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

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4:59 at Shopify, that's S H O P I F Y. Shopify dot com slash Tim. Go to Shopify.com slash Tim to take your business to the next level today. One more time. All lowercase shopify dot com slash tip optimal minimal At this altitude, I can run fly out for a half mile before my hands start shaking. And I asked you personal questions. Now it's seen it. I'm a cybernetic organism, living tissue over metal and those galaxy.

5:37 Hello, boys and girls, ladies and germs, this is Tim Ferris. Welcome to another episode of the Tim Ferris Show, where it is my job to sit down with world class performers. From every field imaginable to tease out the habits. routines, favorite books, and so on that you can apply. And test in your own lives. This episode is a two for one, and that's because the podcast recently hit its tenth year anniversary, which is insane to think about.

6:01 And past one billion downloads. To celebrate. I've curated some of the best of the best, some of my favourites. From more than seven hundred episodes over the last decade. I could not be more excited.

6:13 To give you these super combo episodes, and internally we've been calling these The Super Combo episodes. Because my goal is to encourage you to, yes, enjoy the household names, the super famous folks. But to also introduce you to lesser known people I consider Stars.

6:29 These are people who have transformed my life and I feel like they can do the same for many of you. Perhaps They got lost in a busy news cycle, perhaps you missed an episode. Just trust me on this one, we went to great pains to put these pairings together. And for the bios of all guests.

6:46 You can find that and more at Tim.blog slash. combo. And now, without further ado. Please enjoy. And thank you.

6:54 For listening. First up doctor Gabor Mate. Twitter At Dr. Gabor Mate.

7:02 And DrGaborMate.com Gabor is an addiction and trauma expert. And best selling author of In the realm of hungry ghosts.

7:12 When the body says no. And The Myth of Normal Trauma. Illness and healing.

7:19 In a toxic culture. One of the Epiphanies for me in the last Very recent. Year or two. Mm-hmm.

7:28 has been looking at my coping mechanisms very differently. And what I mean by that is For a very long time I had certain behaviors, certain defaults that I hate it. Which of course means I'm hating a part of myself. That's right. And that included anger, rage responses.

7:48 Use of stimulants, you name it. always apply this loving kindness meditation to other people. And What was recommended is that I apply that loving kindness to the younger Tim to the other versions of Tim who had these behaviors that I had grown to hate and resent.

8:05 and to actually thank them for the role they played. For instance, that rage, that anger. was the fuel that got me out of Long Island. I just love to hear And we can take it anywhere we want, of course, but Once you have shifted the focus from why the addiction to why the pain and you start to work with someone.

8:21 What approaches have you found to help? What tools I call it compassionate inquiry. So inquire in a compassionate way. Now why did I do this, but

8:31 Hm. Why did I do this? Right. The first one is not a question, it's a statement. It's a self condemnation. The second one is a question. Hm. Wonder why he did this. Ah.

8:41 It soothed my pain. And so what your friend said that it served you. So Thank it. Love it.

8:48 But let go of it. I call it the stupid friend. The stupid friend is is is is is the one who helped you in a particular way at a certain time, but it can't learn that that way doesn't function anymore. So it's a friend'cause it's really trying to help, but it's stupid'cause it's not learning that you're no longer that three year old or that five year old or that fifteen year old. You know. So

9:12 Now this leads to the uh the question of trauma. Because It's one thing to recognize that All this originates in shots of pain. It's quite another to transform that pain.

9:22 And for that we have to understand what trauma is. So people often think that trauma is what happens to you. So trauma is A divorce. When you were small and your parents fighting. Trauma is your mother's depression.

9:36 Trauma is your father's alcoholism. Trauma is your parents Argumentation. Trauma is physical or sexual abuse or some loss. Those aren't the traumas.

9:47 Those are traumatic. But the trauma is not what happens to you. The trauma is what happens inside you. And as a result of these traumatic events.

9:58 You say you get disconnected from your emotions. And you're disconnected from your body. And you have difficulty being in the present moment. And you develop a negative view of your world. And a negative view of yourself.

10:11 And a defensive view of other people. And these perspectives keep showing up in your life in the present. They're the stupid friends. And so the issue is not just to recognize what happened at ten, fifteen, thirty However many years ago

10:26 But to actually recognize their manifestations in the present moment. And to transcend them. And how do you do that? By reconnecting with yourself.

10:35 By restoring the connection with your body primarily. And with your emotions that you lost. And once you do When you found these things again. Then you have what we call recovery.

10:46 Because what does it mean to recover something? It means to find it again. Mm. So what is it that people find when they recover? They find themselves And the loss of self is the essence of trauma.

10:58 So the Real purpose of addiction treatment, mental health treatment. Any kind of healing. Is a reconnection. For people who are listening and

11:09 Want to reconnect. With themselves, with their bodies, for instance. What recommendations might you have, whether that's things they can do or resources they can look to. Or both or

11:21 Something else. What recommendations?'Cause I'm sure. I am a hundred percent sure. I've had people. come on and for the very first time on this podcast talk about sexual abuse that they endured as as children and and what they did to

11:34 Help. Recover. From that. Many people listening, I am sure. Have addictions.

11:40 Both traumatic. Past experiences and trauma. What recommendations? Could you bank for them? So I wanna say first of all that

11:48 For trauma you don't need Terribly traumatic events. So There's two ways to look at trauma. One is that bad things happen that shouldn't have. We've talked about those. But the other way to get traumatized is when good things happen that should have happened.

12:00 Good things didn't happen. That should have happened. Look at that. Trauma of omission. Trauma of omission, but the parents not that they didn't love you, not that they didn't do their best, but they were too stressed, traumatized, distracted themselves. Then you get didn't get the kind of attention. And the kind of acceptance and the kind of attuned being with that you needed, that itself can make you disconnect from yourself. The child needs that acceptance, that connection, that attunement. Our brain development requires it, our emotional development demands it. And when we don't get it, not because the parents don't love us.

12:30 But simply because of their own issues. We can also suffer that disconnection. So that's what I call developmental trauma. Now how do we connect? Well

12:40 There are many, many forms of therapy. It's very difficult for anybody to do this on their own. Some people do it. I certainly couldn't do it on my own. I've needed a lot of help. In terms of therapy. That helps you understand what happened to me.

12:53 And so that there's there's a reason for it. So that No, there's if there's a reason for it. Then it's no longer me. I'm not somebody to be ashamed of. I'm just somebody who developed along certain lines for some very good reasons. But it it's not in my deepest character and it's not who I am and I don't have to be that way.

13:12 That's a relief to know. It's also not that I'm genetically programmed, so I'm doomed to stay that way. Number one. Number two. You have to reconnect with the body. There are various body therapies, uh my friend Peter Levine and his somatic experiencing. Waking the Tiger was his first book, and he's written many wonderful books since then. So Somatic Experiencing, his method is called, which he developed. It's brilliant.

13:37 There is EMDR. I movement desensitization, reprogramming. Which is a way of Bypassing the conscious mind and getting to the emotional brain. And Quicker than

13:50 talk therapy by itself can do. So it's combined with talk therapy. But it takes you past just a conscious Defensive egoic mind. There is emotional freedom tapping that people do. There's various variations on that. There is

14:05 There's motor sensory uh integration techniques. Then there's the traditional Therapies like yoga. Now yoga was not simply a physical modality when it first developed. Yoga actually means unity. So the very essence of yoga is is to regain that unity. Not just with ourselves, but also with the larger creation. And so yoga when it's practiced in its intended way, not just the hot yoga where you you get a good work out, that's great. I'm not against it. But I'm talking about

14:32 Intentional yoga with a meditative aspect to it. Which is taught by a number of disciplines, body work of all kinds. Just gonna hit pause for one second. Do you practice yoga? And if so, what type do you practice? So I've always said that with my ADHD I'm not a yoga person, I can't do it. Until a year and a half ago I met actually a yogi, his name is Sadguru.

14:51 He's an Indian yogi with a big following. I was very sceptical. But I met the guy. I now have a fifty minute daily yoga practice. Which I did this morning before coming to the interview. And it's made an enormous difference in my life. With my ADHD mind, I really have trouble just sitting there.

15:05 When I sit on the meditation cushion. My mind is like all over the place. But the yoga which is more body based I can stay much more present. There is a

15:15 meditational component to it. And so the answer is yes, if you had asked me eighteen months ago I would have said no, I support it, but I don't do it. But now I'm actually a very committed practitioner. And and it's really hasn't made a difference.

15:30 Is it a particular type of yoga that people could Google or learn more about a yoga expert and there's many forms of yoga that other people more knowledgeable than I am could recommend but the one I learned is called inner engineering. It and it's Talk by either Sadguru or his followers and you can look up inner engineering online. When I recommend it to friends and others, everybody's been only being grateful, so I can highly recommend it. Typically uh there's to me what seems to be a cult around the guy, which I don't take too particularly

16:01 But he's the genuine article in terms of having it a deep experience and being able to transmit that experience to others. And creating a practical system around it. So it's worked for me. I'm not here to recruit anybody else, but since you're asking.

16:16 No, no. It's just my my fans appreciate Yeah. Well, you know, I'm not gonna blame it on my fans, I like specific methods. Yeah, so inner engineering you can look up online. And it's taught here in the States and uh and in Canada internationally, actually. But I did interrupt you. You're about to mention I think another Technique or modality.

16:32 That can help. Talked about For instance, the somatic experience, EMDR, emotional freedom tapping, motor sensory integration technique. Or techniques. Yoga and then there's something coming up after that.

16:45 But Ten years ago I began to work with psychedelics. No If you fifteen years ago you were to ask me, Will I ever be working with psychedelics as a healing modality, I would have said, You're out of your mind. But then to a series of events.

16:58 I became aware of the Potential role of psychedelics in healing. And I've been doing work with them now for ten years and They're not potent. method and they're not for everybody and I have to emphasize that whatever modality you choose

17:14 Of a psychedelic nature. You have to do it with adept. Practitioners with deep integrity and deep knowledge and experience. But in such hands and in such a context It's can be like a

17:27 Super high weight, uh The self awareness. Not in Icelation. But it opens doors. But otherwise might take.

17:35 Years and so it's not unusual for me to conduct a psychedelic session with somebody or a series of sessions. either in a group or individual setting and have them say That was like ten years of psychotherapy. And uh

17:48 One day. And I've had the same experience myself. So Again, it's not to be isolated from other kinds of work and it has to be integrated. But it's not a potent way of working, and of course. As I know you're personally aware.

18:01 There's an increasing movement amongst Psychologist. Therapists, psychiatrists, medical doctors. other healers to find ways of incorporating psychedelic healing. in the larger therapeutic scheme.

