A Practical Handbook for Facing Death with BJ Miller, MD and Shoshana Berger
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What is the main topic discussed in this episode?
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Hi, everyone. Welcome to another special episode of The Nocturnists, stories from the world of medicine. I'm Emily Silverman. As we work on season three, we've been tackling some big subjects. Today, we revisit one of the biggest, death and dying. As doctors, we learn a lot about the end of life, how to stave it off, how to address it with families, how to manage our patients' suffering from a medical standpoint. But there's a lot that all of us, doctors and non-doctors alike, don't learn unless we have to. My guests today have written a handbook that anyone, the living, the dying, those close to the dying, those treating the dying, can use. It's called A Beginner's Guide to the End, Practical Advice for Living Life and Facing Death.
Honestly, I took a lot away from this book, not just as a doctor, but as a human. To start with, I asked both authors to read an excerpt about what got each of them in the prime of their lives facing death. First, here's hospice and palliative care physician B.J. Miller.
Part of the reason I wound up becoming a doctor is that I came close to death in my own life, earlier than expected and in a dramatic enough way that I had little choice but to sit up and take notice. One night, when I was a sophomore in college, a couple of friends and I headed out for an hour or two on the town and then made our way to the Wawa for hoagies. On the way, we crossed the old rail line. There sat the Dinky, a two-car commuter train that ran from Princeton to Princeton Junction with a ladder up the back. We were exuberant kids spotting a perfectly climbable tree. I jumped on first, and when I stood up, the electric current arced my metal wristwatch, blowing 11,000 volts up my arm and down and out my feet.
For that lark, I lost half an arm and both legs below the knee. I was taken to St. Barnabas Hospital in Livingston, New Jersey's one burn unit. I was intubated but awake and could hear the trauma team taking bets on my survival, some saying, this guy's a goner, others betting we got this. The nurse, Joy, who would become a guiding light for me, must have seen my eyes widening, so she told them to shut up and came to my side. She showed me I was safe there, even amidst danger. Together with close friends, family, and the staff of the burn unit, I would begin to learn what it felt like to be cared for, the terror and grace of depending on others for life. That place would be home for the next four months.
What personal experience led BJ Miller to pursue palliative care?
One night, it began to snow outside. I remember the nurses chatting about the drive in. There was no window in my room, but it was a lovely and frustrating thing to imagine. The next day, my friend Pete smuggled in a snowball for me. Drip by drip, that little shrinking thing unpacked a rapture. Snow, time, water. Knowing that creation held room for both ends, it mattered less whether I lived or died. For a moment, death was in its place, obvious, common, benign. So began my formal relationship with death. I returned to college in the fall. I was trying to be a normal college student, but things were not normal yet. I ditched the wheelchair for a used golf cart, but I had a giant right arm from pushing myself around for months.
The rest of me was real thin. I wore a brown prescription compression vest over my scar tissue so it wouldn't ball up. My skin was sallow. I had a hook at the end of my arm stump that I rarely used and just hung there instead. Really, I was pretty disgusting. Always drenched in sweat, squishing around in my legs that had their own odor, leaving puddles wherever I sat. I'd go into the dorm showers on my knees, sitting down amid the hairballs and athlete's foot flakes, so I was never sure if showering actually made me cleaner. But that didn't matter. Water running over my skin didn't hurt anymore. It felt downright glorious.
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Chapters
6 chapters
1
What is the main topic discussed in this episode?
0:00–3:03
2
What personal experience led BJ Miller to pursue palliative care?
3:03–10:23
3
How does Shoshana Berger describe her father’s decline and the need for a caregiving guide?
10:23–18:49
4
How did BJ and Shoshana first connect and decide to co‑author a handbook on dying?
18:49–23:23
5
What challenges do caregivers face and why are they often invisible?
23:23–28:52
6
What practical communication tips does the book give for talking with doctors about prognosis?
28:52–32:52