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Transcript

David Abend: Hi. I’m David Abend, founder of The Bucket, and your host for the bucket podcast. Today’s podcast is for anyone who thinks they might die someday. I’m talking with Dr. BJ Miller and Shoshana Berger; the authors of a really important new book called A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller is a hospice and palliative care physician who has worked in many settings, inpatient, outpatient, home and residential hospice. He sees patients and families at the University of California, San Francisco’s Helen Diller Family Comprehensive Cancer Center, as part of the Symptom Management Service where he’s worked since 2007. BJ was also Executive Director for the Zen Hospice Project from 2011 to 2016. He speaks around the country and beyond on the theme of living well in the face of death.

His co-author Shoshana Berger has worked in publishing for more than 20 years is a freelance writer, senior editor at wired, and editor-in-chief of Ready Made, the magazine she co-founded in 2001. She became editorial director of the global design firm Ideo in 2013, where she has worked on projects related to the end of life, modern Judaism and school lunch. She has written for the New York Times, Wired, Travel and Leisure, Sunset, Spin, Popular Science, Marie Claire, and The San Francisco Chronicle. Today, you’ll hear how and why these two came together to write this book and why they think you should read it. Welcome BJ and Shoshanna. Thank you very much for being here.

Shoshana Berger and BJ Miller: Thanks for having us.

David Abend: I’ve been really looking forward to this because in my conversations with people about The Bucket, it’s like you’re in another country and nobody speaks the language. You get people smiling and nodding, and so in talking to you guys it’s kind of like I found somebody who speaks the language and that’s really exciting for me. I want to start with the book. The book is called A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death. I just want to get some background. Why did you write it? What are you trying to have people get out of it? Just tell me more about that.

BJ Miller: There’s so much to say. There’s how Shoshana and I came to meet and get to know each other and feel the trust that this book required. There’s a lot to say about that. We had experiences together here at Ideo on some projects and found each other’s like minds and complimentary minds. When Shoshana asked to write this book, it was a pretty quick yes, because from where I sit as a clinician the need for a book like this is obvious. As any kind of medicine or just about anywhere in the world, you’re going to get hit with this issue. Particularly in medicine you’re aware of all the mountains of suffering that happen towards the end of life that are so unnecessary, the reflection of just non-thinking systems or lack of attention to some very basic things. When Shoshana asked it was a very quick yes, because I knew the world needed a book like this. I’ll just say one more thing. What I hope happens is that it’s a nice level set. I think it’s well titled. It’s a beginner’s guide, the subject is huge, there’s no way we can touch on every aspect of this thing. But, we hope we paid it a good respect. In a massive way, “Soup To Nuts”, you have a kind of smattering of all the issues that come up towards the end of life, at least here in the western society. The hope would be that this sort of raises the floor for society. It’s not going to blow off the roof. There are so many other things to get to, but hopefully it raises the floor, so we’ll have a relatively good starting line together. That’s the hope for me.

David Abend: Obviously you probably agree with that, but what motivated you to say, let’s write this book?

Shoshana Berger: Well, I think your listeners probably hear that already because BJ oozes compassion out of his pores. You feel it the minute you’re in his presence. When I met BJ, I was three months into the death of my father. It had been a very harrowing and difficult period of five years watching him lose his mental faculties to dementia. He had been a professor for 50 years. He was basically a walking brain and when he lost that, that was the one thing that mattered to him. I had come out of that experience with a lot of regret for feeling like I just didn’t know how to be a good caretaker. I didn’t understand how to navigate health care. I didn’t understand what care we could expect, what help we could expect. I didn’t understand insurance and how to talk to doctors and the millions of systems questions that come up when you’re taking care of a loved one who’s either chronically ill or dying.