18:13 So Gabor, you mentioned a series of events leading you To psychedelics or to consider psychedelics. Potentially is a healing or medical modality. If you're able to, could you

18:27 Describe? Any of those events? Sure. So in two thousand and eight My book on addiction. in the realm of hunger goes, Close Encounters with Addiction was published in Canada and very quickly it became a number one national bestseller.

18:41 Subsequently published in the States as well. And I was on a book tour. And people kept asking me, What do you know about addictions and ayahuasca as a treatment? Ayahuasca being a Peruvian or Amazonian vine that's made into a brew.

18:57 That has psychedelic properties. I knew nothing. The next speech, the next event. Somebody else would ask, What do you know about I was going to do an addiction? I finally started getting annoyed with it. Like leave me alone. I've just written the book, I've spent years researching it. My life experience and all kinds of uh scientific uh Exploration went into it. Ask me about something I know about.

19:18 And then I realized that maybe The universe is knocking on my door. And somebody said, Did you know you could experience it here in Vancouver? There was a Peruvian shaman leading some ceremonies up in Vancouver.

19:31 So Who might have say no? And I jumped right in and I Sat in this tent with fifty other people. Fifty. Yeah, it was that's how they set it up. It's not what it's not what I recommend, but that's how they set it up.

19:43 And There was a little baby in the room. Mother and Dad were Therefore the experience the baby was in the room and the baby was cooing away.

19:56 And tears started flowing down my face. And these were not tears of sorrow, they were tears of joy. And I got in touch with such profound love that I had never consciously experienced before. And it w they were tears of love.

20:11 And it wasn't love for anybody uh in particular. It was just love. And Then I saw in all the ways that I had closed my heart against love. In my life.

20:23 And how I had betrayed love in my personal relationship with my spouse and my children and in other ways. So I just got this. Experience of love is something profound and and universal and Life defining

20:38 But something from why you've been cut off in so many ways. And I got it. Because I close my heart against love precisely because When it was vulnerable and small.

20:49 I'd be so hurt. Going to my mother's states of mind. She couldn't respond to me if I needed to be responded to. Not her fault, but she couldn't. And then when I was a year old, she gave me to a stranger to save my life. And I didn't see her for a month.

21:03 Which is a huge. Explain that for a second. January, the Russians are circled Budapest and our fighting the Germans. The government empire is a right wing fascist anti Semitic

21:19 And even though the deportations of Jews have stopped The Germans had annihilated half a million Hungarian Jews in three or four months. But now the Hungarian fascists were killing Jews in Budapest. And including in the house where my mother and I were living. So my mother gave me to a stranger in the street, a Christian woman.

21:37 'Cause she didn't know if she'd be dead or alive next day. Well. Or that I would be. And I was quite sick. So I didn't see her for a month. Which I experienced as a deep abandonment. How else could I experience it?

21:48 So my heart closes. Against love. And I got all this. And so I got that if

21:56 This plan that as you say manifests the mind. Can show me Both the ways in which I've closed the off from myself. And that I don't need to because the love is still there. What healing potential it has.

22:10 No, I wish I could say that after that experience I became a loving husband and a loving human being. I didn't. It's not that simple, you know. As my wife could tell you. Uh Nevertheless, it opened the door for me. Mm-hmm.

22:24 And I got right away. However, the thought that I had was That I had no induction, I had no introduction, I had no processing afterwards. Ayahuasca is a medicinal plant that has been used in the Amazon basin for hundreds of years, maybe longer.

22:41 In a cultural context. In a tribe, in a village where people know each other, where they know the shaman, where they share the same assumptions and the same history. That's not the same as a bunch of Westerners, strangers to each other coming together for one night and drinking the stuff and then going their separate ways. Agreed. So Immediately the question that came up for me was how can we create

23:02 A setting that at least resembles as best we can. Fashion. The original setting. So we came up with the idea of a retreat where a small number of people get together With properly trained shamans.

23:17 who have integrity and experience. Deep experience. And With me facilitating people's Preparation and their post ceremony integration.

23:28 And so I've been doing that now for uh ten years. A lot of learning involved. We made mistakes, but it evolved, and the essence of it is that People don't come into the cold, they come into the preparation in a safe setting. There's

23:41 Pretty soon a group becomes a family to each other, which means That not only do they love each other and support each other, but they also Trigger each other. I mean I mean basically I I tell people, guess what, you're back in your family of origin and everything you've hated about your family origin is gonna show up here. But in the context where it's safe for that to happen. And so I've seen lot of great healing. I've had people with multiple suicide attempts heal from depression

24:07 I've seen people get much better with their autoimmune diseases. I've seen people deal with all kinds of addictions and and and life issues, relationship problems Come out of it much more themselves. Much more able to deal with these issues. So long as the proper integration is done afterwards. So that was my personal experience.

24:25 Again give you a quote. Yes, please. Which I love. It's one of my from my one of my favorite teachers. And uh his name is A. H. Almus. And he says, Your conflicts, all the difficult things. The problematic situations in your life. Or not chance or haphazard. They're actually yours.

24:42 They're specifically yours, designed specifically for you. The part of you that loves you more than anything else has created roadblocks to lead you to yourself. You're not gonna go in the right direction unless there's something pricking on the side saying, telling you, look here, this way. That part of you loves you so much that it doesn't want you to lose the chance.

25:04 It will go to extreme measures to wake you up. It will make you suffer greatly if you don't listen. What else can it do? That's its purpose. And I found this to be true of physical illness. And Mental problems and everything, you gotta see

25:20 What is the teaching here? So if we can look at all these things as problems to get rid of Which is what the personality wants to do. Or we can look at them as learning opportunities which is what your true self wants to do. No.

25:33 Two things. One is you talked about intention. In life. So my wife and I had a holiday recently in Costa Rica. Partly it was a working holiday, but partly it was just a holiday.

25:44 Traditionally we've had terrible times during holidays. Probably because of my workaholism and once I go into a holiday I just collapse and now My wife is dragging a corpse around it. You know? Because'cause I'm a workaholic, you know, and I hadn't clear space. So this time we actually went into the holiday with intention.

26:01 This is nothing to do with psychedelics. Just to do that we said, an intention. What is our intention? And if we have an intention, I've learned from What structures? We want to set up to support our intention.

26:14 And how are we gonna handle when there's kind of disagreement or conflict? We had a beautiful holiday. Because it was the first international holiday. That we have had. So that intention in life in general is absolutely essential.

26:26 Every morning. What is my actual intention? So the the the problems, the upset. So wanna do a bit of an exercise? Sure. Okay, and then you know, if you don't like it, just tell me. This is something I do in my groups or when I speak or in the song. Might each.

26:41 I asked people to tell me some recent episode when they're upset with somebody with their lives. And something that they're open to sharing. So it doesn't have to be anything sorted or something. But just something whether it's your spouse, partner, the bus driver. I don't care who. A friend Okay. So are you willing to go there? Anything. Okay. I can share anything.

26:59 Okay. Yes. Okay, so what describe it? What happened, yeah. All right. There were a number of Issues. In my home. Broken. Aspects of the home, things that were

27:11 Falling apart or needed to be fixed. Physically. Right. And I had hired someone to do these things while I was gone. Okay. And I came back and none of them were fixed. Okay. And your emotional reaction was? Anger. Rage. Anger, okay. Anything else besides anger?

27:27 I think they're close cousins. Frustration. Frustration is frustration is anger, yeah. Yep. I was Disappointed. Disappointed is sadness. Yeah, it's a different feeling.

27:40 So it's disappointed. Uh myself also, because I started to look at how maybe Well disappointed is not so much an emotion as a state of mind. I'm asking what the emotions were. I'm what's inside disappointment? Something didn't happen, I want it to happen, how do I feel?

27:55 Isn't there sadness there? Sure. Yeah, there's sadness. I'm not talking into it. I'm just asking. I might be confusing state of mind and states of mind and emotions. I'm not sure how to do that. I'm looking at the role emotion. Yeah. Sadness.

28:10 So there's anger and sadness. Those are the emotions. Let's go with that. Okay. So I'm gonna ask you a silly question. What were you sad in angry about? Well

28:18 I suppose. The answer which is not the right answer I'm expecting was us. Angry that Someone had made commitments to me. And not fulfill those commitments.

28:29 Okay, well tha that's what happened. They had made the commitment in the phone. But that doesn't tell me what you're sad or angry about. What does that mean that they didn't fulfill their commitments? Meant that they didn't Me they didn't Respect me. So they didn't care about you and didn't respect you. What kind of person doesn't get cared or respected?

28:49 I might need a lifeline here. Don't know. Someone who doesn't deserve to be cared for or respected. Exactly. Somebody unworthy, right? Sure. Of respect and and and care. Mm-hmm.

28:58 Okay. No. If two other people here, which there usually are when I do this exercise, I would ask them, Okay. We just listened to Tim tell us about this experience. Are there other reasons why this other person might not have done the work

29:11 That has nothing to do with him or her. Not caring about him or not respecting him. So what other reasons might there be? A million and one. Million one. Yeah. It could be in the hospital. Cared one could have been in a car accident. Exactly. Uh he had a flight delay and got caught on Puerto Rico during a hurricane and he can't follow through. He's under stress and he couldn't Right. Okay, okay. The e the email that I was supposed to send is sitting in drafts and I thought I had sent it, but in fact he never received it. I mean

29:45 Okay. And any number of possibilities. No. Of all the possibilities that you've just outlined. Including

29:53 They don't care about you or respect you. Which is the worst one? The one I immediately defaulted to. Right. No, but internally.

30:05 Yeah, internally the worst assumption is the one that I immediately made. Exactly. So let's notice something. A U, I should say we'cause we're all like this. We don't respond to what happens.

30:16 Mm-hmm. We respond to our perception of what happens. Right. Okay. That's what the Buddha said. It's with our minds we create the world. So that

30:24 If you'd found out he had A H D or or he was stressed, or s you know. You might have been Sad for him, but he would not have been angry and you would not have been sad. So first of all we don't respond to what happens. We respond to our perception of what happens, to our interpretation of what happens. Number one. Number two. Of all the possible interpretations, we choose the worst one.

30:44 Thirdly, what I just said isn't true. We didn't choose it. It's not like you went through all these possibilities and you said multiple choice, option D. Oh no, he doesn't care about me. You didn't do that. Your brain jumped there automatically, right? The question is why? Now here's the learning. First time in your life that You felt hurt and angry that When you perceive somebody didn't care about you or didn't respect you?

31:07 Has it happened before? This is where the exercise might go sideways. I'm gonna hit pause on that. I think that's probably for more of a conversation number one. But you'd probably agree that it's not the first time. It's not the first time. Very good. And most people I talk to It goes back way back. Yeah, this goes way back. And into childhood.

