sort of any time of day or night, this is useful. You know, 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 to your day of gratitude and happiness and some amount of comfort. So I'll catch myself being bitter, or I get kind of road ragey. I'm very aggressive on my motorcycle and car. And actually, just today, I was really annoying someone by following them too close. Whatever, I get, 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

• 1:49:36Speaker 04

  Bay Area, 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, it's just simply that. I actually learned this, my mother took me to a Deepak Chopra conference when I was pretty young. It was a long, long time ago.

• 1:50:21Speaker 04

  And the one thing I heard that stuck, it was really interesting to me, was it was 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 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 gotta believe that that resonates and registers somewhere, you know, that that lands somewhere, that that lends itself 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.

• 1:51:00Tim Ferriss?

  Now, I hate to focus on something maybe superficial, but you said riding your motorcycle. Now, I apologize if this sounds like a weird question, but you...

• 1:51:13Tim Ferriss?

  Have three limbs that have been damaged. How do you ride a motorcycle?

• 1:51:19Speaker 04

  So, yeah, so you know, this is, this was a sort of long dream that recently came true.

• 1:51:25Tim Ferriss?

  Congratulations. I mean, it's awesome. I'm just so curious about the logistics.

• 1:51:28Speaker 04

  Thank you. Well, it's interesting you ask because right now there's the man who helped make this dream come true. Randy, he ended up being my patient and our resident at Zen Hospice Project not long after he converted my motorcycle. So there's a lot to this story, my friend. So cheers to Randy and his family and his wife, I mean, and his mother. Melanie, who I'll be seeing next week, actually. So that's one piece of this story. But the other is this, I'd always, I love two wheels. I love gyroscopic, gyroscopic lifestyle. I love the feeling of it. So 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,

• 1:52:12Speaker 04

  and try to help make it happen. A fellow named Mert Lawwell, who's an old motorcycle racer champion, sort of legendary in that world. He happens to live around here. He lives in Tiburon. And he built a prosthetic component. I don't know what the story that inspired Mert to do this, but he's a machinist himself and a handy fellow. And then in his retirement, he got into this 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 Mert'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.

• 1:52:55Tim Ferriss?

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

• 1:53:02Speaker 04

  Okay, so Randy, what he, what he figured out, so first was to get the arm piece. And then what Randy figured out was, well, then Aprilia, and I know Honda had made a version of this as well, but Aprilia makes a model, the Mana, 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 to hold on to the bike. I'm doing nothing with my prosthetic arm, except for

• 1:53:45Speaker 04

  holding on to the bike. So all the actions in my right hand, brakes into one lever, and Randy built this box and moved all of 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.

• 1:54:08Tim Ferriss?

  That's so awesome.

• 1:54:10Speaker 04

  That's it. You know, that's, that's a way, a way you go.

• 1:54:13Tim Ferriss?

  Okay, I just have to pause here for a second and just ask everyone listening, what bullshit excuses do you have for not going after whatever it is that you want? Like, please, write in, tell us on social media why these are real excuses with hashtag bullshit afterwards. Oh my God, man, that's such a great story. I'm so glad I asked about it. And what a really fantastic workaround. Man, congrats. That's awesome.

• 1:54:48Speaker 04

  Thank you, and thanks Randy, and thanks to the folks at Scooteria, the bike shop in the city. I mean, I, 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.

• 1:55:00Tim Ferriss?

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

• 1:55:15Speaker 04

  No, that was a little more than $1.

• 1:55:19Tim Ferriss?

  Holy cow, man. Wow.

• 1:55:22Speaker 04

  You know, I would probably point us to a beautiful Pinot Noir from Joseph Swan up in Sonoma County. It's like the artwork of Andy Goldsworthy, or anyone who delights in anything ephemeral. The charm in a bottle of wine, the craft, all the work that goes into it. And actually, the lighting and 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 delighting in something that goes away.

• 1:55:58Tim Ferriss?

  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 finished with friends at home. And I have each of them write something on the cork. So I have this collection. The bottles are gone, the wine is long gone. But there's this vestige, right? Maybe that's not the right word. I'm trying to G R E to sound intelligent, but the corks in this sit, I'm looking at it right now. It's on this floating shelf on the wall. And so I see it as I walk by it.

• 1:56:41Tim Ferriss?

  Yeah. So no matter how sort of lonely I might feel at times, I think we all do at moments. It's sort of a reminder of how close by, how within reach sort of friends and that type of experience are. If you could put one billboard anywhere with anything on it, what would it say?

• 1:56:58Speaker 04

  Oh, boy. That's a doozy. Let's see here, man. Well, you know, it makes me think of, as big as billboards are, you cannot, you can only put so much on them. And it makes me think of the, my favorite bumper sticker. And I guess, and it seems like such a potent, I just love, I love it. And so I would love to see it on a billboard, which, and the basic bumper sticker, I'm sure you've seen it, is, "Don't believe everything you think."

