#153: The Man Who Studied 1,000 Deaths to Learn How to Live

At the end of our lives, what do we most wish for? And how can knowing this help you live better lives now? BJ Miller, MD (@zenhospice https://twitter.com/zenhospice) knows. BJ is a palliative care physician at Zen Hospice Project http://www.zenhospice.org in San Francisco, where he thinks deeply about how to create a dignified, graceful end of life for his patients. He is an expert in death, but he's also learned how we can dramatically improve our own lives, often with very small changes. When you consider that he has guided or been involved with ~1,000 deaths, it's not surprising that he's spotted patterns we can all learn from. BJ is also a triple amputee, and his 2015 TED Talk, https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life?language=en "Not Whether But How," is a moving reflection on his vision to make empathic end-of-life care available to all, ranked among the top-15 most viewed TED talks of the year. If you want to know what being around death can teach you about living, you'll want to listen to this. I LOVED this conversation, and I hope you do as well. Enjoy. Show notes and links for this episode can be found at www.fourhourworkweek.com/podcast http://www.fourhourworkweek.com/podcast. This podcast is brought to you by Wealthfront https://wealthfront.com/tim. Wealthfront is a massively disruptive (in a good way) set-it-and-forget-it investing service, led by technologists from places like Apple. It has exploded in popularity in the last two years and now has more than $2.5B under management. Why? Because you can get services previously limited to the ultra-wealthy and only pay pennies on the dollar for them, and it's all through smarter software instead of retail locations and bloated sales teams. Check out wealthfront.com/tim http://wealthfront.com/tim, take their risk assessment quiz, which only takes 2-5 minutes, and they'll show you—for free–exactly the portfolio they'd put you in. If you want to just take their advice and do it yourself, you can. Well worth a few minutes to explore: wealthfront.com/tim http://wealthfront.com/tim. This podcast is also brought to you by Boll & Branch. https://www.bollandbranch.com/tim There is a lot of nonsense in the bedding business. For instance, did you know thread-count is not a good measurement of quality? It's a total myth. The "Made in Italy" label? It isn't something you should necessarily pay extra for because it generally means it's just finished in Italy and woven in places like China. The general industry mark-up for bedding is 700 to 800 percent at most retailers. Boll & Branch https://www.bollandbranch.com/tim creates incredibly high-quality bedding. They are the same sheets you'll find at my home in San Francisco. The best part? You can try anything you order at home for 30 days. If you don't love it, send it back and get a full refund. Go to Boll & Branch https://www.bollandbranch.com/tim and use promo code "TIM" for 20% off your entire order. Whether sheets, towels, blankets, duvet covers, or anything else. Shipping is always free.

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

• 0:01Tim Ferriss?

  At this altitude, I can run flat out for a half mile before my hands start to shake.

• 0:06Speaker 01

  Can I answer your personal question?

• 0:08Speaker 02

  No, we're just in an appropriate time.

• 0:12Speaker 01

  I'm a cybernetic organism, living tissue over metal endoskeleton.

• 0:23Tim Ferriss?

  This episode is brought to you by Wealthfront, and this is a very unique sponsor. Wealthfront is a massively disruptive, in a good way, set it and forget it investing service, led by technologists from places like Apple and world famous investors. It has exploded in popularity in the last two years, and they now have more than $2.5 billion under management. In fact, some of my very good friends, investors in Silicon Valley, have millions of their own money in Wealthfront. So the question is, why? Why is it so popular? Why is it unique? Because you can get services previously reserved for the ultra wealthy, but only pay pennies on the dollar for them. And this is because they use smarter software instead of retail locations, bloated sales teams, etc. And I'll come back to that in a second. I suggest you check out wealthfront.com/tim.

• 1:08Tim Ferriss?

  Take the risk assessment quiz, which only takes two to five minutes, and they'll show you for free exactly the portfolio they'd put you in. And if you just want to take their advice, run with it, do it yourself, you can do that. Or, as I would, you can set it and forget it. And here's why. The value of Wealthfront is in the automation of habits and strategies that investors should be using on a regular basis but normally aren't. Great investing is a marathon, not a sprint, and little things that you may or may not be familiar with, like automatic tax loss harvesting, rebalancing your portfolio across more than 10 asset classes, and dividend reinvestment add up to very large amounts of money over longer periods of time. Wealthfront, as I mentioned, since it's using software instead of retail locations, etc.,

• 1:50Tim Ferriss?

  can offer all of this at low costs that were previously completely impossible. Right off the bat, you never pay commissions or account fees. For everything, they charge 0.25% per year on assets above the first 15,000, which is managed for free if you use my link, wealthfront.com/tim. That is less than $5 a month to invest $830,000. ...account, for instance. Now, normally, when I have a sponsor on the show, it's because I use them and recommend them. In this case, it's a little different. I don't use Wealthfront yet because I'm not allowed to. Here's the deal. They wanted to sponsor this podcast, but because of SEC regulations, companies that invest your money are not allowed to use client testimonials. So I couldn't be a user and have them on the podcast. But

• 2:33Tim Ferriss?

  I've been so impressed by Wealthfront that I've invested a significant amount of my own money, at least for me, in the team and the company itself. So I am an investor and hope to soon use it as a client. Now, back to the recommendation. As a Tim Ferriss Show listener, you'll get $15,000 managed for free if you decide to open an account. But just start with seeing the portfolio that they would suggest for you. Take two minutes, fill out their questionnaire at wealthfront.com/tim. It's fast, it's free. There's no downside that I can think of. Just take a look, see what portfolio they would create for you, and you can use that information however you want. wealthfront.com/tim. This episode is brought to you by Boll and Branch, which is what I have on my bed at

• 3:15Tim Ferriss?

  home in San Francisco. I use it myself. And there's a lot of nonsense in the bedding business. For instance, thread count, not a measure of quality, total myth. Egyptian cotton, well, guess what? It's a plant called Gassipium barbadense. I don't think that's how you say it, but that is how I read it. Generally not even grown in Egypt. And the "Made in Italy" label that you're so proud of, well, you know, you shouldn't necessarily pay extra for that because it often means that it's just finished in Italy and woven in places like China. The general industry markup for bedding is 700% to 800% at the usual retail stores you would go to. Boll and Branch, which is B-O-L-L, is incredibly high quality. They have a higher cost of goods than many products you might buy at

• 4:00Tim Ferriss?

  3 to 4x their prices because they sell direct to consumer. So check it out. Go to bollandbranch.com. That's B-O-L-L-A-N-D-B-R-A-N-C-H.com. Boll and Branch.com. And not that you'd need to, but you can try anything you order at home for 30 days. If you don't love it, send it back and you get a full refund. Go to bollandbranch.com and use promo code TIM for 20% off your entire order, whether that's sheets, towels, blankets, duvet covers, anything. And shipping is always free. Check it out. Boll and Branch.com, promo code TIM.

• 4:34Tim Ferriss?

  Hello ladies and germs, this is Tim Ferriss and welcome to another episode of The Tim Ferriss Show. This one was such a treat for me and I really hope it is for you as well. This is an interview that I had hoped to set up and tried to set up for close to, I'd say, five years. And here's the question I'll pose. At the end of our lives, what do we most wish for? And how can knowing this, if we can know it, help you to live a better life now? Well, it turns out BJ Miller, M.D., Dr. Miller, knows exactly this. BJ is a palliative care physician at Zen Hospice Project in San Francisco, where he thinks deeply about how to create a dignified, graceful end of life for his

• 5:19Tim Ferriss?

  patients. Now, this is of course not one of the usual suspects you would expect to see making the rounds on the podcast. And this is precisely why I wanted him on and why I hope you listen to this podcast. BJ is an expert in death, but important, he's also learned how we can dramatically improve our own lives, often with very small changes. When you consider that he has guided or been involved with roughly 1,000 deaths, it's not surprising that he has spotted patterns we can all learn from. On top of this, BJ has developed incredible empathic abilities. He is a trimple amputee, and his 2015 TED Talk, "Not Whether But How," which is a moving reflection on his vision to make empathic

• 6:04Tim Ferriss?

  end-of-life care available to all, ranked among the top 15 most-viewed TED Talks of the year. I absolutely love this conversation. And without further ado, please enjoy the wide-ranging dialogue, conversation, rambling exploration between myself and BJ Miller, M.D.