31:24 Mm-hmm. Just a quick thanks to one of our sponsors and we'll be right back to the show. This episode is brought to you by LinkedIn Ads. As a business to business marketer, your needs are unique. The B2B buying cycles are long, and your customers face Incredibly complex decisions.

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32:44 And now Doctor BJ Miller. Twitter. At BJ Miller MD.

32:53 A hospice and palliative care specialist. Author and speaker. Who's TED Talk? What really matters at the end of life. has been viewed more than seventeen million times.

33:06 BJ, welcome to the show. Thank you, Tim. It's nice to be here. I have been Wanting to talk to you.

33:14 Or I should say I have wanted to talk to you for years now. And Just give a few examples and illustrate that. The first was an article that I came across in the Princeton Alumni. magazine. Alumni Weekly.

33:30 about your work. And then the next was a profile in a magazine here in San Francisco. Following on the tails of that. Adam Gizali, who is a just an incredible neuroscientist at UCSF who's been on the podcast reached out to me. And that was related to a I think it's a senior partner at IDO who had also

33:53 reached out to him to suggest that you be on the podcast. So I feel like this was Fated to be. And I've been increasingly over the last few years thinking about

34:05 Death and the The value Of meditating on death, among other things. But Before

34:14 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? I guess I generally say, you know

34:24 Generically I'll say Oh, I'm a physician. And People seem like they actually really want to talk things out. Palliative care doc. Mm.

34:34 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 act the person asking the question is, that's what they might hear from me. Let's say they're very interested.

34:54 I don't know if you drank, but let's say the the other person's had Two drinks. drunkenly curious. And they say, What drum are you beating? I'm really interested to hear more. What what is the what is the drum? Well, the drum, I suppose, is really is getting society to pay attention to the inevitables in life.

35:15 Helping each other look at hard stuff. Helping each other to live with hard truths. I'm trying to get people to pay attention to the fact that we all die. And that the way we die Could be a lot better than it is in general.

35:32 Let's dig into that because I really enjoyed, for instance, your TED talk and maybe you've given multiple, but at least The one that I saw. Just one. Yeah. Which is one is enough, by the way.

35:47 But Let's look at a sample experience. So you have a new patient come into Your facility. What does the first meeting look like?

36:01 And what does that first day look like for them? Let me pre answer your question because it it so depends. So for example, at Zen Hospice project. By virtue of coming to our place, by virtue of enrolling in hospice Many corners will have been turned just to get to that place. So When we're meeting folks for the folks for the first time in Z Hospice

36:25 They, for the most part, are aware that time is short, are aware that they're dying soon. Are aware that there's really not much more to beat back their disease. To be done. And there's plenty of work to be done even or you know, on the far side of turning that corner. Another way of answering your question.

36:43 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. That's the kind of person I'll meet in clinic at UCSF. So part of my job is on faculty at UCSF. And I work in a clinic that's called the Symptom Management Service. It's about ten years old.

37:08 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. And is palliative care I'm just gonna plead ignorance here, is that synonymous with hospice care or is are those different things? They are they're related but different. And thank you for asking that question, Tim. I mean it this is part of the drum beat. So hospice is that portion of palliative care that's at the end of the road.

37:35 And hospice is an insurance designation as much as it is a philosophy of care. So Hospice is by definition end of life care. Time is not an issue in palliative care. You just have to be suffering. You can see folks in palliative care for many, many years.

37:50 far in advance of their death. So yeah, all hospice is palliative care. But not all. Palliative care is hospice. Got it. Alright, so palliative care just to kind of make it is basically the

38:03 You know, within the context of dealing with illness. Palliative care is the pursuit of quality of life. Period. That's it. So the fulcrum in palliative care.

38:14 Is suffering. You know, are you suffering in some in tractable way, more than you struggling more than you need to. And if so, then you know, come see us in palliative care. Will help.

38:27 And in palliative care. You can receive Our support. And continue on with your more aggressive Invasive life.

38:37 Sustaining. interventions as well. You don't have to give up one type of care. To add palliative care to the mix. Whereas once you're entering hospice because of its insurance details and vagaries You do have to in general, you have to give up

38:51 Survey intended care. to qualify for hospice And we can spend a lot of time on this, there are a lot of wonky details. But does that sort of make sense to you in the totally makes sense and The first thing that leapt to mind for me

39:05 And that will lead to a lot of tangents, I apologize in advance, but was that the way that you define palliative care would seem to include almost everyone on the planet in some respect. suffering more than they need to and we'll we'll dig into the learnings and and philosophies and so on that

39:24 that you've cultivated, but So let's say they have gone through the paperwork and the process to get to The Zen Hospice Project. Uh-huh. What does their first day look like?

39:35 So first day at Zen Hospice is usually there's always the folks by Almost by definition, 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.

39:53 But As soon as they're beyond the logistics of the trip over. The first day is generally Ar nurses, ar volunteir. The kitchen crews are swarming around that resident and their family and just getting to know them.

40:08 That's where all the potency comes. It's it's inherently a relationship. So There's some details around medications, et cetera, but most of the early work is just getting to know people and making them feel that this is their home now. This is they've come to live here. Yeah, they're gonna be dying soon, but they're here to live. Until they die.

40:27 So It's a very non medical an establishment and the first day doesn't feel anything like being in a h admitted to a hospital. You know, and pretty soon you as you get to know someone within the first day, you invariably questions get asked like you know, tell us what's most important to you now. You know?

40:44 You want something neat, we can whip you up something in the kitchen or Well 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. And What does the just to highlight also the the differences, can you describe Upon the patient's death.

41:03 Mm-hmm. What happens? Yeah. Zen Hospice Project versus in a conventional hospital setting. Mm. And you can present either first. Yeah, well

41:16 So In hospice and palliative care in general, but certainly places like Zen Hospice Project. In many ways they were created as Antidotes to the hospital. So in some ways they're they're really

41:30 You'll feel like opposites. That's to some degree by design. But a death in a place like Zen Hospice Project. is usually very peaceful because We've gotten to know that person. We've been living with that person. We've know what they want, what their idiosyncrasies are. And we work with, you know, local teams of hospice agencies who come in and provide the medical care. So

41:54 For the most part people can enjoy and expect a much more comfortable and peaceful death. That Zen Hospice Project and places like it. That's what the all of the expertise is geared towards. You're not distracted by beeping machines and other things and other agendas happening, research agendas, whatever it is. And to your question though, Tim, you know, so

42:16 W the person. Dies. Invariably the mortuary needs to come and retrieve the body. And we have this Ritual that we offer people.

42:25 Which is On their way out the building. You know that Morchary guys have picked up the body. And if there are family or friends around and certainly staff and nurses and volunteers will gather around and we'll all we'll all gather on the porch.

42:40 And we will do this our flower ceremony. Which is basically we gather around and the Watch our 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 Flower petals.

43:00 No, it's just just Very simple. Gorgeous moment. And Then

43:06 The body bag. Zipped up as it has to be by law and the body. Heads out the door. But Yeah, it's it's it's this very stunning, poignant, gorgeous, simple moment.

43:19 And you can feel everyone Entering into the sort of grieving phase more fully, especially of course to family. And you can watch folks have this little bit of closure. Perhaps. But more of the point is you watch them Swarmed with warmth and love.

43:35 And easing into the grief process. 'Cause 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

43:48 But can do so with some imagery that's Sweet. And beautiful to remember rather than traumatic. So Counter that with the typical hospital death.

44:00 And by the way, Tim, I mean we can talk about all sorts of things together. I hope we do, but You know, no knock on hospitals. They're incredible places. They're just not really designed. To have a beautiful experience per se. And they're not really designed to help you die well. And you feel that mismatch. So I've work done a lot of work in hospitals as a patient, but also as a physician. And No, a typical hospital death is

44:23 Is in a more sterile room. Usually lined with a bunch of machinery. And all the sounds and lights that emitted. And It's very cold. I mean, the second the person dies, you can feel the cleaning crew waiting to descend on the room and they need to get the body out of the room because someone invariably is waiting for the room.

44:44 And there's no ushering in of grief. There's a sort of a snuffing of it. And it's very disorienting for everybody involved, including the clinicians. Because there's no pause moment to reflect on the experience you've just had with this person. It's just kinda on to the next. And it's a stark, stark. Contrast.

45:02 Since You began your work with Palliative care and hospice care. Mm-hmm. How many

45:11 deaths have you witnessed or experienced even in the periphery, not necessarily watching someone die, but Under your care or in your periphery, how many deaths have you experienced? You know, my guests now I mean I finish 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 ten years.

45:35 If it's not a thousand people, it's approaching a thousand. I don't know that for sure, but it's certainly many, many hundreds. What 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

45:52 Observing That many deaths. And the March towards death. Taught you about

46:02 Living. And specifically your own life. 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.

46:16 Because I think the assumption Is that oh wow, that's gotta be very morbid. Yeah, it is. I mean, it's gotta be very morbid work or very depressing work. And sure, it is loaded. I mean it is emotionally laden work without a doubt. I don't mean to make it sound easy, but Those of us who work in the field, you pretty quickly get a

46:36 A real sweet hit. That paying attention to this zone of life It's very nurturing. This sort of sort of secret is that paying attention to the the fact That you die.

46:51 Can Help you live. A lot better. So a lot of my colleagues and I are very, you know, are aware of the clock. You know.

47:01 Sure, that can make you anxious as well, but we you know We know we're aware of our affinitude, 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. So remarkable, vicarious

47:19 Deathbed moments. With our patients and their families. And you you can learn a lot. And and one of the things I love thinking about A a real organizing theme for me is Is avoiding regret, essentially.

47:32 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.

47:47 So in the sense we're exercising these muscles. on behalf of others that all of us need to exercise on behalf of ourselves at some point. We just get pretty well practiced at it. So this is where the work gets extremely beautiful and really nurturing. And can help you live better. And I guess that's part of the drum beat. Why do we wanna talk about this? Well there

48:04 There's some systems issues or some economic issues. But there's these these beautiful sibil issues on behalf of kindness, on behalf of Justice and equality, the fact that we all die. Well, paying attention to this has all this potential.

48:19 For this to be a a a bond among human beings. The fact that we die and the fact that we're cognizant that we die. That's part of this jumping. And In the case of

48:31 Paying attention to decisions. what would be examples of some specific decisions you've made or habits you've developed. that have been impacted by this work. One thing, you know, caveat is I'm I like anybody else um 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

48:54 You know, I got all sorts of work to do on myself, but As as we all do. Yeah, yeah, a amen, brother. So But I do think I've got a lot better at I'm pretty good as a hyper educated person at rationalizing all sorts of things and behaviors and I can convince myself to stay in relationships or in situations.