• 1:57:22Tim Ferriss?

  I've actually never seen that. That's a really good one.

• 1:57:25Speaker 04

  Well, it's so good. I think this is such a sweet, hilarious, true reminder to not take ourselves so dang seriously. You know, and so anyway, that's, that's probably my choice. Don't believe everything you think.

• 1:57:37Tim Ferriss?

  Don't believe everything you think. I was really waiting for what this was gonna be. I was, I was really wondering. I saw one, this is, I'm really gonna 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, um, if you're on my ass, you better be pulling my hair.

• 1:58:04Tim Ferriss?

  I thought that was pretty clever, uh, but it shows you where my level of emotional maturity is. In any case, uh, don't, you're, I, you know, I thought I might, I might lose you with that one. That's okay. I'll try to really reel you back in with the next few questions. So yeah, don't believe everything you think. That's awesome. I'm, I'm astonished. I've 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.

• 1:58:33Speaker 04

  Ooh, wow. That was a particularly poignant time for me, actually. So there's a lot going, I was in, I was deep in med school, it was my last year of med school. Boy, I had kind of really sort of experimental tour of my twenties. 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 your 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.

• 1:59:12Speaker 04

  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, 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 this is all going and you don't need to know where it's all going.

• 1:59:52Tim Ferriss?

  Yeah, you don't need to know where it's all going.

• 1:59:54Speaker 04

  And you can't.

• 1:59:55Tim Ferriss?

  And you can't.

• 1:59:59Tim Ferriss?

  What have you changed your mind about in the last few years?

• 2:00:02Speaker 04

  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 very loose and I was whatever. I didn't feel the need to accomplish so much per se. But in these last few years, I've let myself, I think in a way, man, I think I've let myself get more ambitious in a way.

• 2:00:40Tim Ferriss?

  Mm hmm.

• 2:00:40Speaker 04

  And to take my work even extra seriously, more seriously than perhaps I had been. And letting myself feel like this could all work and letting myself feel like actually the healthcare system could be fixed. So in other words, I guess in a word is to reacquaint myself with something I had 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 too in around where we live and places like Princeton and people stepping all over each other to get ahead. And that's not what I'm talking about.

• 2:01:20Tim Ferriss?

  Maybe it's aspiration.

• 2:01:22Speaker 04

  Yeah, yeah. Mm hmm. Yeah, I think that's right.

• 2:01:26Tim Ferriss?

  Well, on that point, do you have any, any last requests, asks, suggestions or otherwise for the people listening?

• 2:01:38Speaker 04

  Oh, thanks. I mean, that's such a great invitation. I mean, one is, folks, hey, everyone, I would 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, and mortal beings at that. And I guess I would ask that we start looking to make that real. I would ask that we prize kindness. I would ask that we learn to forgive in a daily way. 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

• 2:02:20Speaker 04

  your support at Zen Hospice Project. These places rely heavily on philanthropy. So if you're moved, please come check us out, zenhospice.org. Otherwise, think about what's going on in your own geography. Support hospice and palliative care. It's work that needs to be developed and built. Yeah, I'll leave it at that. That's plenty.

• 2:02:39Tim Ferriss?

  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 Zen Hospice Project, to do a lot of experimentation that could actually translate much more broadly to life, not just at the end of life, but throughout life. And I find

• 2:03:22Tim Ferriss?

  that very, very inspiring and exciting. So I think it's a real tremendous opportunity and a potential point of leverage that you have. And so people can find you at zenhospice.org, Z E N H O S, zenho-spike.org, zen-hospice.org. Facebook is Zen Hospice Project, Twitter, at Zen Hospice. And I'll put all this in the show notes, of course, for everybody listening.

• 2:03:53Speaker 04

  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?

• 2:03:59Tim Ferriss?

  Absolutely, of course.

• 2:04:00Speaker 04

  The Symptom Management Service in the UCSF Cancer Center, the outpatient palliative care program there, Mike Raybo 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.

• 2:04:14Tim Ferriss?

  Definitely, yeah. UCSF is just spectacular and I've done, I've also been involved with, well, the Giselle Lab and other folks at UCSF. I'm just continually impressed. BJ, hopefully we'll get to do a round two, maybe with some wine sometime, but I really appreciate, number one, first and foremost, the work that you're doing and how you've dedicated your life. It's tremendously important and tremendously impactful. And also, on a smaller level, of course, the time that you carved out today for this.

• 2:04:45Speaker 04

  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.

• 2:04:52Tim Ferriss?

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

• 2:05:11Tim Ferriss?

  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? Between one and a half and two million people subscribe to my free newsletter, my super short newsletter called Five Bullet Friday. Easy to sign up, easy to cancel. It is basically a half-page 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 I'm reading, books I'm reading, albums perhaps, gadgets, gizmos, all sorts of tech tricks and so on that get sent to me by my friends, including a lot of podcast guests. And these strange esoteric

• 2:05:55Tim Ferriss?