We met on this fateful day, it was an Ideo kickoff for a project around the hospice that he was then director of, Zen Hospice. The idea was how do we get the message out about hospice that it is not a death sentence. Hospice actually offers you the best and freest care possible in a time that’s incredibly trying for your family. And yet, people see it as the end of the road. They often don’t elect it until it’s far too late. We actually built this kind of death yurt inside the Ideo offices for us to have this conversation. I mean literally erected this kind of dome and you walked through this tunnel with flickering lights coming in from above and music, essentially, we’re trying to create an intimate space to have this conversation. The people in the room were sharing what they wanted for their last day on Earth. There were some very grand visions like I want to be on an iceberg in Iceland and I have a whole playlist that’s going to connect me to myself. I remember thinking this doesn’t resemble at all my experience with my father, which was sitting in my sister’s childhood room, scrambling around to find a tape of old Yiddish music that he might like to hear as he was dying, staying up all night just stroking his head and watching him go. That was quite a different vision. I think many people will resonate with what it truly is, which is very quiet and intimate. Sometimes in the hospital it can be a very noisy experience with alarm bells going off in the ICU. I needed to reconcile our desire for a grand experience at the end of life and for something that feels like it reflects our identity and the real experience that I had just had. BJ came in with this really incredible vision for how we could start to reframe our relationship with death based on his work. It was so clear to me in that moment: people need help with this. I need help with this and there’s a million people who need help with this. We should write a book that walks people through this.

David Abend: I listened to it. You had said in the opening that you didn’t necessarily write what you read, but it was great to hear your voices, the emotion of that, because I felt your pain with your father when you talked about it. It also feels like you learned from each other. I’d like to know what you learned from what BJ wrote that you didn’t know before and what did you learn from Shoshana?

Shoshana Berger: Again, I’m just going to return to this notion of open-heartedness and compassion. I come from a very hard-boiled journalistic world where you’re there to entertain, enlighten and speak truth to power. That’s a pretty hard brass-tacks voice. That’s the way I write. Then I would read BJ’s words and it was like this flowing philosophical open-hearted lyrical compassionate voice and I was immediately comforted by it. I put that up against my magazine voice and said we need to find a happy medium here. I think both of us shifted to the medium. He picked up a little from me, but I certainly picked up a lot about how to put the reader at ease, how to give the reader the sense of space, sense of your with a friend now, and as a journalist, I did not know how to do that.

BJ Miller: I didn’t know anything about writing. I’m not a writer. If we had endless time, it would have been so interesting for each of us to write the book independently and just cross-reference. My book would have been terrible. I would not have ever looked found myself comfortable stating something declarative. I would have always been dwelling on the exceptions to the rules. I would have just been. By itself, it would have gone into the ether, as there would have been no end point for the reader, it would have gone in loops. Anyway, a big piece for me was just watching and learning about the craft of writing in such a way that actually you’re getting information in this practical way. You’re not trying to write poetry, you are trying to parlay information. You’re also trying to do it with emotional support underneath the words because we know the reader is going to be in some amount of vulnerability with this subject. We had to find a way to share the emotion as well as sort of the practical stuff, and that’s why the marriage between us works so nicely. I also learned how Shoshana writes, and just the content that she brought as a journalist. I learned a lot about the finances, I learned a lot about the insurance hell, I learned a lot about the sort of day-to-day vagaries of the stuff that doesn’t really make its way into a clinical encounter, although it probably should.  I learned a lot from the content that she brought to the book as well.

David Abend: When I think about the reaction to the book, I’d like to find out what the reaction has been from people. What have you been hearing?

BJ Miller: Your listeners may hear my dog Maisie in the background. That’s not my stomach. Interestingly, we haven’t heard a lot of negative feedback. The book of course is imperfect and it’s not going to do justice to every situation. I’m waiting for a real hard critique. Your podcast is a good example. We’ve experienced how in the world there’s a hunger to talk about these things, and a desire to have some language and some safety around it. Mostly what we hear is some amount of gratitude for even trying to put a book out there, just for cracking the plane.

David Abend: For you to write this book, nobody’s surprised, you are a palliative care doctor. This is something that you do, but not for you Shoshana. When I talk to people about what I’m doing with The Bucket or talking about, as I call it, mortality-based living, people look at me, close their eyes, put their hands over their ears and say what’s wrong with you. Since you didn’t have this background, what’s the reaction you’ve gotten from people?