49:14 That don't necessarily feed me or That aren't working very well. And I I think I've gotten a lot better at calling that. For everybody's sake, you know. So I might be I think I'm a little bit better these days.

49:28 At not squandering my time. And in terms of friendships and relationships, navigating them. Not taking them seriously. So that we're just not wasting each other's time. So I feel that in my relationships.

49:43 I feel these lessons in my relationship to nature. So that's a great sab 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

50:03 I get thrilled that I can feel anything. Sometimes even pain. I can if the way I deal with my own pain is I'm just I remind myself that I'm glad to To feel anything at all. So my relationships I think are impacted my s orientation to mother nature's impacted.

50:24 I've got a lot lot better at forgiveness. So not holding grudges. You know how we walk around with anger at others and ourselves, and it's just unnecessary. It doesn't help anybody. So I've got a lot better, I think, of letting go of certain things. So to dr to drill into that, I apologize for interrupting, but because this is a particular Achilles heel of mine and I've improved, I think I'm trending in the right direction over the last few years, but I have always had a lot of difficulty letting go of grudges and those loops that we tend to repeat or at least I tend to repeat and reinforce like a groove in a record that can just Create this.

51:02 Bitterness might be a strong word, but it's not totally out of place. When you find yourself When you catch yourself. angry with someone. Or not letting go. What is the internal dialogue?

51:15 What do you say to yourself? How do you ameliorate that? Well this is where You know, meditation, mindfulness. Self awareness, whatever you want to call it, can be so helpful because One thing to

51:26 It's just get better at and realizing you're doing it in the first place. Definitely. Even be you know, even before you're able to change it at all. Is there's great potency and just being aware that you're doing it. I used to be much more I could walk around for months.

51:41 With grudges and chips on and bitternesses, et cetera, before I really even realized that I would just be really moody or whatever else. So No, job one, I guess, is just paying attention to yourself and seeing it for what it is. And then the next steps actually that's the hard part, I think, at least for me. I mean the next step is actually kind of easy because then

51:59 As you watch yourself spinning out. Then you can kinda 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. And for me You know, my life, me, I

52:13 The absurdity The being in touch with absurdity has been very very helpful. Yeah. So that's my next step. So the awareness and then is sort of watching the silliness of it all. And then that anger. And maybe with some deep breaths or whatever else or a a walk to sort of bleed off the physical anxieties of it. But

52:35 Then I can sort of unspool, unwind. And maybe even quickly kinda laugh at myself. And that's great because A, you've let go of the junk. And B, it's a exercise in humility and forgiveness, which It's always pretty dang useful.

52:52 And For those people listening who might have these same issues and a lot of us do, of course. There's a book with a very bland title called Radical Acceptance by Tara Brock that I found very, very particularly helpful to me in this

53:08 In this instance. You mentioned mindfulness meditation. Do you have a regular meditation or mindfulness practice? Hello. Uh, not really. Well, I guess your whole job in a way is a mindfulness practice, so I That perhaps might be overkill, they'll just add another

53:27 session on top of Nothing else you're doing. Thank you for that way out, brother Man. You're welcome. But no, I mean it's you know, it there there is some truth in it actually. This is where it's another reason why this work is so potent and fun is your personal and professional lives are deeply entwined, almost necessarily. Because so much of this work is

53:47 Just being aware. Is listening. Is Paying attention and bearing witness? And

53:54 Come to terms with all the stuff you can't control. Whether it's on my for my s own sake or my page sake. So there is some real truth that I I kind of feel like doing this job well. And so empathy is job one in this work. And so I do feel that much of my daily life, the daily grind for me is itself Sort of meditative. I also want to be clear. I mean, I do I have my own relationship. For me it's

54:19 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

54:32 movement. There's 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

54:45 So I feel like I'm doing it a lot in a way, but I also want to honor those folks in the audience who truly have a meditation practice. And that is really its own discipline. So I I don't really have that, but I got those other things. Well I think they're

55:00 all present state mindfulness practices, right? And if you're riding a bike Now you mentioned something we haven't covered and I didn't cover it very deliberately, but it makes sense, I think, at this point. To rewind the clock. Could you tell us about The dinky.

55:16 Yeah. I'm sorry, I love Speaking of absurdity. Yeah. I mean I lost three limbs to a thing called the dinky

55:28 Sorry I'm laughing, but I laughed. No, but please laugh. I mean it is kind of Silly. But anyway. So as you know Hello, Tiger. Yeah, there's this commuter train that runs on the campus of Princeton University. Although I guess it doesn't run on campus anymore, but

55:46 And it's a commuter train. You know, it's called the dinky. With affection to some. And the the Day runs from Princeton to Princeton Junction and commuters can take the trains into Philly or New York or whatever else. Oh. That's what the denky is. But why it's significant in my life in particular is

56:05 Yeah, one night it was November. It was just after Thanksgiving vacation sophomore year. November. twenty seventh. couple friends of mine and I were out just Hanging out, having fun. Not a crazy night.

56:19 But we were walking well, you remember the Wawa Market, Tim? I do. I was at Forbes. So I walked by the Ninky and the Wawa every single day multiple times. Right. 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 and we were just walking by the dinky.

56:38 It was just part there. It's just n not operating hours. And you know, it has a ladder on the back and we just Walk by it and just decided to climb it, you know, like you would climb a tree. We really did not think we were doing anything that daring. But put it this way, we've done a lot stupider things besides

56:55 That at least we thought. But I just happened to be the first one up on top of the train and that the those trains run. Like the buses in San Francisco wires that run overhead, and then there's this metal thing called the pantograph. I think it's what it's called. And that

57:10 connects the train itself to the power source. It's this big metal Cool. So when I stood up on top of the train, I I had a metal watch on. And I happen to be close enough to the power source and the electricity art. Choose a watch.

57:26 And uh Yeah, entered my arm and then blew down the feet. How was that? So what happened at that point? Well, I should say I don't really remember anything about that night, but My friends were with me. Uh

57:38 pieced it back together. But there's you know, it was a big explosion and I was thrown some distance And One friend. Came up on top of the train. While the other friend

57:50 ran and called nine one one. And You can imagine. I mean, both of my friends were freaking out and Right into action mode. And you know, getting up on top of the train that had just in ways they couldn't have possibly understood.

58:04 had just electrified their friend. And yet they got up on top of the train to help me. I mean, just ever a daily shout out to my friends Jonathan and Pete. And Tommy too. For all they did for me that night and

58:18 Oh God, and so many nights. But yeah, so Pete held me down'cause I guess I I guess at some point I 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.

58:34 And people Wake with extreme energy. I mean you are You are electrified. So I mean I'm just flailing, punching him through I'm just A wild tear. Apparently.

58:46 So Pete, who is w a very particularly large, strong and sturdy heroic friend of mine. Held me down so I didn't roll off the top of the train and make things worse. And then the ambulance came. And I don't blame them one bit, but the ambulance drivers refuse to get on top of the train as As they should have.

59:03 But between my friends and uh and uh a Princeton police officer by the name of Officer Dawson, I believe his name was. We went on to become was uh promoted, I think, after that to Sergeant Dawson. But anyway, Sergeant Dawson got up on the train with Pete.

59:18 And together with Jonathan, they got me into the stretcher and handed me down to the ambulance. Guys and the ambulance whists me off to the local hospital. And the local hospital did a these things where they basically just slice open the skin to allow the heat out. It's called this fasciotomy. So that you stop burning yourself, essentially. And then I was flown to the burn unit at Saint Barnabas Hospital in Livingston, New Jersey, which is New Jersey's one and only burn unit. At least it was at the time.

59:45 And that's that. And Flash forward. When you became fulnizant of what had happened.

59:55 You open your eyes. I mean, what does the scene look like? It's interesting. It's like I was Conscious I was awake.

1:00:03 So out. The ordeal. And it's just more the the sleepiness of memory. So there really w it's not it was not like coming out of a coma where I was asleep and then awake. So there was not a sort of a singular moment. reprisal, you know. But I tell you the first memory, which I actually some freakish reason I love this story. It just

1:00:23 I don't know why. I do like the story, so I will tell it to you. Anyway. Please do. So Your blood pressure's unstable, you're just a hot mess. So surgery can't happen until you're more stable if it can be avoided. And so it's common to wait several days before surgical amputation of the dead tissue.

1:00:44 And it's also in part because it's not totally clear what tissue's viable and what tissue's not. So Anyway. 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 feeling where you wake up from

1:01:03 A dream. Yeah. 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. Mm-hmm. You know that sensation and it's incredible somatic.

1:01:20 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 I was just describing a moment ago. at Zen hospice. It's a very technical sterile intense environment. And

1:01:38 Somehow in my stupor I looked around and saw all these machines. And still manage to think Oh. Thank God, that was just a dream. And so I s I had the sensation I had to use the bathroom.

1:01:52 I said, Oh. Get out of bed and go to the bathroom. And In this state I X I was intubated on a ventilator. I Extubat myself, which is not easy to do. She stretched so I extubate myself. I pull out have all these lines running into my

1:02:09 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.

1:02:21 To go to the bathroom. You know, I just Obviously out of it. Um but in my mind, very clear, everything's fine. And then the you know what a foley catheter is, Tim? Uh I don't know what a foli catheter is, but a catheter I would understand as something that's probably in your urethra. There you go, pal. You got it. So yeah.

1:02:40 That's right. And the way it stays in there is there's a little balloon on the tip of it. So the tip is fed through your urethra into your bladder. And the catheter just is there to spontaneously drain your bladder. But the way that thing stays in there is they inf the 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

1:03:01 You know. Small ping pong ball at the end of it. It's now inflated. So I'm walking the door and they usually clip the cast that are in the bag onto the side of the So you know where this is going. So anyway, I'm walking to the door and the thing runs out of slack.

1:03:17 And yanked the danger, of course. And it comes not all the way out, but like partially out. Sorry, do you annoy us? No. Are we talking like a small python that in a golf ball kind of situation? No no offense I mean large python that eight or small python. Yeah, so no, that's right, man. So I mean this is The total reverse that total warm bath of relief that you experience thinking it was a dream. But that just goes totally in reverse and in a millisecond I realized that all of this was not a dream.

1:03:57 I fall down to the floor. 'Cause all of a sudden I really can't walk either. I just fall on the floor and I'm screaming and I'm pulling on the I'm trying to break the rubber tubing of the catheter, which there's no way I could. T. somehow relieve the pain. And anyway, finally a nurse comes running in.

1:04:13 And Gets me back in bed and That was that. But so anyway, that's my first real memory. My God. I can see why it's vivid. Oh yeah. I'm I'm sort of bent over as I'm talking to you. Um Yeah.

1:04:28 Let's contrast that. With One that I've heard you tell, but I don't recall the details. And this is Snowball. Am I getting this right?