• 6:29Tim Ferriss?

  BJ, welcome to the show.

• 6:31Speaker 03

  Thank you, Tim. It's nice to be here.

• 6:33Tim Ferriss?

  I have been wanting to talk to you, or I should say, I have wanted to talk to you for years now. And to just give a few examples and illustrate that, the first was an article that I came across in the Princeton Alumni Magazine, Princeton Alumni Weekly, about your work. And then the next was a profile in a magazine here in San Francisco. Following on the tails of that, Adam Gazali, who is just an incredible neuroscientist at UCSF who's been on the podcast, reached out to me. And that was related to, I think, a senior

• 7:15Tim Ferriss?

  partner at IDEO who had also reached out to him to suggest that you be on the podcast. So I feel like this was fated to be. And I've been increasingly, over the last few years, thinking about death and the value of meditating on death, among other things. But before we get there, and I suppose we'll get there rather quickly, when people ask you, "What do you do?", how do you answer that?

• 7:49Speaker 03

  Well, 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 out 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.

• 8:22Tim Ferriss?

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

• 8:39Speaker 03

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

• 9:05Tim Ferriss?

  So let's, 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.

• 9:15Speaker 03

  Just one, yeah.

• 9:16Tim Ferriss?

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

• 9:19Speaker 03

  No kidding.

• 9:21Tim Ferriss?

  But let's, 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?

• 9:41Speaker 03

  Well, so, let me pre-answer your question, because it so depends, you know, at Zen, 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 at Zen Hospice, they, 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. So, and there's plenty of work to be done, even on the far side of turning that corner. But I think another,

• 10:28Speaker 03

  you know, a more, I don't know, an interesting, another way of answering your question, is really, you know, upstream of hospice. When folks are struggling, gone to war with their disease, engaged in that fight, whether it's chemotherapy or whatever.

• 10:50Speaker 03

  Now, that's the kind of person I'll meet in clinic at UCSF. So, a part of my job is on faculty at UCSF and I work in a clinic that's called the Symptom Management Service. It's about 10 years old. And that's just basically a euphemism for palliative care. The Cancer Center wanted us to call it the Symptom Management Service because it felt that the palliative care phrase had too much baggage around it.

• 11:14Tim Ferriss?

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

• 11:21Speaker 03

  They are, they're 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. So, and hospice is an insurance designation as much as it is a philosophy of care. So, hospice is by definition, end of life care. Palliative care makes no, it doesn't not, time is not an issue in palliative care. You just have to be suffering. So, you know, 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.

• 12:06Tim Ferriss?

  Got it.

• 12:07Speaker 03

  All right. So palliative care, just to kind of make it, is basically the, you know, within the context of dealing with illness, palliative care is the pursuit of quality of life. Period. You know, that's, 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.

• 12:49Speaker 03

  You don't have to give up one type of care to add palliative care to the mix. Whereas, once rendering hospice because of its insurance details and vagaries, you do have to, in general, you have to give up curative intended care to qualify for hospice. So, 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?

• 13:11Tim Ferriss?

  It totally makes sense. And, I mean, it would, 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, 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. What does their first day look like?

• 13:50Speaker 03

  So, first day at Zen Hospice is usually, there's always the, 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, 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 crew sort of swarming around that resident and their family and just getting to know them. That's where all the potency comes, it's, it's inherently a relationship, so there's

• 14:33Speaker 03

  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 going to be dying soon, but they're here to live until they die. So, that's, you know, it's, it's a very non-medical establishment, and the first day doesn't feel anything like being in a, admitted to a hospital. You know, and pretty soon, you, as you get to know someone within the first day, invariably questions get asked like, you know, you know, tell us what's most important to you now, you know? You want something to eat, 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.

• 15:18Tim Ferriss?

  What does the, just to highlight also the, 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.

• 15:38Speaker 03

  Yeah, well.

• 15:40Speaker 03

  So so much of, you know, in hospice and palliative care in general, but certainly places like Zen Hospice Project, in in many ways, they were created as antidotes to the hospital. So in some ways, they're they're really, you'll feel like opposites. And that that's to some degree by design. Um, but a death in a place like Zen Hospice Project um, 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 uh teams of hospice agencies who come in and provide the medical care.

• 16:22Speaker 03

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

• 17:07Speaker 03

  And if there are family or friends around, and certainly staff and nurses and volunteers will gather around and we'll all we'll all gather on the porch. And we will do this, our our flower ceremony, which is basically, we gather around and the 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 is just leaving us. And then we'll sprinkle the body with uh 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.

• 17:51Speaker 03

  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, 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 uh 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.

• 18:35Speaker 03

  So, you know, counter that with a typical hospital death. And 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. Uh they're incredible places. They're they're just not really designed to have a beautiful experience per se. And they're not really designed to help you die well. Um so and 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. Um and all the sounds and lights emitted.

• 19:16Speaker 03

  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 s- 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. Uh and it's a stark, stark contrast.

• 19:49Tim Ferriss?

  How many, since you began your work with palliative care and hospice care, how many deaths have you witnessed or experienced even in the periphery? Not necessarily watching someone die, but under your care or in your periphery, how many deaths have you experienced?

• 20:13Speaker 03

  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. You know, 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.

• 20:33Tim 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?

• 20:59Speaker 03

  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. And then, because I think the assumption is that, oh, wow, that's gotta be very morbid. You know, it is, I mean, it's gotta be very morbid work or very depressing work. And sure, it is, 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, get a, get a real sweet hit that,

• 21:36Speaker 03

  you know, paying attention to this zone of life is very, it's a lot, it's very nurturing. The sort of, the sort of secret is that paying attention to the fact that you die. Can help you live a lot better. So a lot of my colleagues and I are very, you know, aware of the clock. You know, and I'm 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, you know, sort of remarkable vicarious deathbed moments with our patients and their families.

• 22:21Speaker 03

  And you can learn a lot of, you can learn a lot. And one of the things I love thinking about, a real organizing theme for me is, is avoiding regret essentially. And we avoid regret by, again, paying attention to our decisions, paying attention to how precious things are. And getting very good at forgiveness and reconciliation. And these are themes that play out in this work all the time. So in 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, uh, yeah, 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?

• 23:06Speaker 03

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

• 23:34Tim Ferriss?

  And it, in the case of paying attention to decisions, um, what would be examples of some specific decisions you've made or habits you've developed, uh, that have been impacted by this work?

• 23:54Speaker 03

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

• 24:09Tim Ferriss?

  As, as we all do.

• 24:11Speaker 03

  Yeah, yeah, A- amen brother. So, but, um, but I do think I've gotten a lot better at. You know, when I, I, I, 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. Uh, that no, 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, uh, 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. Um, and in terms of friendships and relationships, navigating them, not taking them seriously.

• 24:55Speaker 03

  So that we're just not wasting each other's time. So I feel that in my relationships. I feel the, these lessons in my relationship to nature. So that's a great sav 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, it's the way I deal with my own pain is I'm just, I remind myself that I'm glad to be, to feel anything at all.