Shoshana Berger: That’s a great question because it really did come out of left field. The first reaction is are you okay. Is there something we should know, thinking that you got a diagnosis? But no, you’re absolutely right. It was it was out of left field for me. The interesting thing is that you think people have a certain conception of you and a certain image of you, that you have to hold to. You kind of pigeonhole yourself in life. I find that, first of all, people are not thinking about you, they’re thinking about themselves. Second of all, they are incredibly forgiving of whatever choice you decide to make. They’re just like that’s interesting tell me more. There were certainly some people who I couldn’t have a conversation with about it. I remember walking into my accountant’s office and putting the book on his desk, he visibly recoiled and pushed his chair back. He said, “Why would you write that?” People have different reactions, but I’ve found that most people want to be thought of as a person that contains multitudes, and someone who is expansive and can reach all sorts of different places in life. How boring would life be if we had to do one thing our whole lives? I think people are actually encouraged and emboldened by it. Like wow, you had a do-it-yourself design magazine and now you’re doing death. So, I like that part.

David Abend: I’m sure you’ve encountered what I call the choir. You’re familiar with the death positivity movement. Some of the people I talk to are in the choir, like Kimberly Paul’s Death by Designs, doing the Live Well, Die Well tour across the country, and the Before I Die Festivals that go on throughout the world. When you talk to people in this choir, everybody’s all in. How do we get outside the choir because your book is to the choir. The people that are going to pick up your book and say I got to read this, are the people that are probably already there. Not necessarily the practical stuff that you talked about, but the emotional stuff. How are you reaching outside the choir? And, how do you think we can?

BJ Miller: You’re bringing up a really important point. There is something lovely about the choir, because first of all it is something very important and intimate to have in common. When you meet someone from this choir, it is pretty quickly warm and lovely. This choir traditionally over the years has been a little bit at odds with the rest of Life on some level or the rest of society on some levels. In some ways there’s a little counterculture to it and when counter culturists meet each other there is a sweetness to it. It really feels like you are a part of, sort of a revival. We’re checking in together in groups to kind of reaffirm our interest and learn a new thing or kind of remind ourselves that’s beautiful and it’s important. I don’t want to discount that, but the people who really need this information aren’t necessarily looking for it or willing to pick up that book. You can look at us as a design problem. That’s one of the reasons why it was such an easy yes to work with Shoshana, with her background in design knowing that we could work together and with our illustrator Marina, who did beautiful work. We felt like we could create an object and the design brief for the book itself was that the book itself be palliative, that it had to be comforting even just to touch. The texture of the paper, the imagery, the way the book is spaced, etcetera is really important. We hope that the design principles help people be attracted to a thing that they are otherwise repelled by.

That was a huge piece of why we put so much energy into the design of it.  That’s a start, we will see where it goes. We’re hoping that more and more people will catch on. We wrote it really with the sensitivity of the person who is dealing with illness themselves, but right behind them and next to them, of course, is the caregiver. Our hunch is that most of the time it’s going to probably be the caregiver that picks it up. We get asked a lot, “how do I give this to my parents? What message will I be sending them if I give them this book?” We’ll just have to see how it plays out. I think there are ways to do that for your listeners. For one you could say, “mom and dad I found this book very helpful and it would be helpful to me if you read it, it would help me, it would mean something to me, you would be doing me a favor.” We’ll see if we can infiltrate this that way, but that’s the hope. It’s an open question.

David Abend: I know you had a title that was even more direct.

Shoshana Berger: Yeah, the original title was How To Die.

David Abend: That’s one of the things that we’re trying to do is to take away these words and language, that try to hide it. I think the hiding and not dealing with it is one of the biggest problems. Do you think that’s a way to get to the choir, to be so direct?

Shoshana Berger: I do and, in fact, one thing we really were mindful of when we were writing this book is not being Pollyannaish about the beauty of death. Believe me I love the choir, but there are times when the death positivity movement goes so far in the direction of positivity that you forget that this is also a process that can be enormously difficult, painful and involve a lot of grief. Again, this is trying to reconcile the reality with us working with it as an abstraction. BJ and I have never died, we’re beginners too. We wanted to take the full breadth of experience in. I want to tell a quick story about this. I just visited with a dear friend from college who is now dying of a brain tumor glioblastoma, and he doesn’t have long left. When I saw him, part of him was paralyzed and he was having real trouble with speech. He had come home basically in what felt like a farewell tour to Los Altos, to his mom’s home. All of his relatives had come to basically say goodbye. Nobody said it out loud, but that’s what it was, and I didn’t know much about the situation. He had literally texted me saying, “Good timing for your book. I have brain cancer. Can you meet me in Los Altos on this day?” That’s all I knew. I show up and all the relatives are there. His mother walks me to the bathroom and in the hallway, I said, “Can you just tell me a little bit more about what’s going on?” She broke down and she said, “He has a brain tumor, it’s progressing, it’s incurable and he is going through treatment.” Then she started crying and I said, “I’m just so sorry.” She said, “It’s unbearable.” She had been smiling, keeping a brave face on and greeting me like a host. This was not the moment when I was going to say I have a book for you.