  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/friday, type that into your browser, tim.blog/friday, drop in your email and you'll get the very next one. Thanks for listening. This episode is brought to you by Shopify, one of my absolute favorite companies, and they make some of my favorite products. Shopify is the commerce platform revolutionizing millions of businesses worldwide. And I've known the team since 2008 or 2009. But prior to that, I wish I had personally had Shopify in the early 2000s when I was running my own ecommerce business.

• 2:06:40Tim Ferriss?

  I tell that story in the Four Hour Work Week, but the tools then were absolutely atrocious, and I could only dream of a platform like Shopify. In fact, it was you guys, my dear readers, who introduced me to Shopify when I polled all of you about best ecommerce platforms around 2009, and they've only become better and better since. Whether you're a garage entrepreneur or getting ready for your IPO, Shopify is the only tool you need to start, run, and grow your business without the struggle. Shopify puts you in control of every sales channel. It doesn't matter if you're selling satin sheets from Shopify's in-person POS system or offering organic olive oil on Shopify's all-in-one ecommerce platform. However you interact with your customers, you're covered.

• 2:07:22Tim Ferriss?

  And once you've reached your audience, Shopify has the internet's best converting checkout to help you turn browsers into buyers. Shopify powers 10% of all ecommerce in the United States. And Shopify is truly a global force as the ecommerce solution behind Allbirds, Rothy's, Brooklinen, and millions of other entrepreneurs of every size across more than 170 countries. Plus, Shopify's award-winning help is there to support your success every step of the way if you have questions. This is possibility powered by Shopify. So check it out. Sign up for a $1 per month trial period at Shopify. That's S-H-O-P-I-F-Y. Shopify.com/Tim. Go to Shopify.com/Tim to take your business to the next level today.

• 2:08:04Tim Ferriss?

  One more time, all lowercase, Shopify.com/Tim. This episode is brought to you by Vuori Clothing, spelled V-U-O-R-I. Vuori. I've been wearing Vuori at least one item per day for the last few months, and you can use it for everything. It's performance apparel, but it can be used for working out, it can be used for going out. Out to dinner, at least in my case, I feel very comfortable with it. Super comfortable, super stylish, and I just want to read something that one of my employees said. She is an athlete, she is quite technical, although she would never say that. I asked her if she had ever used or heard of Viori, and this was her response.

• 2:08:49Tim Ferriss?

  "I do love their stuff, been using them for about a year. I think I found them at REI, first for my partner, t-shirts that are super soft but somehow last as he's hard on stuff. And then I got into the super soft cotton yoga pants and jogger sweatpants. I live in them and they too have lasted. They're stylish enough, I can wear them out and about, the material is just super soft and durable. I just got their clementine running shorts for summer and loved them. The brand seems pretty popular, constantly sold out. In closing, and I'm abbreviating here, but in closing, with the exception of when I need technical outdoor gear, they're the only brand I've bought in the last year or so for yoga, running, loungewear that lasts and that I think look good also. I like the discreet logo."

• 2:09:28Tim Ferriss?

  So that gives you some idea, that was not intended for the sponsor read, that was just her response via text. Vuori, again spelled V U O R I, is designed for maximum comfort and versatility. You can wear it running, you can wear their stuff training, doing yoga, lounging, weekend errands, or in my case, again, going out to dinner, it really doesn't matter what you're doing. Their clothing is so comfortable and looks so good, and it's not offensive, you don't have a huge brand logo on your face. You just want to be in them all the time. Their men's KORE short, K O R E, the most comfortable lined athletic short is your one short for every sport. I've been using it for kettlebell swings, for runs, you name it.

• 2:10:11Tim Ferriss?

  The banks short, this is their go to land to sea short is the ultimate in versatility. It's made from recycled plastic bottles. And what I'm wearing right now, which I had to pick one to recommend to folks out there, or at least to men out there, is the Ponto Performance Pants. And you'll find these at the link I'm going to give you guys, you can check out what I'm talking about. But I'm wearing them right now, they're thin performance sweatpants, but that doesn't do them justice. So you gotta check it out, P O N T O, Ponto Performance Pants. For you ladies, the women's performance jogger is the softest jogger you'll ever own. Vuori isn't just an investment in your clothing, it's an investment in your happiness. And for you, my dear listeners, they're offering 20% off your first purchase.

• 2:10:53Tim Ferriss?

  So get yourself some of the most comfortable and versatile clothing on the planet. It's super popular. A lot of my friends have now noticed are wearing this. And so am I. vuoriclothing.com/Tim. That's V U O R I clothing.com/Tim. Not only will you receive 20% off your first purchase, but you'll also enjoy free shipping on any US orders over $75 and free returns. So check it out. vuoriclothing.com/Tim. That's V U O R I clothing.com/Tim. And discover the versatility of Vuori Clothing.