• 25:36Speaker 03

  So my relationships, uh, I think are impacted, my sort of orientation to Mother Nature's impacted. I think I'm a lot, lot, 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 gotten a lot better, I think, on letting go of certain things.

• 25:59Tim Ferriss?

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

• 26:02Speaker 03

  Yeah, yeah, no.

• 26:03Tim 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.

• 26:12Tim Ferriss?

  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, 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?

• 26:47Speaker 03

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

• 27:01Tim Ferriss?

  Definitely.

• 27:02Speaker 03

  Even before you're able to change it at all, there's great potency in just being aware that you're doing it. You know, I could, I was, 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. So, 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, 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.

• 27:46Speaker 03

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

• 27:58Tim Ferriss?

  Yeah.

• 27:59Speaker 03

  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.

• 28:33Tim Ferriss?

  And for those people listening, you might have these same issues and a lot of us do, of course, there's a book with 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?

• 28:57Speaker 03

  No, not really.

• 29:01Tim Ferriss?

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

• 29:12Speaker 03

  Thank you for that way out, brother.

• 29:13Tim Ferriss?

  You're welcome.

• 29:15Speaker 03

  But yeah, 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 to so much of this work is is just being aware, is listening, is paying attention and bearing witness and coming to terms with all the stuff you can't control, whether it's on my for my own sake or my patient's sake. So there is some real truth that I kind of feel like doing this job well and empathy is job one in this world in this work. And so I do feel that much of my daily

• 29:55Speaker 03

  life, the daily grind for me is itself, you know, sort of meditative. But I also I also want to be clear. I mean, I do, I have my own relationship. For me, it's a bike ride or it's time with my dog, or it's time sitting in my backyard, just looking out at the hills. And it feels to me like a meditation. I like movement, something ever since I became disabled, you know, I think I'm particularly primed to appreciate movement. So I like a walking or bike ride, and it feels like meditation. But so I feel like I'm doing it a lot in a way, but I also want to honor those folks in the audience and elsewhere

• 30:40Speaker 03

  who truly have a meditation practice. And that is really its own discipline. So I don't really have that, but I got those other things.

• 30:48Tim Ferriss?

  And I think there All present state mindfulness practices, right?

• 30:54Speaker 03

  Yeah.

• 30:54Tim Ferriss?

  And if you're riding a bike, uh, now you mentioned something we haven't covered. Uh, 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?

• 31:10Speaker 03

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

• 31:24Tim Ferriss?

  Sorry, I'm laughing, but.

• 31:25Speaker 03

  You should laugh. I mean, this, I laugh. No, please laugh. I mean, it is kind of silly, but anyway. So as you know, um, fellow tiger, the, um, 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, uh, and it's a commuter train. You know, it's called the dinky, uh, 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. So that's what the dinky is.

• 32:01Speaker 03

  So, uh, the why it's significant in my life in particular is, you know, one night it was November. I was just after Thanksgiving, uh, vacation sophomore year. So it would have been November 27th, 1990. Couple of friends of mine and I were out just hanging out, having fun, not a, not a crazy night. Um, but we were walking, well, you remember the Wawa market, Tim?

• 32:28Tim Ferriss?

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

• 32:33Speaker 03

  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 or whatever, you know, and so when we were just walking by the dinky. And it was just parked there. This is not, this is not operating hours. And, uh, you know, it has a ladder on the back and you just walked by it and just decided to climb it, you know, like you would climb a tree or whatever. It didn't, we really did not think we were doing anything that daring. Or put it this way, we'd done a lot more, like a lot stupider things besides that, at least we thought, so. Um, but I just happened to be the first one up on the, up on top of the train and that those trains run

• 33:16Speaker 03

  like the buses in San Francisco, wires that run overhead. And then there's this metal thing called a pantograph, I think is what it's called. And that connects the, uh, train itself to the power source. It's this big metal pole. And so when I stood up on top of the train, I had, I had a metal watch on and I happened to be close enough to the power source and the electricity arc to the watch. And, uh, yeah, entered my arm and then blew down the feet. Now, that was that.

• 33:49Tim Ferriss?

  So what happened at that point?

• 33:52Speaker 03

  So, well, I should say, I don't really, I, I actually don't remember anything about the, that, that night. Um, but my friends who were with me, uh, pieced it back together, but there's, you know, there's a big explosion and I was thrown some distance. Uh, and one friend came up on top of the train while the other friend ran and called nine one one. Um, and you can imagine, I mean, both of my friends were freaking out and extremely, 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.

• 34:37Speaker 03

  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, um. 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 electricity enters your body and so you've got all this heat you burn from the inside out and apparently it's very common and people wake with extreme energy. I mean, you are electrified. So I mean, I'm just flailing punching him through I'm just a wild tear apparently. So Pete, who was very particularly large, strong and sturdy heroic

• 35:20Speaker 03

  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 then and I don't blame them one bit, but the ambulance drivers refused to get on top of the train as they should have. But between my friends and a police officer, 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 Dawson got up on the train with Pete and together with Jonathan, they got me into the stretcher and handed me down to the ambulance guys and the ambulance whisked me off to the

• 36:01Speaker 03

  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 a 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.

• 36:27Tim Ferriss?

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

• 36:44Speaker 03

  Well, you know, so, uh, it's interesting, it's like, it's, it's, I was conscious, I was awake uh, throughout the ordeal, uh, and it's just more the, 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 Right. reprisal, you know, but I tell you the first memory, which I actually, I, some freakish reason I love this story, it just, I don't know why, but I'll tell it to you anyway. Um, I, I, I do like this story, so I will tell it to you anyway. Please do.

• 37:23Speaker 03

  So, uh, it was, so, you know, your, your blood pressure is unstable, you're, 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, it's common to wait several days before the 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 is not, uh, not. So, anyway, it takes, it was maybe day five or day six before the first amputations. And, uh, I woke up the night before, I remember this very, very well. You know that, uh, that feeling where you, um, you wake up from a dream?

• 38:07Speaker 03

  And it's been a bad dream and you, 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, that was, that was just a dream. You know that sensation? And it's an incredible somatic, you know, it's a beautiful feeling of relief that washes over you. So, anyway, I, somehow I looked around a burn unit, which is a particular environment. It's not like our guest house that I was just describing a moment ago at Zen Hospice. It's, it's, 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.

• 38:50Speaker 03

  And so I had the sensation I had to use the bathroom. And so I got, I said, oh, well, get out of bed and go to the bathroom. And uh, so in this state, I was intubated on a ventilator. I, I extubated myself.

• 39:07Tim Ferriss?

  Oh, Jesus.

• 39:08Speaker 03

  Not, not easy to do. By e-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, um, you know what a Foley catheter is, Tim?

• 39:38Tim Ferriss?

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

• 39:46Speaker 03

  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. Uh, 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. Uh, that's now inflated. So I'm walking the door and they usually clip the catheter, 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.

• 40:26Speaker 03

  And it yanks the dang catheter, of course, and it comes not all the way out, but like partially out.

• 40:35Speaker 03

  Sorry to you and all your listeners.

• 40:37Tim Ferriss?

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

• 40:46Speaker 03

  No, no, no, small python. Uh, yeah, so, no, that's right, man. So, I mean, this is hot.

• 40:53Speaker 03

  And the total reverse, that total warm bath of relief that you experienced thinking it was a dream. So that just goes totally in reverse. And in a millisecond, I realized that all of this was not a dream. I fall down to the floor, because all of a sudden, I really can't walk either. I just fall to the floor and I'm screaming, I'm pulling on the, I'm trying to break the rubber tubing of the catheter, which there's no way I could. Um, and to somehow relieve the pain. And anyway, finally, a nurse comes running in. Uh, and gets me back in bed. And that was that. But, so anyway, that's my first real memory.