We don’t want to be opportunists. In that moment, I just was there that day. Mike knew about the book because he had texted me. Anyways, I just got a text from his mother saying that she had gotten the book, read it, and it was enormously helpful to her and that it was comforting just to know that it was out there, and that I was out there. This is not someone who would have really been in the death positivity movement, nor would she have thought about these issues and again she’s the kind of person who I think probably would not have been in this conversation had she not been forced to be a part of this conversation. It was such a moment for me thinking, “oh good, maybe people will just come to it if they need it. I don’t have to do any work here. I don’t have to give her the book. I don’t have to say anything about the book. Just knowing that it’s out there, maybe that’s enough and that was really helpful.”

BJ Miller: That’s beautiful. I’m sorry. I hadn’t heard that story. That’s beautiful. It reminds me of this this feeling of putting something out in the world that will be there when someone needs it, was just a lovely feeling and trusting that they’ll find a way to it or vice versa. What has felt actually really good on our end is to put it out there. I think you bring up some really important points here. One is amen to death positivity movement. There’s a lot to say about that. I think we try to be death neutral, not for or against it. If we’re pro anything, we’re pro-reality. I would love readers who hate death and want nothing to do with it, think this book is still for them. The best thing about this subject matters its total inclusion. We really try to be neutral in our tone, but really love reality, if we’re loving anything.

David Abend: I’ll bet this is a book that is passed around a lot. All the pages dog-eared and stuff like that, with people saying this helped me. One of the things I want to talk about is regret. You’ve seen regret firsthand with hospice. It’s an undercurrent. I have a quote that I want to read. “My goal in all of this is to appreciate the life I have while I have it, drive it earlier in life, not hedging our bets, not deferring those important moments with people we care for and love.” You talked about in your creative mornings video. Bronnie Ware’s Top 5 Regrets, is there something you’re not letting yourself do? How can we help people not have these deathbed regrets? Do they need a death sentence to get there?

Shoshana Berger: The way this book, meeting BJ and being in this movement has helped me is that I really just don’t sweat the small stuff anymore. Being engaged with this topic really helps you think about what matters and focus on what matters in life. If I have one thing that I’m really trying to do now, it’s clearing the space to do this. Of course it takes you away from all of the things that matter, like my kids, my family and just having some time. That’s a constant juggling act as any working parent knows. It’s not always easy to focus on what matters sometimes you are really bogged down and there are people who are a lot less fortunate than I for whom thinking about what matters seems like a ridiculous luxury. They’re just trying to get food on the table. Realizing that it’s a luxury to do it, and knowing your time is limited, it becomes more precious and you really start to clear space for what matters.

David Abend: It seems that it’s hard for people that notice that time is limited?

Shoshana Berger: Can I just add one quick story? This was in that creative mornings talk but I just love it so much. It shows that sometimes people really need to be forced. This is the story of Alfred Nobel waking up one morning in Paris, reading his own death notice in the paper. It was his brother who had died, and they had made an error and written it for Alfred. The headline was The Merchant of Death Has Died. Until that day Alfred Nobel had been known for being the inventor of dynamite. The man who found a way to kill more people faster than anyone else has died, basically good riddance. He was horrified that this is what he would be remembered for. It was thought that this incident is what got him to endow the Nobel Prize, and be a great benefactor and be remembered as that. We can’t always have that moment of reading our own obituary, but there are some really fun things to do like actually doing the exercise of sitting down and writing about your life.

