December 11, 2019

In an interview with NPR's Terry Gross, B.J. Miller shares the shocking story of how a night's adventure cost him half of an arm and both his legs below the knee—and how his near death experience shaped his decision to become a palliative care physician.

Use these resources to help you deliver effective palliative care

How an accident inspired a career

Miller, who today works at the University of California, San Francisco's Cancer Center, recalls a life-changing evening in 1990 during his sophomore year in college when he decided to climb on top of a parked commuter train. While the train had been parked for the night, Miller soon was hit with 11,000 volts of electricity.

"There was a big explosion, a big flash of light, and I was thrown ... quite some distance," Miller said. "My body was literally smoking."

While Miller survived the accident, he lost both of his legs below the knee and half of one arm. Initially, after his accident, Miller said he started "doing a little work [in] arts advocacy and disability rights," and thanks to his work in that field, he "realized that disability is not something to be ashamed of."

"It's not something to overcome, to put behind you—it's something to work with. It doesn't go away. I can't overcome this; it's my daily experience," he said.

With that realization, Miller decided the best professional path for him was one that enabled him to "work with" his disabilities. He explained that medicine came to mind "as a way where I could use these experiences and pay them forward in some way or draw from them—not overcome them and put them behind me."

Using his life experiences to support patients

Miller said his brush with death gave him a new perspective on life. "I came out of there eventually holding life much more loosely," he said. As Gross writes, Miller was able to "find the balance between life and death, and joy and sorrow." And that perspective has helped him care for his patients, especially when speaking with patients who are afraid of death and of dying—and those fears are distinct, Miller said.

For example, if a patient voices a fear of how painful the dying process may be, Miller said he can reassure them that "any hospice and palliative medicine team can do a lot to quell the pain and the sorrow that happens during the dying process. We have medications. We have ways of being with each other. We have ways of positioning your body. There's all sorts of things to do, so suffering is not necessarily part of the dying process."

And for those patients who express a fear of actually being dead and what comes after, Miller—while frank with them that he doesn't "know what that's like"—engages them in conversation about their worries. "[L]et's think about it," he tells them. "Let's talk about it."

And once they start talking about it, Miller said "most of us can get to a place where we realize that we're not just our bodies—and our bodies, once they're dead, aren't likely to be feeling anything."

But digging further, Miller said some patients open up to a fear of missing out after they're dead, "this idea that the world is going to continue on without them, all the things they're not going to get to see, etc."

But, Miller said, "if you go there, then what has that done? That has pointed us very squarely to all the things we love and care about. And then that becomes a nice compass for our way forward, how we're going to live until we die. The fear there, the things we are afraid to miss, are the things we really should uptick in terms of our attention now."

As for whether he regrets his accident, Miller said that's hard for him to do.

"So much has flowed from it," he said. "If I'm honest, there's a little bit of pride … [What] I'm a little proud of is the decision to work with this experience over time, to dig into it, to mine it, to find a creative energy in it" (Gross, "Shots," NPR, 12/3).

Use these resources to help you deliver effective palliative care

Palliative care offers a cost-effective way to reduce patients' symptom burden, increase patient and family satisfaction, and even reduce unnecessary utilization. Despite the growing body of research documenting these benefits, many organizations still struggle with misconceptions about palliative care and entrenched practice patterns—not to mention insufficient reimbursement.

Use these resources to help confront the cultural and clinical barriers to effective palliative care:

Get the Resources
Download Now

Topics