• 41:30Tim Ferriss?

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

• 41:33Speaker 03

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

• 41:37Tim Ferriss?

  Oh, God. Uh, so let's, 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?

• 41:51Speaker 03

  Uh huh.

• 41:52Tim Ferriss?

  Could you, could you tell the snowball story?

• 41:55Speaker 03

  So, yeah, so, you know, so a burn unit, uh, is, like I said earlier, a particular place. Uh, they're gruesome places. Uh, they're very difficult environments. The pain that, that patients are going through is gut wrenching. And so, working in a burn unit is, is, is very difficult. Uh, people often don't last in a burn unit very long, um, as a clinician. It's, it's incredibly difficult work. Um, and it's, and we learn from, uh, wars over time, is my understanding of certain medical history, that, that the way burns often kill people is by, is indirectly through infection. So, once you've disrupted the integrity of your skin, you're much more vulnerable to infection.

• 42:40Speaker 03

  Right? 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.

• 42:51Speaker 03

  Uh, for the first maybe several weeks, I could only have one person in my room at a time. Uh, you know, it's just like you're in a bubble. In other words, and, and therefore you're cut off from everything. There, 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, and even when people are at your bedside, there, there's all this garb in between you and them. So there's no, you have no relationship to the natural world. You can touch nothing. And, 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.

• 43:35Speaker 03

  But, uh, 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. Um, and it may have been one of them. Uh, I think it was, it may have been, her, 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, uh, and she had the, uh, bright idea of just smuggling in a snowball to me so I could hold, so I could feel snow. And man, it was so, oh, I mean, it was just stunning. You know, what a simple little thing,

• 44:19Speaker 03

  right? But she 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, and, and also watching it melt and watching the snow become water. And just the simple miracle of it, uh, was just a stunner for me. And, 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, if we can't take, if our senses are choked off, we are choked off. And it was the most therapeutic moment I can imagine, and I would never have guessed this, but just holding that snowball, first of all, the sensation,

• 45:04Speaker 03

  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. And it was, it was, it was potent.

• 45:27Tim 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.

• 45:38Speaker 03

  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, that were foreign to me, you know? Totally seeing a different worldview and really delighting in the liberal arts education. And so with that, Tiananmen Square had just happened before freshman year and I was, so China was on my mind. And so I, I was, I started studying Chinese language and was heading for a major in East Asian studies.

• 46:11Speaker 03

  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 and looking at it, but the idea of art. So I, I switched my major to art history and that's what I ended up studying.

• 46:33Tim Ferriss?

  What do you mean by the idea of art?

• 46:36Speaker 03

  So why the hell do, what are hu, 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. We, we, it's, it's this, and you know, what's the purpose of making art? Art is inherently kind of useless and that seems to be part of its charm.

• 47:15Speaker 03

  Um, so, so I, that seemed to me, the, the fact that we as a species make art and care about it seemed to me really important because I was trying to figure out, well, who am I now? Like, what, what, am I, my less human because I have less, fewer body parts? You know, am I, is that the measure of, of what it means to be a human being? Well, uh, no, but I couldn't really answer the question, what, 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.

• 47:53Tim Ferriss?

  Uh huh.

• 47:54Speaker 03

  So, so studying art, the hunch was, well, hmm, well, this seems to be a peculiar, the, the situation I'm in was a 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 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, uh, something like art as, as a, as a guide to help me get creative with the reality I was now facing.

• 48:27Tim Ferriss?

  Hmm.

• 48:28Speaker 03

  In a, in a way, it was, the, the thing I was trying to learn how to do was, was make perspective. And that's what art really helps you exercise that muscle. It helps you, uh, 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 have changed so much about it, but I couldn't. But I could change with this knowledge. Uh, I could change my perspective. I could change how I saw myself. And there's, so that's, that's what art helped me learn and where to focus my energies. And, you know, it really paid off, I have to say. It's very helpful.

• 49:12Tim Ferriss?

  I'd love to, I'd love to explore that some more because I've been in the last few months in particular, uh, asking myself over and over again, why do humans?

• 49:28Tim Ferriss?

  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, birdsong and animal mating calls and mating dances and all this, that and the other thing. But there's, there seems to be many layers. There seem to be many layers to it. So what did you find?

• 49:54Tim Ferriss?

  How did it pay off? I mean, you gave one example already in terms of changing perspective. Uh, but were there any particular classes, teachers, books, pieces of art? That really influenced you?

• 50:11Speaker 03

  So, boy, let's see here, man. So let me, yeah, so 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 we're, and went from there, which was cool. I mean, it just put me in, it basically put me in front of a lot of art and helped me tweak my eye and my ear. And that was great. But for, 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.

• 50:53Speaker 03

  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 through, through his, to his doctorate. And frankly, a lot of stuff we're talking about right now, Tim, and the, and the benefits I reaped from it was really in, from conversations with Justin. Fed the backdrop by this, this pounds of artwork that I got to spend time with. But working through this philosophical stuff was really with my buddy, Justin. Uh, so that's one point. Uh, and there was no particular work of art. Again, it was more the idea of art than it was any particular piece of art. Uh, that was so potent for me. And even this day, I mean, I love going to museums,

• 51:34Speaker 03

  but I just like being around art. Sometimes I don't even look at it. Um, I just like that it exists and I like to reward places to help it exist. So I, yeah, so anyway, um, 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, uh, poignant and potent for me. I just, any chance I get to stand in front of a Rothko, I will, I will do.

• 51:59Tim Ferriss?

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

• 52:02Speaker 03

  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. Yeah.

• 52:16Tim Ferriss?

  Quick, random anecdote, uh, 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, uh, he actually used to show up at one of my relatives' homes, completely shitfaced drunk, all, 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, 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

• 52:57Tim Ferriss?

  on our way to dinner. Because what would happen is he would stay, the dog, he would forget about the dogs, they would shit all over the car. He would take the dogs home, leaving the shit intact in the car, and then blame it on my relatives to his wife, who then had to contend with the whole mess. So, anyway, related but totally unrelated. Uh, the, but if we're talking about abstract, uh, the, uh, if you were, this is an awkward transition, but here we go. Um, that's kind of my MO. If you were, uh, brought in as a physician slash, let's just say mentor, guide to someone who had just suffered nearly identical

• 53:42Tim Ferriss?

  injuries to yourself, twenty some years old.

• 53:48Tim Ferriss?

  What would you, what would your conversation be like with them? Or what resources or reading or otherwise would you point them to?

• 53:59Speaker 03

  You know, so 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.

• 54:17Speaker 03

  I should say both legs.

• 54:22Speaker 03

  And I, you know, and, and I learned a lot from how I, 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? What's it going to feel like to walk on prostheses? And that's kind of what, you know, it was that nuts and boltsy kind of stuff. Will I ever have a, will anyone want to date me again? You know, I mean, I don't know. It was on that level.

• 55:03Speaker 03

  And, and so when this guy would come visit me, it was just seeing him, just seeing him upright, just knowing that by virtue of the fact that he'd entered my room, he came from somewhere else. He was out in the world, knowing he was a functioning human being out in the world. 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 and the bearing witness. And so that's, so that's your question. When I do go into folks' room, I'm there and I'll avail myself to any questions they have.

• 55:47Speaker 03

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

• 55:56Tim Ferriss?

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

• 56:24Speaker 03

  Yeah.

• 56:25Tim Ferriss?