David Abend: I don’t know if you know this, but we have an article about that, that talks about Nobel. Our article is telling people to write their own obituary and we reference that story. We think of people having their heads down, just not looking up, whether they don’t have time or whether they just don’t want to, and not doing the things they want to do. Is that something you see with the people you deal with?

BJ Miller: All the time. The hardest questions for me to answer are what do I want? It is important, you would think, and I’m with Shoshana that it is a luxurious question. There’s an interesting history of leisure and the idea of having free time for a cognitive power to roam and explore. It’s a lovely notion and it is luxurious. It’s really hard. I really don’t know what I want much of the time. What has adapted for me is I’ve gotten much better at finding something to like in just about anything. That’s how I’ve adapted my life. I don’t always know what my gut always tells me that I want. It’s a very difficult question. I don’t know that we can or should live in every moment of every day. It’s just not practical and even if you did, you’d have so little in common with people around you that you might feel alone.

Regret is a big part of what comes up in the deathbed movement. I do talk to my patients about regret. It certainly comes up. What comes out pretty quickly once the context of the preciousness of time, once the context of mortality sets in, and once that abstraction is becoming real for someone, are other things like forgiveness and the impossibility of going through life without compiling some regrets. Let’s be realistic. I often see patients explore some amount of regret, but also let it go. I often see where the regrets get so sticky are with the family. People have to keep living with those regrets. I see that in myself. One of the side effects of this book for me is it ginned up my regret. I still am shocked how much time in any day I spend thinking about regret, not in an abstraction or intellectual way but my own regrets. It’s really ramped up that engine for me. I’m working through stuff. This is a long-winded way of saying regret is normal. It’s forgivable. Like a lot of the reframing we do in the book, it’s a sign, you regret something because you love life so much, you’re trying to fit a lot into it. Seeing love as the source of your regret I think is a very helpful tool.

I think why there’s something to be said about helping each other fit the idea of death into our daily view of reality is because that’s where all the trouble lies. If it’s is this foreign thing, that’s outside of normal life, if it’s this anomaly, this foreign invader, then we’re going to be at war with death. If we can rope it into our sort of daily purview, lower the charge a bit. Once you tune into that, death is just everywhere. Shoshana mentioned earlier, death has a lot of cousins, like loss of any kind. From my experience personally, I have shed just about as many tears for lost car keys and wallets, as I have lost limbs. Ends are ends; death is death. You walk down the street and it’s just everywhere. I think it’s another reason why meditation is finding its way in our world these days, it is a way to stay present with all that actually is. All that actually is includes a heck of a lot of loss, regret, death, etc.

Shoshana Berger: One notion that BJ brings up, which I just love, is the idea of actually practicing loss. Like actually making it a daily practice. You know, I miss the bus I’m going to take a walk instead. I’m going to walk and see what happens, just kind of just allowing that to happen. I am losing shit all the time. And yeah, there’s a moment of grief and anger and all that. Then you just get through it, you accept it and that is the daily practice you talked about helping you get ready for the big loss, which I think is really profound.

BJ Miller: I think grieving is a skill. I think loss is a skill.

David Abend: That’s really fascinating. Helping people do this, there are a lot of obstacles. You’ve had some very real obstacles in your life. For our listeners, if you don’t know BJ has a story to tell that you can go on watch the Ted Talk, which nine and a half million people have seen, and get the whole story. If you can just give us two minutes of your story and the obstacles you faced.

BJ Miller: There have been many obstacles, like we’re saying, but the big one that made me take notice and take stock of my life in a different way, was when I was a sophomore in college. In November, I was horsing around with some friends one night and we decided to climb a parked commuter train in New Jersey with the wires running over head. It wasn’t moving. It was just sitting there, and we thought we had done much more foolish things. We’re just climbing like a tree, but I had a metal watch on. When I stood up on top of the train, I was close enough to the power source. The electricity arced to the watch and in a millisecond, electricity entered the arm and then blew out the legs. It was all instantaneous, then that landed me in the hospital for many months with a series of amputations. I lost both legs below the knee, my left arm below the elbow and came close enough to death to smell its reality, to actually viscerally get it on some level.