1:04:38 Uh-huh. Could you tell the snowball story? So a burn unit. is like I said earlier, a particular place. They're gruesome places. They're very difficult environments. The pain that the patients are going through is gut wrenching. And so working in a brand it is very difficult. People often don't last in a Bernie very long.

1:04:57 As a clinician, it's it's incredibly difficult work. And We learn from wars over time is my understanding of certain medical history that That the way burns often kill people is

1:05:09 indirectly through infection. So once you've disrupted the integrity of your skin, you're much more vulnerable to infection. And so the thing that often kills burn victims after they've survived initial trauma is infection. So burning nuts are incredibly sterile environments. So everyone's gowned up, masked. Gloved. for the first maybe several weeks, I could only have one person in my room at a time.

1:05:31 You know, it's just ex like you're in a bubble. In other words, and therefore you're cut off from everything. You're there's no day, night runs together. There was no window in my room. There's no, you know, you're in a whole cell. And even when people are at your bedside, there's all this garb in between you and them. So there's no relationship to the natural world you can touch nothing. And also you're in a fair amount of pain, of course, which does not necessarily reward your paying attention to anything. So it's just

1:06:03 It's not fun. So this was November at some point in December, maybe it's early January. And honestly, I can't remember Who brought me the dang snowball?

1:06:13 Mm. I can't remember. There were two nurses in particular that I was felt very close to. And it may have been one of them. I think it was it may have been her name was Joy Varcardopone. 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 And she

1:06:30 I had the 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 man, it was just stunning. You know what a simple Little thing, right? To put it in my hand.

1:06:46 And just feeling the contrast of that cold snow on my sort of Crisp. Like you know the burnt. skin, the obnoxious inflamed skin. And also watching it melt and watching the snow become water and just The simple miracle of it. Was just

1:07:04 A stunner for me. And it really made it so palpable that we as human beings, as long as we're in this body. We are feeling machines, and if we're cut off, we can't take If our senses are choked off. We are choked off. 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, this the sensation.

1:07:26 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.

1:07:38 And it just felt so beautiful to be part of this weird world in that moment. You know, I just felt part of the world again rather than removed from it. It was potent. B J what did you study?

1:07:50 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. 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 s of learning things that that were foreign to me. You know, totally seeing a different worldview and really delighting in the liberal arts education. So with that, Chen on Men Square had just happened. Before freshman year. And I was So China was on my mind.

1:08:21 I started studying Chinese language and was heading for a major in East Asian studies. But when I was out. With this injury. Art. Which I'd always been interested in, especially music.

1:08:33 I became much more interested in art. Not just But The idea of art. So I switch my major

1:08:43 to art history. And that's what I ended up studying. What do you mean by the idea of art? What is this art stuff, right? I mean Why do humans

1:08:51 It 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.

1:09:04 We use them as creative grist. So either in our sort of daily lives Or those of us who Make art. You know, we use it to make art. You know, what's the purpose of making art? Art is inherently kind of useless.

1:09:19 And that seems to be part of its charm. 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 my less human because I have less Fewer body parts.

1:09:35 You know, and like Is that the measure of uh what it means to be a human being? Or uh no. But I couldn't really answer the question. What was my humanity? What did it mean to be a human being? Why was I happy to be still alive? Those are the kinds of questions I was trying to kinda wade through. Like

1:09:51 Essentially. Questions of identity. No. So So studying art, the hunch was, well

1:09:58 Mm. Well, this seems to be a peculiar the the situation I'm in was a p 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. And it seemed to be rightly placed to focus on

1:10:19 Something like art as a guide. To help me get creative with the reality I was now facing. In a way it was the thing I was trying to learn how to do was make perspective. And that's what Art really helps you.

1:10:34 Exercise that muscle helps you. Lear 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.

1:10:50 But I couldn't. Well I could change it. with this knowledge, uh, I could change my perspective. I could change how I saw myself. That's what art helped me. learn and where to focus my energies. And it you know, it really paid off. I had to say it's very helpful.

1:11:05 I'd love to explore that some more because I've been In the last You months in particular. Asking myself over and over again, why do humans

1:11:20 music, create music, like a compulsion and dance. Every Every group of humans on the planet. It just seems so peculiar. Yeah. Unsurprising if you look at, say, bird song and animal mating calls and

1:11:35 mating dances and all this, that and the other thing, but it there seems to be uh many layers. How did it pay off? I mean you gave one example already in terms of changing perspective. But were there any particular Classes.

1:11:48 Teachers. Books. That really influenced you.

1:11:55 Really so much of I mean art history the way the curriculum was set at the time. It really didn't actually dig in so much. Around why humans make art. It just presupposed that we do and that that's interesting. And went from there, which was cool. Basically put me in front of a lot of art.

1:12:13 and help me tweak my eye and my ear. And that was great. But for on the sort of Identity sort of philosophical front. Like the existential, like why do we do this?

1:12:25 What's the meaning of this? That was actually kind of left up to me as an individual and in my relationships. And there was one of my dearest friends, a guy named Justin Burke, who is He is a philosopher and art historian. I mean, that's what he studied to his doctorate. And frankly, a lot of stuff we're talking about right now, Tim. And the benefits I reaped from it was really in c from conversations with Justin.

1:12:48 fed in the backdrop by this pounds of artwork that I got to spend time with, but Working through this philosophical stuff was really with my buddy Justin. So that's one point. And there was no particular work of art. Again, it was more of the idea of art than it was any particular piece of art. That was so potent for me. And even this day, I'm love going to museums. But I just like being around art.

1:13:10 Sometimes I don't even Look at it. I just like that it exists and I like to reward places to help it exist. So there's no one work I can point to. Although I would say probably the the painting of Mark Rothco has proven to be very Poignant and potent for me. I just Any chance I get to stand in front of a Rothco, I will I will do. How do you spell that last name? I'm a ignorant when it comes to this type of thing. Oh, Rothko, R O T H K O

1:13:34 Mark Rothko. abstract expressionist mid twentieth century guy made these big beautiful Color form paintings. Non representational. Quick.

1:13:44 Random anecdote. That There might be Entertaining. So I grew up on Eastern Long Island where

1:13:52 Jackson Pollock basically turned himself into one of his paintings by driving a car into a tree. And he actually used to show up at one of my relatives' homes completely shit face drunk. All the time. And he would bring his poor dogs in the car and he'd show up at like nine o'clock And this man and his wife

1:14:12 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 be go, Oh, we're so sorry we can't stay, we're just on our way to dinner. Because what would happen is he would stay He would Forget about the dogs. They would shit all over the car.

1:14:30 The dog's home. Leaving the shit intact in the car. And then blame it on My relatives. To his wife.

1:14:38 Who then had to contend with the whole mess. So anyway. Related, but totally unrelated. But if we're talking about abstract The uh If you were this is an awkward transition, but here we go. That's kind of my MO. If you were

1:14:53 Brought in. As a Position Slash let's just say mentor guide to someone who had just suffered

1:15:01 Nearly identical injuries. To yourself. Yeah. Twenty some years old. What would your conversation be like with them or what

1:15:10 resources or reading or otherwise would you point them to. Yeah, 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.

1:15:31 I should say both legs. Um anyway. And I learned a lot from how I gained from his visits to me, I have just sort of reproduced. Which is Basically walking in these rooms with almost no agenda, almost no plan to advise in any way. The potency, especially early on, was just seeing someone in similar shoes.

1:15:54 My early questions when I was in the bed was like what am I gonna look like? What's it gonna feel like to walk on prostheses and That's kind of what you know, that it was that nuts and boltsy kind of stuff. Will will anyone want to date me again? You know, I mean yeah I don't know. It It was on that level. And so when this guy would come visit me. He was just seeing him.

1:16:14 Just seeing him upright. Just knowing that by virtue of the fact that he entered my room, he came from somewhere else. He was out in the world, knowing he was a functioning human being out in the world. Then just seeing him look me in the eye With some kinship? That was the therapy of it.

1:16:31 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 um the camaraderie.

1:16:43 And the bearing witness. So to answer your question, when I do go into folks' room, I'm there and I'm I'll avail myself to any questions I have. But I think most of the power of visit is just visiting. Just

1:16:53 Being together. And sharing this awkward body. From what I've heard and read of yours, One of the recurring Themes.

1:17:02 appears to be, and please correct me if I'm getting this Off at all. Is how powerful simple things can be. Or maybe R. And that are

1:17:13 tendency is to perhaps undervalue the things that are not expensive or difficult to obtain. Yeah. The snowball. Could you talk about The things you've noticed that most help

1:17:28 people in hospice care. And the reason I ask is specifically related to cookies. Mm-hmm. Which maybe you could talk about. But I'd be curious to hear sort of what really brings the most peace to these people. So You're right. I mean I think one of the joys about

1:17:45 One of the upshots or silver linings about the end of life is that if you want it to, if you let it You can let a lot of the rules that govern our daily lives fly out the window. Because you realize that we're walking around in systems and society. And much of what consumes most of our days It's not some natural order.

1:18:05 We're all navigating some superstructure that we humans created. That is the work day, the work week. Whatever it is. I think part of the trick is if when you're dealing with serious illness or some a natural trauma. Or or facing the end of your life. Oftentimes that becomes crystal clear. Like where you've been hanging out and spending so much of your time and energy and worry.

1:18:30 Yeah, it's like living in someone else's dream. You know, it's not sure. I mean society and what we've structured there's a lot of importance to it. I don't mean to dismiss it. But We inherit that. We don't spend a lot of time creating our realities in a uh most of us don't in a sort of

1:18:48 Uh uh. Clear or intentional way. And so when you have this excuse To forget all that. It can be really

1:18:58 Liberating. A little bit scary too, because a lot of people then invariably realize that they feel like they've been wasting so much of their time on things that actually weren't that important. Right. And that's part of the trick of checking yourself and you know, over time, you know, in a daily way, am I doing things that I really care about, et cetera. So Back to your question. To this point about simple things. I mean the simple things

1:19:20 The small things ain't so small. You know, actually. the like I was saying about the snowball, just the joy of feeling anything. Of having a body at all. But being capable of movement.

1:19:32 At all. That Is so profound. It's so Point. And yet

1:19:38 I think most of us take that for granted, you know. So As a clinician and as a person, I love looking for moments where the rules get to go out the window. I love when I have you know, I love having residents at the guest house at Zen Hospice who smoke, frankly. You know, or you know, anything that just kinda gets to That kind of reorients us and puts things in proper poor proportion relationship to the natural world.

1:20:02 And re jiggers our priorities. I I I love that. I love that reorienting feeling and and and again, it does seem to be one of the silver linings for folks. In this zone. Like I think about this most nights. Every night, depending on where you are, of course, but you can look up and usually find A star.