  The snowball. Could you talk about

• 56:31Tim Ferriss?

  the things you've noticed that most help

• 56:36Tim Ferriss?

  people in hospice care? And the reason I ask is specifically related to cookies, uh, which maybe you could talk about, but I'd be curious to hear sort of what really brings the most peace to these people?

• 56:52Speaker 03

  Well, so you're right. I mean, I think one of the joys about the, one of the upshots or silver linings about the end of life is that if you wanted to, if you let it, you can let a lot of the rules that 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 something that, you know, 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, you know, it's, it's not, and if, and I think part of the trick is if when you're dealing with serious illness or some natural trauma

• 57:37Speaker 03

  or are facing the end of your life,

• 57:41Speaker 03

  oftentimes that becomes crystal clear. Like where you've been hanging out and spending so much of your time and energy and worry has been, 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, you know, 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. Um, 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.

• 58:26Tim Ferriss?

  Right.

• 58:27Speaker 03

  Um, and that's part of the trick of checking yourself and, you know, over time, you know, in a daily way, am I doing things that I really care about, et cetera? So, but back to your question, so, you know, to this point about simple things, I mean, the simple things. Uh, the small things ain't so small, you know, actually. Um, 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. Uh, that, that is so profound, it's so potent. And yet, you know, I don't know many of us take that, I think most of us take that for granted, you know?

• 59:08Speaker 03

  Um, so, anyway, 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 that just kind of gets to, that kind of reorients us and puts things in proper proportioned 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. So, you know, like, I don't know how many of us, like, I think about this most, most nights, like, every night, depending on where you are, of course, but you can look up and usually find a star.

• 59:53Speaker 03

  I mean, I feel like, you know, when, when any of us is struggling with just about anything, you know? Look up, just ponder the night sky for a minute. And, and re, to just to realize that we're all on the same planet at the same time, you know? And that, and as far as we can tell, there, we're the only life, uh, only planet with, with life like ours on it, anywhere nearby. And then you start looking at the stars and you realize that the lights that hitting your eye is, you know, 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, awe me, freak me out.

• 1:00:38Speaker 03

  And kind of, uh, put, put all my neurotic anxieties in their proper place.

• 1:00:47Speaker 03

  No.

• 1:00:48Tim Ferriss?

  Right.

• 1:00:48Speaker 03

  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, you're, you're, can be much more in tune with that cosmos than you are with what the body is doing in, you know, in a day-to-day kind of way. Does that make sense, Tim?

• 1:01:04Tim Ferriss?

  Oh, no, it makes perfect sense. And the, so just because I brought it up and I don't want people to be harassing me about it on the internet.

• 1:01:11Speaker 03

  Hmm.

• 1:01:11Tim Ferriss?

  The cookies. Can you mention?

• 1:01:14Speaker 03

  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? It's, 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 thirty years ago. Like, I, I still want out, there's, I, 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. And so the power, sense of smell is potent. And food is primal and potent.

• 1:01:57Speaker 03

  I mean, it's nourishment, it's nutrition, it's how we live in some ways, right? So there's all this symbolic stuff happening too. But there's also just 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, as part of its poignancy and music and the dance, is its purposelessness. And just delighting in the wacky fact of, of perhaps a meaningless universe and how remarkable that is.

• 1:02:40Speaker 03

  You know, that's the, 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, those little moments.

• 1:02:51Tim Ferriss?

  And the, you guys, I might be fabricating this, but make cookies at the Zen Hospice Center. This is 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.

• 1:03:12Tim Ferriss?

  But just the... Being able to try to laugh at the cosmic joke, so to speak, I mean, like, the meaninglessness, if it is in fact meaningless, of things, as opposed to taking all things so damn seriously, which, in a way, prevents you from doing a lot of the serious work you'd like to do. But the question I was gonna ask is, to get your opinion on a modality, we'll call it, or a tool, and I'm gonna explain this vis-à-vis a friend I'll keep anonymous. So this is a female, young woman, who used to work in hospice care.

• 1:03:56Tim Ferriss?

  And she found, just as you alluded to earlier, that she felt like she was sitting on a secret. It gave her incredible joy and presence to do that work. She really loved the work. At some point, became very frustrated with the insurance policies and vagaries of our healthcare system, and now does something that is illegal, but I think should not be, which is guided work with psilocybin. And she said, "Now, I get to experience people dying every weekend. The only difference is, they come back to life."

• 1:04:36Tim Ferriss?

  And many people listening to this will have read, or should read, an article that was titled "The Trip Treatment" by Michael Pollan in The New Yorker, about the use of, I believe specifically, psilocybin, for those people not familiar, which is extracted, or the psychoactive compound in magic mushrooms, for end-of-life care in terminal cancer patients. And so, I'd just love to hear your opinion on the use of compounds such as those in end-of-life care or otherwise.

• 1:05:14Speaker 03

  Yeah, well, I'm so glad you're asking this question. I mean, this is, so there's all sorts of stuff coming out of the closet these days, and it's really wonderful. Uh, and, you know, there's, so there's a, there's a, there's a movement afoot to revisit, uh, psychedelics, uh, from a therapeutic perspective. And I don't pretend to know the full history of how psychedelics became, went from considered therapeutic to considered, you know, you know, toxic and, and devil's work. But here we are, we're, there's a, there's a revisiting happening, uh, with fresh eyes, in serious eyes. So it's not folks who are just with a wink trying to justify their own recreational use of these.

• 1:05:56Tim Ferriss?

  UCSF, UCLA, Johns Hopkins.

• 1:05:59Speaker 03

  Johns Hopkins, you got it right, NYU. Uh, friends at the River Styx Foundation have been funding some of this work. They do beautiful, they, they, the people I know who are involved in this work are deeply thoughtful, caring, loving people. Uh, so, anyway, so that's a, that's a sort of a preamble, but, you know, to get to your question, I am thrilled for this, um, for a number of reasons. One is just the, 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, uh, a lot of folks of that generation have experience with these compounds, and

• 1:06:44Speaker 03

  now they get to sort of be above board potentially. So, anyway, I love the subject for many reasons, but as a, as a clinician, you know, I'm, I'm particularly excited because we're pretty good at treating nausea, treating pain, um, as a rule, and where, where we get, where things get very difficult. And in palliative care, we talk about this. We call it existential distress. And, and basically existential distress is a, is a, is a crisis of, 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.

• 1:07:27Speaker 03

  It can be really traumatizing to realize, oh gosh, to take, all of a sudden to take that seriously and then realize you don't have much time to do much with it. So anyway, this idea of existential distress is huge. In medicine and palliative care, it's very nascent. I mean, the way we treat it now is, well, if someone comes to us and they're miserable, well, we rule out and or treat pain, nausea, other anxiety, depression. We, 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.

• 1:08:10Speaker 03

  Uh, and this, this is what we call medicine, a diagnosis of exclusion. So, and no one knows what the hell to do about this.

• 1:08:16Tim Ferriss?

  Diagnosis of exclusion.

• 1:08:18Speaker 03

  Yeah. So you just rule out everything else that you understand 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, but this is where it also gets thrilling. This is my favorite thing about my field, which is, so 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 it's total ubiquity, you know, 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.

• 1:09:00Speaker 03

  And what's more, we have named this thing existential suffering, which is so mysterious, right? And, 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 there's a ton of reasons why I love this space. And I'm getting around to an answer to your question, which is, so we have named-

• 1:09:32Tim Ferriss?

  I'm not in any rush, man. This is a long podcast. Always is.

• 1:09:35Speaker 03

  Good, good, because I love this subject. So we have the leverage, now that palliative care is accepted and part of healthcare, and has called out the nature of suffering, and has called out this thing existential suffering, we have this portal to upload all these other fields and interests, and to keep them, to make them relevant. So this is where it gets thrilling.