I still haven’t died, but parts of me have, but I think many of us can say that. That was sort of the one the big event. But what I say that I want to get across to our listeners, is that one of the things you learn in clinical medicine and palliative care is the treachery of comparing sufferings, like who suffered more. I wouldn’t go down that path. The truth is we all have some access point to it. Mine’s just been pretty darn obvious and dramatic.

David Abend: I think the physical obstacles are sometimes easier. I can’t speak for you and I don’t mean to, but if I have a problem with my knee, I go get a knee replacement. If I have a problem that’s keeping me from doing what I’ve really wanted to do, it’s inside. How do you get over that? How do you overcome those obstacles where you can get out of the rut that you can be in and say I can’t do that? One of the things we want The Bucket to be is not a philosophy, but a how-to. A lot of our articles are this is how you do that, this is how you house swap so that you can go to France, even though you don’t have a lot of money. So, getting over these mental obstacles about, like, oh, I can’t do that. How do people do that? What’s the trick?

BJ Miller: One thing to say is what Shoshana was mentioning for practice of loss is really the practice of adapting. Maybe you missed the bus, then you got to rethink: The day is not going like you imagine, you have to regroup, and rethink. If you embrace that then maybe on that walk you see something you’ve never seen before, and all sorts of things open up that you wouldn’t have guessed. One piece of advice is just don’t be so certain of your vision for the future. You’re likely to be disappointed. More importantly you’ll miss out on all these very adaptive, creative moments where you shape-shift to meet the scene that you’re in front of. We are very malleable. Part of this is the practice of being changed. I’m very proud that I’m still soft and mushy and affectable. I’ll get really worried. I can be moved. I can be changed. Embracing that, rolling with that, and having an identity that is agile like that versus the contrast of folks who love conviction, like I am this, I am not that. I respect that, but I also want to be around that day where they can no longer be that thing that they’re so convinced of. The fact is, we as humans, are extremely adaptive critters if we let ourselves be. In general, I think one of the things where the design world is so useful is, if you can boil down the ability for us to make perspective, we can’t change so much of what we see, but we can change how we see it. We can change the lens; we can change the frame. We can change the context and all of a sudden that dynamic opens up a whole other world of possibilities. Last point is one of the things that gets in our way is fear. Before my injuries, I was much more affected by fear than I am since my injuries. I got to see a version of a mountaintop and know that I could get through it and know that I could live with fear and I could work with it. That was one of the great gifts of these injuries. I think I could have always done that, but the experience of going through that proved it to me. Fear became less frightening, and this is a really good frame for mortality. If we’re all going to die, no matter what we do, no matter how good or bad we are, no matter how many veggies we eat, whatever it is, if death is not a failure and we’re going there no matter how we live, then the pressure’s off to get everything just so. Imagine if the setup was if you do everything just right you can get to a keyhole, and .1 percent of us will live forever. Imagine the pressure to get that through that keyhole and get everything right? One of the gifts of death is you’re not going to fail at death, so failure loses its punch. You can try things and fail at them, and you’ll still be around until you’re not. In this way death can be a very liberating, or reconciling with death can be a very liberating beast.

Shoshana Berger: That was beautiful. I have nothing to add.

David Abend: That was amazing. One of the things we have at The Bucket is something called the Bucket Age. Your Bucket Age is your statistical life expectancy minus your current age. My statistical life expectancy is about 85. I’m 61. So, my Bucket Age is 24. We’re using this to try to get people to say, this is statistically how much time I have left. How am I going to use it? Use it as a catalyst to get people to count down instead of up. What’s your bucket age?

BJ Miller: I’m 48. If I figure what if I live to be 85 like yourself? If I’m sticking with your convention, let’s just say 85. I’ve got 37 years to go. I like that construct, sort of forward thinking in a very important way. I think it brings up a really nice frame of here’s what time I have left to go do some stuff, to be some things, to have some thoughts, and to have some feelings. I got 37 years to go. One thing I’m pretty sure of is I’m not going to keep doing the work we’re doing now. I love this subject, but I don’t think I’ll do this work forever. There is just way more to life, so one thing that I’m clear on is I’m looking already to think about retiring and what to do from this work, where would I go from here?