1:20:20 I mean I feel like You know, when When any of us is struggling with just about anything Look up.

1:20:25 Just Ponder the night sky for a minute. Just To realize that we're all on the same planet at the same time. And it as far as we can tell, we're the only life only planet with life like ours on it, anywhere nearby and

1:20:39 Then you start looking at the stars and you realize that the lights that hitting your eye Is ancient. And that the stars that you're seeing may no longer exist. by the time the light gets to you and just just sort of mulling the the bare naked facts of the cosmos. For me is it not to just

1:20:55 Thrill me? Aw me? Freak me out. And kind of Put all my

1:21:02 Neurotic anxieties in their proper place. No. Right. So Yeah, and a lot of people when you're standing at uh edge of horizon on death's door, you know, you're can be much more in tune with that cosmos than you are with what the body is doing in the You know, in a day to day kind of way. Does that make sense, Tim? Oh, no, it makes perfect sense.

1:21:23 So just because I brought it up and I don't want people to be harassing me about it on the internet. The cookies. Can you mention it? Yeah. Yeah, well you know, I mean the smell of

1:21:35 Fresh bread or for most of us the smell of a chocolate chip cookie does magical things, you know. Well, first of all, food is primal. You know, our sense of smell. I mean the shortest I mean it is a It is one of our oldest senses. It is primal. You know you can walk by someone who may

1:21:52 be wearing a cologne or perfume of someone you knew thirty years ago. Like I I still well there's it's been maybe a few years, but there's a perfume that I would smell that my babysitter wore when I lived in St. Louis when I was in preschool. And it would Throw me back there. Instantaneously. Sense of smell is is potent.

1:22:09 And food is primal and potent. I mean it's nourishment, it's nutrition, it's how we live in some ways, right? So there's all this symbolic Stuff happening too. But there's also this 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.

1:22:29 Smelling the cookies not on behalf of some future state. It's great. In the moment by itself, on behalf of nothing. You know, and this is another thing back to art. Art for its own sake. Art as part of its poignancy and music and in dance is its purposelessness.

1:22:46 And just delighting in the f wacky fact of um Perhaps a meaningless universe and how remarkable that. Yeah it's That's kinda 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.

1:23:01 is to prize those those little moments. You guys I might be fabricating this, but Make cookies. At the Zen Hospital Center. For this precise reason, right? And

1:23:12 So you mentioned absurdity a few times. This is something I've been thinking about a lot. I mean, um And for reasons that may inferentially become super clear in a second. But just the being able to try to laugh at

1:23:26 the cosmic joke, so to speak. I mean like the the meaninglessness if it is in fact meaningless. of things as opposed to taking All things. So Damn seriously, which in a way prevents you from doing a lot of the serious work you would like to do. But the the the the question I was gonna ask is

1:23:44 To get your opinion on a modality, we'll call it. Or tool. And I'm gonna explain this. V vis a V An anonymous a friend I'll keep anonymous. So this is a f a female

1:23:56 young woman who used to work in hospice care. And she found just as you alluded to earlier That she felt like she was sitting on a secret. It gave her Incredible joy and presence to do that work. She really loved the work.

1:24:14 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. Cellocybin and she said now

1:24:31 I get to experience people dying every weekend. The only difference is they come back to life. And many people listening. read or should read.

1:24:44 An article. It was titled The trip treatment. By Michael Pollan in the New York. About the use of I believe specifically psilocybin, for those people not familiar, which is extracted or

1:24:55 the psychoactive compound in Magic mushrooms. Uh for end of life care in terminal cancer patients. I'd just love to hear your opinion on the use of compounds such as those end of life care or otherwise. Mm-hmm.

1:25:13 Yeah. Yeah. Well, I'm so glad you're asking this question. I mean, this isn't so there's all sorts of stuff coming out of the closet. these days and it's it's really wonderful. And There's a movement afo to revisit Psychedelics from a therapeutic

1:25:28 Perspective. And I don't pretend to know the full history of how psychedelics went from considered therapeutic to considered, you know Toxic and and the devil's Work. But here we are. We're there's a there's a revisiting happening.

1:25:43 With fresh eyes and serious eyes. So it's not folks who are just with a wink trying to justify their own recreational use of these U C S F U C L A Johns Hopkins. Johns Hopkins you got it right, NYU. Friends at the River Sticks Foundation have been funding some of this work. Are deeply thought, caring, loving people. Anyway, so I've that's a sort of a preamble, but you know, to get to your question, I am thrilled.

1:26:10 For this. For a number of reasons. One is just the the counterculture fun kind of things coming out of the closet. the another is a whole generation, i.e. the the baby boomers who are now the focus of so much of our efforts in healthcare and the aging population. How do we cater to this population? Well A lot of folks of that generation have experience with these compounds that and now they get to sort of be above board potentially. So anyway, I love the subject for many reasons. As a clinician, you know?

1:26:39 I'm particularly excited because We're pretty good at treating nausea, treating pain. As a rule. And where things get very difficult. And and in palliative care, we talk about this. We call it existential distress. And basically existential distress is so or is a is a crisis of of meaning.

1:26:58 In some way or another. So it's particularly potent at the end of life when people don't have much time left to make meaning and they realize they haven't been making living a very meaningful life or haven't Thought much about it. It can be really traumatizing to realize, oh gosh, to take all of a sudden to take that seriously and then realize you don't have much time to do much with it. So anyway, this idea of existential distress is huge.

1:27:24 In medicine and palliative care, it's very nascent. I mean, the way we treat it now is well, if someone comes to us and they're miserable Well, we rule out And or treat pain. Nausea, other anxiety, depression. We look for a diagnosis that we can treat and then we treat it.

1:27:41 And if folks after all that are still Miserable and shut down. Then we'll sort of invoke this phrase. Existential suffering or existential distress. This is what we call a diagnosis of exclusion.

1:27:55 So and no one knows what the hell to do about this. So diagnosis of exclusion. Yeah. So you just rule out everything else that you understand and if you're s then then whatever you're left with, you just call it this bucket term. And in this case, that bucket term is ex existential suffering. It's not a not a particularly inspired Right. Right. But but this is where also gets thrilling. This is my favorite thing about my field, which is Hallo 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 this total ubiquity, absolutely unesoteric field, absolutely relevant, you know?

1:28:33 No one I know has not suffered. It seems to be elemental to being a human being. And this is our fulcrum in palliative care. And what's more, we have named this thing existential suffering, which is so mysterious, right? 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.

1:28:59 All these otherwise non medical issues. So that was on ton of reasons why I love this space. And I'm getting around to answering your question, which is We have named I'm not in any rush, man. This is a long podcast. Always is. Good, good because I love this subject. So So we have the leverage now that palliative care is accepted and part of healthcare.

1:29:21 And has has called out the nature of suffering and has called out this thing existential suffering. We have this. portal to upload all these other fields and interests. And to keep them to make them relevant. So this is where it gets thrilling. Meaning you have a channel because you've wedged your foot in the door with palliative care. Yeah. Through which you can insert other things that wouldn't otherwise have an easy gateway. Exactly.

1:29:45 You got it. Right. So now enter the relevance of the arts, philosophy. Design. You name it. There's I mean what field isn't relevant

1:29:54 in some way or other to the human condition, right? So all of a sudden there's this Huge invitation. Possible. invitation to the rest of the world besides the medical s the sort of narrow medical sciences per se. That's really exciting. So

1:30:09 Back to psychedelics. Well So We can call out this existential suffering, but today. As clinicians, we don't really have much to offer it. We're aware that we've talked about as we've talked like bearing witness and non-abandonment accompanying people in their struggles is itself a great salve, and that's beautiful work.

1:30:29 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

1:30:46 Or sun on their skin. Some just to note when you feel happy to be alive. And there's our little toe hold to work from. So there's a lot to build around this. But what we haven't had is

1:30:58 We certainly haven't had any chemicals to offer people to help in this way. And it seems The data to date seem really robust that it may be that compounds like MDMA, psilocybin and other things may be radically helpful. In fostering A meaning making moment for someone.

1:31:20 of fostering a sense of belonging in this sort of cosmic way. And so in other words We have potentially with these compounds. Away. to respond to this wacky thing called existential suffering.

1:31:33 So this is just Really? For all those reasons. Yeah, I couldn't agree more. And for people who want to dig into this, and I would encourage everyone listening to take a closer look at this, there's a great organization. I think that they're really well organized and comprised of very good MDs and PhDs called the Hefter Research Institute. H E F F T E R it's just heftar.org.

1:31:58 And they do some incredible work with not only patient focus studies, but also research studies using things like F MRIs and uh different types of neuroimaging. to look at the specific effects of different types of psychedelics, whether you call them in theogens or psychoactive, psychotropics, whatever it might be. So it's a very, very a lot of interesting interesting work. And you can learn a lot about how these compounds function just by looking at

1:32:25 For instance, some of these studies And examining sort of the methodology, right? The protocols that they use. So if we look at And by the way, Tim, can I just interrupt interject? I've also had some really fascinating conversations with other folks in this space. And another organization to pull your listeners to is a group called Compass.

1:32:45 I think they're compass and they are beginning to also support research in this vein and also starting to try to align Health care systems and other institutions to participate in this work one way or another and to sort of pull this stuff again out of the closet. I'm not sure where they are in their development, but it's another group to be aware of. And I think their website is compasspathways.org.

1:33:08 So just another group in this space that's doing cool stuff. Cool. And you know what I'll throw one more in there maps. Uh which is doing a lot of investigation interesting work related to policy and the legal side of things. as well. And that that's worth checking out. And for for people wondering, these will all be links to all these things will be in the show notes at um

1:33:29 four hour workweek dot com forward slash podcast all spelled out. But coming back to Your story. And your life. I mean, I I really I have so much I would love to ask and we'll dig into some of them, but we're not gonna have time for all of them.

1:33:45 Which is fine. The Question that I'd love to ask next is What you feel you do. on a daily or weekly basis that is different from most people. Routine wise, thinking wise, self talk wise, anything.

1:34:01 Different from other physicians or just people in general? 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. R Practices that you've

1:34:14 adopted or developed habits, whatever it might be. that people listening might be able to test drive for themselves. Mm. Well let's see here, my friend. I've two I have two answers to that.

1:34:26 question. So the one is we you know we've touched on a little bit, but Aye. Find myself increasingly interested in the aesthetic domain, and by aesthetic I mean just the life of the senses. Not just beauty, but just the felt environment at all.

1:34:43 Mm that is the world of the aesthetic domain. And one of the reasons I'm particularly interested in the aesthetic domain Besides just delighting in having a body to feel anything, like we've talked. Is it's how it prizes Purposelessness.