• 1:09:58Tim Ferriss?

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

• 1:10:02Speaker 03

  Yeah.

• 1:10:03Tim Ferriss?

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

• 1:10:07Speaker 03

  Exactly. You got it. Right. So now enter, you know, 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 another 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. All right? So that's, that's really exciting. So now, so back to psychedelics, well, so we can call out this existential suffering, but to date,

• 1:10:45Speaker 03

  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. But what else can we do? Well, I often find myself prescribing people for their existential suffering, you know, to remember what it is that they love, to keep an eye out for aesthetic moments in their days where they feel something, anything, and just, whether it's that snowball, or sun on their skin, some just to note when you feel happy to be alive. And there's our little toehold to work from.

• 1:11:26Speaker 03

  Right, so, 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, uh, compounds like MDMA, psilocybe, and then other things, may be radically helpful in fostering, um, a meaning-making moment for someone, of fostering a sense of belonging in this sort of cosmic way. Uh, and so in other words, we have potentially with these compounds, a way to respond to this, this wacky thing called existential suffering.

• 1:12:10Speaker 03

  So this is just thrilling, uh, for all those reasons.

• 1:12:14Tim 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, uh, I, 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.

• 1:12:58Tim Ferriss?

  So it's a very, very, a lot of interesting, interesting work. And you can learn a lot about how these compounds function just by looking at, for instance, some of these studies, uh, and examining sort of the methodology, right? The protocols that they use. Uh, so if we look at...

• 1:13:15Speaker 03

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

• 1:13:18Tim Ferriss?

  Absolutely.

• 1:13:19Speaker 03

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

• 1:13:26Tim Ferriss?

  Compass?

• 1:13:27Speaker 03

  I think they're Compass, and they are beginning to also support research in this vein, and also starting to try to align... Healthcare systems and other institutions to participate in this work one way or another and to sort of pull this stuff again out of the closet. I'm not sure where they are in their development, but it's another group to be aware of. And I think their, I think their website is compasspathways.org. So just another group in this space that's doing cool stuff.

• 1:13:54Tim Ferriss?

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

• 1:13:58Speaker 03

  Yeah.

• 1:13:58Tim Ferriss?

  Which is, uh, which is doing a lot of investigation, interesting work related to policy and the legal side of things as well. Uh, 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, I really, uh, 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. Uh, the, the question that I'd love to ask next is what you feel you do on a daily or

• 1:14:43Tim Ferriss?

  weekly basis that is different from most people? Routine wise, thinking wise, self-talk wise, anything?

• 1:14:51Speaker 03

  Hmm.

• 1:14:53Speaker 03

  Different from other physicians or just people in general?

• 1:14:59Tim Ferriss?

  Uh, people in general, because I don't want to make it exclusively professional. This is because I'm looking for, what I'm fishing for are practices that you've adopted or developed habits, whatever it might be, that people listening might be able to test drive for themselves.

• 1:15:17Speaker 03

  Hmm. Well, let's see here, my friend. I have two, I have two answers to that question. So the one is, you know, we've touched on a little bit, but, uh, I find myself increasingly interested in the aesthetic domain. 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 I am 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.

• 1:16:01Speaker 03

  I see human beings as meaning-making machines. And we talked about this a little bit, like whether there is some grander meaning in the universe, I don't really know. And frankly, I'm fine not knowing. I enjoy the mystery of it. And I'm okay if there's meaning 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. And 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.

• 1:16:43Speaker 03

  So like, again, like the snowball or anything that makes us feel, in our bones, feel happy to be alive in that moment, on behalf of nothing else but that moment. And that is, I think, we could all benefit from letting ourselves delight in things that don't necessarily have any meaning, but just feel good, 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.

• 1:17:28Speaker 03

  They can no longer do that job they loved, or their role in their family has changed. And they're so crestfallen because they don't have that reason to get out of bed. So let's find new reasons to get out of bed. Let's repurpose ourselves. Yes, yes, yes. And let's get really good at honoring. Just the joy of smelling 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, I, I, I do.

• 1:18:09Tim 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 anyone let, 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, this, this long walk that he takes to mail something at the post office.

• 1:18:55Tim 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, no, you don't get it. I didn't waste time because, and he runs through all of these seemingly meaningless,

• 1:19:10Tim Ferriss?

  seemingly trivial, but to him, very important, kind of absurd interactions with multiple people along the way. And it's just a very good meditative exercise because I feel like it's extremely easy to think that the big overarching abstract things are the important things. And the small tangible things with sensory inputs are the unimportant things. And I am not convinced at all that that is the case. Uh, in fact, it might be quite the opposite. And, uh, if you had a patient come in, they are finally getting comfortable at Zen Hospice Project.

• 1:19:59Tim 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, what one to three books would you suggest I read?

• 1:20:15Speaker 03

  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, uh, college and stuff. I, I, uh, if I, I am.

• 1:20:31Tim 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?

• 1:20:43Speaker 03

  Thank you. That's better. Uh, 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 those, that's for me to let me, uh, so, but I would put, uh, 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 suit your taste. So for me, I guess I put some, a picture book of, of Mark Rothko paintings in front of them.

• 1:21:22Speaker 03

  I would put probably any music from Beethoven, uh, into their ears.

• 1:21:31Speaker 03

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

• 1:21:37Tim Ferriss?

  Before they stared into space, they wanted to watch a movie.

• 1:21:42Tim Ferriss?

  What would you put in front of them?

• 1:21:45Speaker 03

  Man, there's so many good ones. Oh.

• 1:21:48Tim Ferriss?

  Ratatouille? No.

• 1:21:50Speaker 03

  I I I think, you know, I have a real soft spot for Waiting for Guffman. Um, not that it has this great meaning per se, but by speaking of absurdity, I just think it's hilarious.

• 1:22:05Tim Ferriss?

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

• 1:22:08Speaker 03

  You've never heard of Waiting for Guffman?

• 1:22:10Tim Ferriss?

  No.

• 1:22:10Speaker 03

  Wow.

• 1:22:11Tim Ferriss?

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

• 1:22:17Speaker 03

  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.

• 1:22:26Tim Ferriss?

  Oh, wow.

• 1:22:27Speaker 03

  Uh, you know, Best in Show.

• 1:22:29Tim Ferriss?

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

• 1:22:32Speaker 03

  I think it's G U F F M A N.

• 1:22:34Tim Ferriss?

  Okay, got it. I'm on it.

• 1:22:35Speaker 03

  It's friggin hilarious. Uh, so that I I just always a long term favorite. I mean, as a kid growing up, Kentucky Fried Movie.

• 1:22:46Tim Ferriss?

  My God, I haven't thought about that in decades.

• 1:22:49Speaker 03

  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. Uh, 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, I don't know if you really even consider it a documentary, but I guess it is. It's, you know, the movie Grizzly Man.

• 1:23:22Tim Ferriss?

  Oh, man. Oh, man. Yeah, I consider that a documentary.

• 1:23:25Speaker 03

  Yeah, sure. Let's call it a documentary. So, yeah, of course it is. I mean, 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 just 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.

• 1:24:04Speaker 03

  And how we humans think of ourselves and somehow opposed to nature. And yet, when we try to reinsert ourselves into the wild, it doesn't necessarily go very well. And how we romanticize how Mother Nature can coddle us. And, you know, I spend a lot of time in the desert in southern Utah, as much time as I can. I just love that landscape. And then speaking of perspective, making, you know, thinking on geologic time and making myself feel very, very small and inconsequential is really deeply therapeutic for me. So, and when I go out in Utah, and I've 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

• 1:24:48Speaker 03

  as I can tell, is pretty indifferent to us.

