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On life, death and David Bowie: A palliative care physician shares words of wisdom

One doesn’t expect to walk out of a talk called “The problem with dying and what we might do about it” feeling uplifted, but that was exactly what happened when I left BJ Miller's presentation at Medicine X yesterday afternoon.

Miller, MD, kicked off with a tribute to the late David Bowie, whose last album, released posthumously, was designed as "his final creative act." Though death can be a taboo subject in our society Miller said that people should — like David Bowie — look at death openly, creatively and inquisitively. “There’s a real craft to ‘paying attention’ to something," he said, "especially when it’s something as difficult as the abyss.” He also suggested that people should embrace this great unknown, noting that "there's a lot of beauty in mystery."

Miller shared how a brush with death during his college years — an accident left him a triple-amputee — started Miller’s personal inquiry into the subjects of suffering and dying. His search for answers eventually led to his life's work as a palliative care physician and advocate; he's now an assistant clinical professor of medicine at UCSF and an advisor for the Zen Hospice Project of San Francisco, which is pioneering efforts to make end-of-life care more compassionate and human-centered.

Death can be a difficult subject to discuss — our own deaths even more so. However, Miller said everyone should accept that we’re all among “the dying.” And instead of this filling us with fear, he argued, this should help us tap into a universal human experience. "There’s a major inclusion in that," he explained. "It means that we have something in common with people all over the world.” Illness, suffering, disability, aging and dying are all a normal part of life, and he urged people to stop "pathologizing" these parts of life.

Miller also argued in his talk that there can be better ways to die. Instead of simply looking to make death less awful, what if we worked to make it more wonderful? Why not let patients find joy in their final days, even if it's in small ways, versus simply alleviating their suffering? Miller said he'd like to see a move away from a disease-centered model of palliative care towards a more patient-centered one, and he reminded the audience that "dying people are still living."

One of the most important lessons Miller has learned, both from his work and his own experiences with suffering, is that life is finite. This knowledge can be empowering, he said, as it teaches us to avoid regret and to not squander the time we've been given. He urged the audience to ask themselves, “What gives me joy in my life?" For Miller, it's clear that the little things, from feeling the sun on his skin to walking his dog in the park, have been made that much sweeter and more precious through his understanding of their very transience. By embracing death, we can actually all embrace life more fully.

This way or no way
You know, I’ll be free
Just like that bluebird
Now ain’t that just like me

-David Bowie, Lazarus

Previously: Medicine X, the academic conference where "everyone is included," returnsAuthor-physician on dying and end-of-life care, No one wants to talk about dying, but we all need to and How a Stanford physician became a leading advocate for palliative care
Photo courtesy of Stanford Medicine X

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