1:34:57 So I am all for meaning. I see human beings as meaning making machines. And we talked about this a little bit like whether there is some grandeur Meaning in the universe? I don't really know. And frankly I'm fine not knowing. I I enjoy The mystery of it. And I'm okay if there's meaning on a grand scale or not.

1:35:16 Frankly. But meanwhile I am aware of our talent as a species to make meaning for ourselves and to string together narratives and stories and to make sense of our lives. I think it's a profound impulse and a lot of good comes from it. And I also just increasingly want to carve out a space for meaninglessness, purposelessness.

1:35:37 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

1:35:51 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 and don't hurt anybody else. But just

1:36:06 Give ourselves a space to delight, delight in purposelessness. That to me is is a huge deal. And I see it's therapeutic relevance for my patients very often who are beyond their life of purpose. They can no longer do that job they loved or their role in their family has changed. And they're so crestfallen because they don't have that reason to get out of bed.

1:36:27 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 at honoring Just

1:36:37 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 f of us are out there prizing purposelessness, but I do.

1:36:56 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.

1:37:11 You read his fiction But one of his quotes. But I've always Loved is I tell you we are here on earth to fart around and don't let anyone tell you different Don't let anyone tell you different And there's a story, I think it's actually in a dialogue.

1:37:26 with another writer at some type of event, and I'm sure someone will be able to find it. I'll try to put it in the show notes, but it might be tricky to find where he talks about this long walk that he takes to mail something at the post office and his wife just laughs and asks him why you wasted so much time and he's like, No, no, no, no, no, you don't get it.

1:37:48 I didn't waste time because and he runs through all of these seemingly meaningless Uh Seemingly trivial, but to him very important. Kind of. absurd interactions with multiple people along the way.

1:38:01 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

1:38:20 things with sensory inputs are the unimportant things. And I am not convinced at all that that is the case. In fact, it might be quite the opposite. And If you had a patient Come in.

1:38:35 They Are finally getting comfortable. at the Zen Hospice Project. Very introverted. And they say to you, you know

1:38:45 Yeah. I'm going to want to talk to everybody and get to know them, but I'm not quite ready. I just want to read. What one to three books? Would you suggest I read?

1:38:56 So funny because I mean I'm laughing because I am probably the least well red person you will ever meet. And especially one with like Degrees. College and stuff. I I uh if I I am all right, if they're give me

1:39:14 one to three things that I can watch, do, absorb, look at, et cetera, without human interaction. What would your answer be? Yeah. Thank you. That's better. For me. I mean, hey, I'm all for books too. Those are apparently are cool. Um but for me, you know

1:39:33 I love film. I love music. I love art. I love doing nothing. I love being outside. So That's for me to lit me. But I would put Big picture books in front of people.

1:39:45 I I mentioned Mark Rovko. Staring at Mark Rothko work is just a Gorgeous splendor, but it you know. Suit your taste. So For me, I guess I put some a p a picture book of uh Mark Rothco paintings in front of them.

1:39:58 I would put probably Any music. From Beethoven. Into their ears. And I probably would reserve that third thing for staring into space.

1:40:09 Before they stared into space if they wanted to watch a movie. Mm-hmm. What would you put in front of them? Man, there's so many good ones. Oh Ratatouille.

1:40:20 No. I think you know I I have a real soft spot for waiting for Guffman. Not that it has this great meaning per se, but by speaking of absurdity, I just think it's hilarious. Waiting for Govffman. I've never even heard of it. Never heard of waiting for Govman? No. Wow, wow. Ignorance on my part in this conversation. Although you don't read books, so I feel that evens us out.

1:40:45 So yeah, and you're but this is good news'cause man, you have so much to look forward to. I mean, so this uh this movie is by Christopher Guest and Company. The guys who did Spinal Tap and Oh wow. You know Best in show. Sure, sure. How do you say Govmit? Or how do you spell Govmit? I think it's G-U-F-F-M-A-N. Got it. So That I I've just always a long term favorite. I mean as a kid growing up.

1:41:10 Kentucky fried movie. My God, I haven't thought about that in Decades. Yeah. Wow. That was like really an important movie in my childhood. We watched it probably I don't know. A hundred times? I mean. Every day.

1:41:24 I mean that and Groove Tube, I mean it was you know Formative for us. And I heard uh that you asked another question specifically about documentary film of other guests and I was thinking about that. And

1:41:38 You know. One that leaps to mind I I don't No of you really even consider it a documentary, but I guess it is. It's you know, the movie Grizzly Man. Oh man, oh man. Yeah, that's I consider that a documentary.

1:41:50 Yeah, sure. Let's call it a documentary. So yeah, of course it is. I mean it in in it is I f Any Piece of art. Where I simultaneously or I'm not sure whether to sob.

1:42:01 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 so I just I think it's a beautiful like an amazing piece of film making.

1:42:21 And I also particularly like its poniency around our Humans uh silly dance around nature. And how we humans think of ourselves as somehow opposed to nature. And yet when we try to reinsert ourselves into the wild

1:42:36 It doesn't necessarily go very well. Uh and how we romanticize 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 speaking of perspective making, you know, and thinking on geologic time. And making myself feel very, very small and inconsequential is is really deeply therapeutic for me.

1:43:00 When I go out in Utah and I got lost twice walking around this particular area. And it's the same feeling I had watching Grizzly Man, which is Mother Nature As far as I can tell, it's pretty indifferent to us. You know. Yeah, I would say so.

1:43:14 So anyway, there's my answer for you. So the that brings to my two things. The first is you mentioned that feeling which is two sides of the same Coin almost. That of being a simultaneously repulsed

1:43:28 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 the response tends to be breaking out into what would be considered by primatologists Hysterical laughter.

1:43:54 And this this seems to be something very, very hardwired. So returning to that in some way and it being therapeutic doesn't surprise me. The second Is Just to tie together a few things you've said related to sort of the meaninglessness Which may be

1:44:12 too loaded a term for some people, it might come off as very negative, but yeah seeming inconsequential or small in meditating on that, or or not even meditating on it, experiencing it in a very visceral way by his being in the desert. Or looking up at the sky. I think it's very compatible with Something that struck me, which was told to me by Tony Robbins, who's also been on the podcast. And uh he said that

1:44:36 And I'm paraphrasing, but that Most human suffering comes from a focus on me, like a self. Focus. And If that is true, it makes perfect sense that focusing on

1:44:49 this expansive geological timeline which which puts our like shitty week into a Just hilarious. perspective.

1:45:00 Mm-hmm. Makes a lot of sense. Uh-huh. This is unrelated, but What do you think of or who do you think of when you hear the word successful? Mm. I think of

1:45:10 Well, you know, you just pointed to something the the relationship of self. And the silliness of self. And the power of the self. And I think we do ourselves disservices by by playing into po polemics around, you know. Selfishness or selflessness.

1:45:27 So there's a lot to say about that, but So the 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.

1:45:45 And therefore not make the measure of some external success. But someone who has sort of become themselves Delighted in themselves, including their quirks and awkwardness. And played that self out.

1:45:58 You know, insisted on itself all the way to the end. To me that may be a version of success. So I guess I'm one part of my answer to your question is I I think of it as as really an internal Process. But then beyond that, too, I guess I'm a little torn here because

1:46:14 I I agree. That that What I just said sort of Focuses us and success back into the self. And I suppose

1:46:24 The second half of the question really has to do with Orienting oneself to the other. To everyone but oneself. And to the relational dynamics between the self and the other. And so

1:46:37 I think probably success may be or the second half of it has to do with Anyway, 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 is it has the potential to be this equalizing, uniting. Force. So success may be this sort of self actualized piece, but part of that self actualizing is it is exploding the sense of self and feeling part of everything around you and vice versa. That consonance with the world around you, that seems like a great success.

1:47:12 Is there anyone who embodies that for you or comes closest? Well, I recently had the joy of sitting with Oprah Winfrey. And watching her make use of her life and now point and and and also point her energy to pr promoting and helping others is It is that.

1:47:30 There you go I mean A remarkable life's work. And it's just a name we all know. Wow. But you know I'm also

1:47:39 interested in all the gazillion successful people we walk by every day and don't even know it. You know. Mm-hmm. This kind of happiness, this kind of success doesn't necessarily brag about itself and I love presuming it when I'm unaware of it and and assuming it exists in others that I walk by on the street.

1:47:56 In a way you find yourself kind of imbuing others an idea of success that changes how you look at them and how you treat them. Definitely. And that's a sort of a sweet favorite daily exercise of mine. Yeah. So no, I it's hard for me to say a single person that I would point to as embodying all this. So let's you actually

1:48:15 answer or point then my question deserved, which is your Morning practice. So could you elaborate on that, please? When do you do it and how do you do it? So you're walking Just t to take us through this morning exercise.

1:48:32 How I get up in the day to start the day? No, what you just talked about. Sort of assuming the presence of this type of success. You said uh it's morning exercise of yours. Oh I'd love to just hear you elaborate on that. Oh, I don't know. I I I w I didn't remember saying morning. That's what tripped me off. Ah, sorry. Daily daily exercise, perhaps. Oh, there we go. Yeah, I could have made up the morning part. Who knows, but sure. But it's sort of an any time of day or night if this is useful.

1:48:57 You know, it's kind of like Just the power of mean of of of meaning well. Of of wanting well of others. And when there's a choice in the matter to see to choose to see good. And and if you can't know, assume good. And this kind of builds an argument to your day.

1:49:14 Of gratitude and happiness and some amount of comfort. So I'll catch myself being bitter or I get kinda road ragey. I'm very aggressive on my motorcycle and car and actually just today I was really annoying someone by following them too close. Whatever I get Again in my Bullshit zone pretty quickly. But when I'll catch myself and then so when I walk by you know, particularly here the Bayer, the homeless epidemic is enormous.

1:49:39 And it's just I'm I'm particularly Uh acutely aware of this exercise when walking by someone who Otherwise the world would assume in a sense that they ha are 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

1:49:58 Whatever they're going through is vital to them. And that may be Whatever junk we project onto them. That inside. Maybe they're all right with who they are.

1:50:08 Maybe they're way more all right with who they are than a lot of people I see striving in otherwise looking successful. So it's really it's just simply that. I actually learned this. My mother took me to a Deepak Chopra conference when I was pretty young. It was a long, long time ago. And the one thing I heard that stuck that was really interesting to me was is getting in the habit of saying, you know, and It when anyone when you hear anyone sneeze Either say it out louder to yourself, say bless you.

1:50:33 It's just uh It's like a ner 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.