• 1:24:50Tim Ferriss?

  Yeah, I would say so.

• 1:24:52Speaker 03

  So, anyway, there's my answer for you.

• 1:24:55Tim Ferriss?

  So, that brings to mind two things. The first is you mentioned that, 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

• 1:25:34Tim Ferriss?

  by primatologists, hysterical laughter. And this seems to be something very, very hardwired. So, returning to that in some way, and it being therapeutic, doesn't surprise me. The second is, just to tie it together, a few things you've said, related to sort of the meaninglessness, which may be too loaded a term for some people. It might come off as very negative, but seeming inconsequential or small and meditating on that, or not even meditating on it, experiencing it in a very visceral way by being in the desert or looking up at the sky. I think it's very compatible with something that struck me, which was told to me by Tony Robbins,

• 1:26:15Tim Ferriss?

  who's also been on the podcast. And he said that, and I'm paraphrasing, but that 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 like shitty week into a just hilariously diminutive perspective, makes a lot of sense.

• 1:26:50Tim Ferriss?

  This is unrelated, but what do you think of, or who do you think of when you hear the word "successful"?

• 1:27:03Speaker 03

  I think, 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. But someone who

• 1:27:47Speaker 03

  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 question is, I think of it as really an internal process. But then beyond that, too, I guess I'm a little torn here, because I agree that what I just said sort of focuses us back into, focuses us and success back into the self. And I suppose the second half of the question really has to do with orienting oneself

• 1:28:31Speaker 03

  to the other, to everyone but oneself, and to the relational dynamics between the self and the other. And so I think probably success may be, or the second half of it, has to do with, um, 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, uh, so anyway, 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.

• 1:29:13Speaker 03

  That, that, that consonance with the world around you, that seems like a great success.

• 1:29:19Tim Ferriss?

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

• 1:29:24Speaker 03

  Hmm, man. And well, some, yeah, gosh. Hmm. 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. It's, it's 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

• 1:30:05Speaker 03

  I, I love the, I love presuming it when I don't, when I, when I'm unaware of it, and assuming it exists in others that I walk by on the street. And in a way, you find yourself kind of imbuing others with, with an idea of success, and it changes how you look at them, and how you treat them.

• 1:30:22Tim Ferriss?

  Definitely.

• 1:30:23Speaker 03

  And that's a sort of a sweet, favorite, daily exercise of mine. Um, so no, it's hard for me to say a single person that I would point to as embodying all this.

• 1:30:32Tim Ferriss?

  So let's, let's, you, you actually touched on a much more interesting, uh...

• 1:30:38Tim Ferriss?

  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.

• 1:30:52Speaker 03

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

• 1:30:54Tim 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. I'd love to just hear you elaborate on that.

• 1:31:05Speaker 03

  Oh, I don't know. I didn't remember saying morning. That's what tripped me up. That's sort of a daily, daily exercise, perhaps.

• 1:31:11Tim Ferriss?

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

• 1:31:14Speaker 03

  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 through your day of gratitude and happiness and some amount of comfort. So, so I'll, you know, 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 falling them too close and whatever. I get, I get in my bullshit zone pretty quickly.

• 1:31:56Speaker 03

  But when I'll catch myself and then, so when I walk by, you know, particularly here in the Bay Area, the homeless epidemic is enormous. 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 however, whatever junk we project onto them, that inside, maybe, 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.

• 1:32:40Speaker 03

  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. And the one thing I heard that stuck, that was really interesting to me was Is getting in the habit of saying, you know, when anyone, when you hear anyone sneeze, either say it out loud or to yourself, say bless you. It's just a, it's like a neural 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,

• 1:33:25Speaker 03

  uh, project well wishing onto them.

• 1:33:29Tim 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 have three limbs that have been damaged. How do you ride a motorcycle?

• 1:33:49Speaker 03

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

• 1:33:56Tim Ferriss?

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

• 1:34:00Speaker 03

  Thank you. Well, it's interesting you ask, cause right now there's the man who helped make this dream come true. Uh, Randy, Randy, uh, he, 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. Uh, um, so cheers to Randy and his family and his wife, I mean, and his mother, Melanie, who I'll be seeing next week, actually. Uh, but, so that's one piece of this story. But the other is this, I'd always, I'd love, I love two wheels. I love gyroscopic, gyroscopic lifestyle. I love, uh, the feeling of it. So I've always loved riding bicycles.

• 1:34:41Speaker 03

  Um, 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, and no one, no one got into it. And I could never find a mechanic who was willing to take it on and, 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 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

• 1:35:24Speaker 03

  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.

• 1:35:37Tim Ferriss?

  Now, does that, does that connection, so you have throttle, rear brake, and then typically front brake on the left, do you have, how are those controls modified?

• 1:35:50Speaker 03

  So, okay, so Randy, what he figured out, so first was to get the arm piece, and then what Randy figured out was, and then, well, then Aprilia, and I know Honda had made a version of this as well, but they, 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, 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 the, into a single lever.

• 1:36:31Speaker 03

  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 holding on to the bike. So all the action's in my right hand. Brakes into one lever, then Randy built this box and moved all of the controls, the turn signals, horn, and all that stuff, over to the right side, right side of the bike, and in, in, in good distance for my thumb to reach them. So I have throttle, brake shift, a brake lever, and then the turn signal box, all going with one hand.

• 1:37:09Speaker 03

  And that's

• 1:37:09Tim Ferriss?

  So awesome.

• 1:37:10Speaker 03

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

• 1:37:14Tim 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, uh, write in, tell us on social media, why these are real excuses?

• 1:37:35Tim Ferriss?

  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, what a really fantastic workaround. Man, congrats. That's awesome.

• 1:37:49Speaker 03

  Thank you, and thanks, Randy, and thanks for the folks at Scooteria, the bike shop in the city. I mean, I, it, a lot of people helped me make this come true, and it took a long, long time, time of trying to find the right folks to make it happen. So amen.

• 1:38:03Tim Ferriss?

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

• 1:38:19Speaker 03

  No, that was a little more than $1.

• 1:38:23Speaker 03

  Holy cow, man. Wow. You know, I would probably point us to a beautiful Pinot Noir from Joseph Swan up in Sonoma County. You know, it's like the artwork of Andy Goldsworthy, or anyone who delights in anything ephemeral. The, the, the charm in a bottle of wine, the craft, all the work that goes into it, and actually delighting in the fact that it's perishable and goes away, I find really helpful. So I've gotten a lot of miles out of a beautiful bottle of, bottle of wine, not just for the taste and the buzz, uh, but the symbolism of delighting in something that goes away.

• 1:39:06Tim Ferriss?

  Here, here. And I, I have a practice that some folks might enjoy, which I didn't come up with. I'm, 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. That's the right, maybe that's not the right word. I'm trying to Jerry to, to sound intelligent, but the, 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.

• 1:39:51Tim Ferriss?

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

• 1:40:12Speaker 03

  Oh, boy. That's a doozy. Uh, 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, and the basic bumper sticker, I'm sure you've seen it is, don't believe everything you think.

• 1:40:38Tim Ferriss?

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

• 1:40:41Speaker 03

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

• 1:40:54Tim Ferriss?

  Don't believe everything you think. I was really waiting for what this was gonna be. I was, I was really wondering. Uh, 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. Uh, I'm not sure with the license plate casing, I guess. It said,

• 1:41:17Tim Ferriss?

  if you're on my ass, you better be pulling my hair.

• 1:41:21Tim Ferriss?

  I thought that was pretty clever, but it shows you where my level of emotional maturity is. In any case, uh, don't you're, you know, I thought I might, I might lose you at that one. That's okay. I'll try to really reel you back in with the next few questions. Uh, so yeah, don't believe everything you think. That's awesome. Uh, I'm, I'm astonished. I've never seen that. Uh, 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.

• 1:41:53Speaker 03

  Ooh, wow. That was a particularly poignant time for me, actually. Uh, so there's a lot going. I was in, I was deep in med school. It was my last year of med school.

• 1:42:04Speaker 03

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

• 1:42:41Speaker 03

  And I think, I guess I would have helped myself get, uh, you know, I, this sounds way too tidy, but I might've said something like, hey, man, you don't believe everything you think. Don't, you know, let it go. Uh, you know, don't take it all, don't, I, I, 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, you know, uh, so I don't mean this, this is not, this is not meant to be light, but I think I would have somehow encouraged myself to let go a little bit more and say, and hang in there and don't, don't, don't pretend to know where this is all going.

• 1:43:26Speaker 03

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

• 1:43:29Tim Ferriss?

  Hmm. Yeah. Yeah. You don't need to know where it's all going.

• 1:43:33Speaker 03

  And you can't, you can't.

• 1:43:37Tim Ferriss?

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

• 1:43:45Speaker 03

  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, undance 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. And I was, but in these last few years, I've let myself, I think in a way, man, I think

• 1:44:27Speaker 03

  I've let myself get more ambitious in a way. And to take my work even extra seriously, more seriously than perhaps I had been. And letting myself feel like this could all work. And letting myself feel like actually the healthcare system could be fixed. And 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

• 1:45:12Speaker 03

  stepping all over each other to get ahead. And that's not what I'm talking about.

• 1:45:15Tim Ferriss?

  But maybe it's aspiration.

• 1:45:19Speaker 03

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

• 1:45:22Tim Ferriss?

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

• 1:45:37Speaker 03

  Uh, thanks. I mean, that's such a great invitation. I mean, one is, uh, folks, hey, everyone. I hope we could start seeing the remarkable amount that we all have in common uh, 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, looking to make, make that, uh, make that all real. I would ask that we prize kindness. I would ask that we learn to forgive in a daily way. Um, but more strategic, I would ask you guys, um, if you're so moved to get involved, uh, reifying and supporting hospice and palliative care.

• 1:46:20Speaker 03

  If, if you're in and around the Bay Area or just so moved, we would love your support at Zen Hospice Project. These places rely heavily on philanthropy. Um, so if you're moved, please come check us out, zenhospice.org. And if, uh, 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, and built.

• 1:46:45Speaker 03

  Yeah, I'll leave it at that. That's, that's plenty.

• 1:46:47Tim Ferriss?

  And I just, I've, I've really, I've been so excited to chat with you for so long. And, uh, 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,

• 1:47:28Tim Ferriss?

  not just at the end of life, but throughout life. And I find that very, very, uh, inspiring and exciting. Uh, so I think it's, it's a real... Tremendous opportunity and a potential point of leverage that you have. And so people can find you at zen hospice.org.

• 1:47:46Speaker 03

  That's right.

• 1:47:47Tim Ferriss?

  Z E N H O S zenho spice.org zen hospice.org. Facebook is Zen Hospice Project, Twitter at Zen Hospice. And I'll put all of this in the show notes, of course, for everybody listening.

• 1:48:04Speaker 03

  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?

• 1:48:10Tim Ferriss?

  Absolutely, of course.

• 1:48:12Speaker 03

  The Symptom Management Service and 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.

• 1:48:25Tim 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.

• 1:49:00Speaker 03

  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.

• 1:49:07Tim 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.

• 1:49:30Tim Ferriss?

  Hey, guys, this is Tim again. Just a few more things before you take off. Number one, this is Five Bullet Friday. Do you want to get a short email from me? Would you enjoy getting a short email from me every Friday that provides a little morsel of fun before the weekend? And Five Bullet Friday is a very short Email where I share the coolest things I've found or that I've been pondering over the week. That could include favorite new albums that I've discovered. It could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up in the world of the esoteric as I do. It could include favorite articles that I have read and that I've shared with my close friends, for instance. And it's very short.

• 1:50:13Tim Ferriss?

  It's just a little tiny bite of goodness before you head off for the weekend. So if you want to receive that, check it out. Just go to fourhourworkweek.com. That's fourhourworkweek.com all spelled out and just drop in your email and you will get the very next one. And if you sign up, I hope you enjoy it. This episode is brought to you by Boll and Branch, which is what I have on my bed at home in San Francisco. I use it myself. And there's a lot of nonsense in the bedding business. For instance, thread count, not a measure of quality, total myth. Egyptian cotton? Well, guess what? It's a plant called Gassipium barbadense. I don't think that's how you say it, but that is how I read it, generally not even grown in Egypt.

• 1:50:58Tim Ferriss?

  And the made in Italy label that you're so proud of, well, you know, you shouldn't necessarily pay extra for that because it often means that it's just finished in Italy and woven in places like China. The general industry markup for bedding is 700 to 800% at the usual retail stores you would go to. Boll and Branch, which is B-O-L-L, is incredibly high quality. They have a higher cost of goods than many products you might buy at three to four X their prices because they sell direct to consumer. So check it out. Go to bollandbranch.com. That's B-O-L-L-A-N-D-B-R-A-N-C-H.com. Boll and Branch.com. And not that you'd need to, but you can try anything you order at home for 30 days. If you don't love it, send it back and you get a full refund.

• 1:51:42Tim Ferriss?

  Go to bollandbranch.com and use promo code TIM for 20% off your entire order, whether that's sheets, towels, blankets, duvet covers, anything. And shipping is always free. Check it out. Boll and Branch.com, promo code TIM.

• 1:51:57Tim Ferriss?

  This episode is brought to you by Wealthfront, and this is a very unique sponsor. Wealthfront is a massively disruptive, in a good way, set it and forget it investing service led by technologists from places like Apple and world famous investors. It has exploded in popularity in the last two years, and they now have more than $2.5 billion under management. In fact, some of my very good friends, investors in Silicon Valley, have millions of their own money in Wealthfront. So the question is, why? Why is it so popular? Why is it unique? Because you can get services previously reserved for the ultra wealthy, but only pay pennies on the dollar for them. And this is because they use smarter software instead of retail locations, bloated sales teams, etc. And I'll come back to that in a second. I suggest you check out wealthfront.com/tim.

• 1:52:42Tim Ferriss?

  Take the risk assessment quiz, which only takes two to five minutes, and they'll show you for free exactly the portfolio they put you in. And if you just want to take their advice, run with it, do it yourself, you can do that. Or, as I would, you can set it and forget it. And here's why. The value of Wealthfront is in the automation of habits and strategies that investors should be using on a regular basis, but normally aren't. Great investing is a marathon, not a sprint, and little things that you may or may not be familiar with, like automatic tax loss harvesting, rebalancing your portfolio across more than 10 asset classes, and dividend reinvestment add up to very large amounts of money over longer periods of time. Wealthfront, as I mentioned, since it's using software instead of retail locations, etc.,

• 1:53:24Tim Ferriss?

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• 1:54:06Tim Ferriss?

  But I've been so impressed by Wealthfront that I've invested a significant amount of my own money, at least for me, in the team and the company itself. So I am an investor and hope to soon use it as a client. Now, back to the recommendation. As a Tim Ferriss Show listener, you'll get $15,000 managed for free if you decide to open an account. But just start with seeing the portfolio that they would suggest for you. Take two minutes, fill out their questionnaire at wealthfront.com/tim. It's fast, it's free. There's no downside that I can think of. Just take a look, see what portfolio they would create for you, and you can use that information however you want. Wealthfront.com/tim. And until next time, thank you for listening.