1:50:50 You know, that that lands somewhere, that that lands up to a vibe. Mm. So that's the kind of stuff. You walk around and you see people and you just project Well wishing onto them. Now I hate to

1:51:03 Focus on something maybe superficial, but you said riding your motorcycle. No I apologize if this sounds like a weird question, but you Have

1:51:15 three limbs that have been damaged. How do you ride a motorcycle? So yeah, so you know this is This was a sort of long dream that recently came true. Congratulations. I mean it's awesome. I'm just so curious about the logistics. Thank you. Well, it's interesting you ask because uh right now there's

1:51:32 The man who helped make this dream come true. Randy He ended up being my patient and our resident at Zen Hospice Project not long after he converted my motorcycle. So there's a lot to this story, my friend. So Cheers to Randy and his family and his wife. I I mean and his mother.

1:51:48 Elone whom I'll be seeing next week actually. So That's one piece of the story. But the other is it's I'd always I love two wheels. I love gyroscopic gyroscopic lifestyle. I love the feeling of it. So I've always loved riding bicycles. And then I'd always wanted to get on a motorcycle, but I kept going to shops and you know

1:52:06 People would sort of look at me and no one got into it. No, 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 Lawwill, who's an old Motorcycle racer champion. Well sort of legendary in that world.

1:52:22 She happens to live around here. And he built a prosthetic component. I don't know what the story that inspired Mert to do this, but he he's a machinist himself and a handy fella. And then his retirement he got him in his business of building this prosthetic component that lends itself very well to mounting an arm onto a bicycle.

1:52:43 Or a motorcycle. So the first piece of this puzzle was discovering Mert's invention. And getting a hold of it myself, which allowed me to get my prosthetic arm attached to a handlebar in a very functional way. So you have Throttle.

1:52:57 rear brake and then typically front brake on the left. How are those controls modified? Okay, so Randy, what he what he figured out, so first was to get the arm piece, and then what Randy figured out was Well then Aprilia And I know Honda had made a version of this as well, but

1:53:13 Prillia makes a a model the Mana M A N A. That is Clutchless. So That was a huge to get out of the way. So this is essentially an automatic transmission. So n that do away with the clutch and gear changes. So that's a huge piece of the puzzle out of the way.

1:53:31 And then Randy figured out a way to splice the brakes front and rear in a certain ratio into a single lever. So I'm doing nothing with my prosthetic feet. Except to hold on to the bike. I'm doing nothing with my prosthetic arm except for holding on to the bike. So all the actions in my right hand.

1:53:48 Breaks into one lever. And Randy built this box and moved all the controls, the turn signals, horn and all that stuff over to the right side of the bike. than good distance for my thumb to reach'em. So I have Throttle.

1:54:03 Brake lever and then the Turn signal box all going with one hand. And that's so awesome. That's it. You know, that's that's a way away you go.

1:54:13 Okay. I just have to pause here for a second and just Ask everyone listening, what bullshit excuses do you have? For not going after whatever it is that you want. Like, please write in, tell us on social media why these are real excuses. With hashtag bullshit afterwards. Oh my God, man. That's such a great story. I'm so glad I asked about it. And what a really Fantastic.

1:54:45 Work around. Man, congrats. That's awesome. Thank you, and thanks, Randy, and thanks to the folks at Scuderia, 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 of trying to find the right folks to make it happen. So amen. Amen to that. So just just a few more questions. I wanna be respectful of your time, but I'm having a blast here. What

1:55:07 One hundred dollar or less purchase has most positively impacted your life. In recent memory. I'm guessing not the motorcycle. No. That was a little more than a bucks. Holy cow man, wow! You know?

1:55:23 I would probably point us to a beautiful Pinot Noir from Joseph Swan up in Sonoma County. It's like the artwork of Andy Goldsworthy or anyone who delights in anything ephemeral, the charm in a bottle of wine, the craft, all the work that goes into it. And Actually delighting in the fact that it's perishable and goes away. I find really helpful.

1:55:48 So I've gotten a lot of miles out of a beautiful bottle of wine. Not just for the taste and the buzz But The s symbolism. Of delighting in something that goes away. Here, here. I have a practice that some folks might enjoy, which I didn't come up with. I'm pretty sure I borrowed it from uh some past girlfriend, but

1:56:07 I have a small glass jar. And I keep The corks. From bottles that

1:56:17 I finished with friends at home. And I have each of them write something on the quirk. So I have this collection, the bottles are gone, the wine is long gone. But there's this vestige. The right maybe that's not the right word.

1:56:31 I'm trying to Gary. To to sound intelligent. The quirks 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. Yeah, so no no matter how sort of lonely I might feel at times.

1:56:45 I think we all do at moments. It's sort of a reminder of how close by how within reach sort of friends and that type of experience are. If you could put One billboard anywhere with anything on it. What would it say?

1:56:58 Oh boy. That's a doozy. Let's see here, man. Well, you know, it makes me think of As big as billboards are, you can't only put so much on them and it makes me think of the My favorite bumper sticker.

1:57:11 I guess and it seems like such a potent I I just love I love it. And so I would love to see it on a billboard, which and and the basic bumper stick. I'm sure you've seen it is don't believe everything you think. I've actually never seen that. That's a really good one. Oh, it's so good. I this is a sweet, hilarious

1:57:30 true reminder to not take ourselves so dang seriously. You know, and so anyway, I that's that's probably my choice. Don't believe everything you think. Don't believe everything you think. I was really waiting for what this was gonna be. I was I was really wondering. I saw one. This is I'm really gonna lose any shred of respect that people have for me by saying this, but I saw one recently that was a it was not a bumper sticker. It was surrounding the license plate. Uh I'm not sure what the license plate Casing I guess. Um If you're on my ass, you better be pulling my hair. Thought that was pretty clever.

1:58:06 Uh, but it shows you where my level of emotional maturity is. In any case Paul. Don't you're I you know, I thought I might I might lose you with that one. That's okay. I'll try to really reel you back in with the next few questions. So yeah, don't believe everything you think. That's awesome. I'm I'm astonished I've never seen that. D what advice would you give your

1:58:26 Thirty year old self. And if you could place us with where you were, what you were doing, that'd be helpful also. Ooh, wow, that was a particularly poignant time for me, actually. So there's a lot going on. I was in I was uh deep in med school. It was in my last year of med school. Boy.

1:58:42 I had kind of really ex sort of experimental tour of my twenties. And I was sort of settling into a new rhythm. I had finally let go of a f fair amount of guilt around my own accident and the effect on my friends and I was pretty neurotic at that time and my sister had just died, so it's

1:59:05 This may not be the intention of your question, but thirty happened to be a really sort of heady, heavy time for me. But I'll I'll still roll with the question. And I think I guess I would have Help myself. Did you You know, I this sounds way too tidy, but I might have said something like, Hey man, you know, don't believe everything you think. Don't, you know. Let it go.

1:59:27 Don't take it all. Yeah. I do mean to take life very seriously, but I mean to take things like playfulness and purposelessness very seriously. So I want to take So I don't mean this this is not meant to be light. But I think I would have um somehow encouraged myself.

1:59:43 To let go. Little bit more and and hang in there and don't Pretend to know where this is all going and you don't need to know where it's all going. Yeah, you don't need to know where it's all going. And you can't. And you can't.

1:59:56 Yeah. Yeah. What have you changed your mind about? In the last few years. Well, for all my talk of purposelessness and all this stuff, you know, I have in the last several years allowed myself to feel that I have a true vocation in this work around palliative care and

2:00:14 Helping us as a species. Deal with our and dance with our mortality. I had Convince myself that You know, hey man, I had gotten to very loose and I was whatever. I didn't feel the need to accomplish so much per se. But in his last few years I've let myself

2:00:33 I think in a way, man, I think I've let myself Get More ambitious in a way. Mm-hmm. And to take my work

2:00:43 Even Extra seriously. More seriously than perhaps I I had been. And letting myself feel like This could all work.

2:00:52 And Letting myself feel like actually the healthcare system Couldn't be fixed. So in other words. I guess in a word.

2:01:00 is to reacquaint myself with something I talked myself out of, which was ambition. I still think of that word in negative with negative connotations. I see bad behavior on behalf of ambition a lot. And I'm sure you have too in around where we live and Places like Princeton and people stepping all over each other to get ahead, and that's not what I'm talking about. Maybe it's aspiration. Yeah, yeah.

2:01:23 Mm-hmm. Yeah. That's right. Well on that point Do you have any

2:01:29 Any last Requests. Ask. suggestions or otherwise for the people listening. Oh thanks, man. That's such a

2:01:40 Great invitation. I mean one is Folks, hey every everyone, I I would hope we could start seeing the remarkable amount that we all have in common. By virtue of being the same species on the same planet, et cetera, and mortal beings at that end. I guess I would ask that we start looking to make that Real?

2:01:59 I would ask that we prize kindness. We would ask that we learn to forgive in a daily way. But more strategic, I would ask you guys, if you're so moved, to get involved reifying and supporting hospice and palliative care. If you're in and around the Bay Area or just so moved, we would love your support as an hospice project. These places rely heavily on philanthropy. So if you're move, please come check us out, zenhospice.org.

2:02:30 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. Yeah, I'll leave it at that. That's a that's plenty. And I really I've been so excited to chat with you for so long and I I've had so much fun in part Because it's exciting to me to think that

2:02:51 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

2:03:06 The ability to do it. In this laboratory called Zenhos's project. to do a lot of experimentation that could actually translate Much more broadly.

2:03:17 to Life. not just at the end of life, but throughout life. And I find that very, very inspiring and exciting. So I I think it's a real tremendous opportunity and and uh potential point of leverage that you have and so people can find you

2:03:33 At Zenhospice.org. Z E N H O S. Zenho spice.org, Zenhospice.org. Uh Facebook is Zen Hospice Project, uh, Twitter at Zen Hospice. And I'll put all this in the show notes, of course. for everybody listening.

2:03:53 Can I also on that note, Tim, can I just give a shout out to the work that's also the great work that's being done at UCSF. Absolutely, of course. the symptom management service in the UCSF Cancer Center, the outpatient palliative care program there, Mike Raybo and all the work going on around there is is gorgeous. And that's another thing to s consider supporting. But that's another place to find my work too. Definitely. Yeah. U C SF is just spectacular and uh I've I've done I've I've also been involved with um both the Gazali Lab and and other folks at UCSF. I'm just continually

2:04:26 Impressed. B J 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

2:04:42 On a smaller level, of course, the time that you carved out today. For this. Mm-hmm. It's such a pleasure, Tim. And that went really fast, man. And thank you so much for having me on the show. It's such a joy. And to everyone listening.

2:04:55 You can find the show notes, links to everything we discussed. at four hour workweek dot com forward slash podcast. All spelled out or just search. Tim Ferris and Podcast. And as always, and until next time, thank you for listening.

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