Shoshana Berger: I am older than BJ by a couple years. I just had the big birthday, 50. You can edit this out if you don’t like swearing, but all of my 50-something friends have said, welcome to the give no *bleep* 50’s. This is your time. Everyone said, 40’s can be full of a lot of suffering, you have young kids, etc., but the 50’s this is when you can start really enjoying it. I actually am really looking forward to it.

I’m also looking forward to feeling more fiercely like myself. I think there’s a lot of identity making in the first third to half of life, and I think there’s a settling that happens now. I feel like the Bucket Age is a really interesting construct. I would like to think of it as dog years, because you can do a lot more living when you’ve settled some of the basic identity stuff. Even if you don’t know exactly what you want, and you can’t always trust your gut, you probably aren’t focused on a lot of the little dumb stuff that we’re focused on as younger people. All of the insecurities and moments of shame throughout our day. The what did I do wrong to that person, and constantly checking yourself?

I find that that stuff really quiets down as you get older. I like spending time with older people much more than I like spending time with younger people. I love young people too, but like the wisdom I get from people in their 70’s and 80’s. The sense that they’re just kind of rooted in the Earth, it is quite different. I think these Bucket Years are going to be the most exciting, the most productive, and also the most engaged with the reality of our mortality, because you start losing stuff. You start losing physical capacity. You start losing energy. You start losing lots of things. In a way that gets you even more engaged with what matters.

David Abend: Yeah, it’s the quality. With the death positivity movement, there’s been a lot of books written like Atul Gwandi’s book Being Mortal, Frank Ostaseski’s book The Five Invitations, When Breath Becomes Air, and Katie Butler’s new book The Art of Dying Well. Do you see the currency changing? This is kind of paradox because we’re living longer, but is the currency becoming quality not quantity?

Shoshana Berger: I wish I could say yes, but I still think this culture is really mired in the idea of quantity and abundance. It’s too bad because all the research suggests that after a certain point the more money you make, the less happy you are. All of those intuitive things we think about like getting rich or having more are the inverse of true. Actually, sometimes when you have more you are more miserable. That certainly can be true about the end of life too. Sometimes we extend life beyond our ability to really have it be a meaningful and good life. I certainly saw that happen to my father. I think we have a lot of work to do. I think the conversation has started and those books have laid the groundwork. We do feel like younger people especially are open to this conversation in a way that past generations haven’t been. Which is really interesting, because if you think about it, a hundred years ago people were dying all over the place, right? We didn’t have the medicines or technology we have now. On the farm, animals were dying, and grandma died upstairs, you had first-hand knowledge of death. It was in your face. Maybe that alleviated the need for the conversation, now that we have outsourced death, we have cordoned it off. We send our elderly to homes. Many of us die in a clinical setting rather than at home, even though we often desire to die at home. In a way, we don’t have any experience with death and the conversation is so much more important now. BJ and I’ve had this experience of having these 20-somethings get up to the microphone and ask us questions saying, I really want to start thinking about this now, what can I do as a twenty-something? What can I do in my 30s? What can I do to prepare myself for this experience? We’ve been really heartened by that.

BJ Miller:  It was true. It was also true back when Zen Hospice house had to close. When I was there, we were surprised but extremely heartened to see that more and more people in their 20’s were coming to volunteer at the hospice house. It was an amazing realization. Picking up on what Shoshana’s saying, I see it as, yes, the relationship between quantity and quality is part of what’s happening here, but I think the bigger context that I’m feeling is our human relationship with nature. That seems to me where the big reckoning is happening. The model of man versus nature, all the literature that we all grew up with in English High School class, that has all shifted. We have a different relationship to nature. Now, we have to reacquaint ourselves with nature. In fact, we’re more and more aware of the model of acquisition, just get more stuff and that way you’ll buffer yourself from pain. That is showing itself to be a pretty bankrupt pursuit. Where are we going to put all this stuff? We have these very practical questions happening around our climate, waste, etc.

I see how this kind of conversation we’re having is part and parcel of us revisiting our relationship to nature, and in some ways reacquainting ourselves with it, but also having to find a new dynamic with nature because we’ve tinkered with it so much. I’m hopeful that that’s what’s happening. There’s a clock ticking on all this too, so the books that you mentioned give me great hope. The fact that your podcast exists, the fact that people are actually buying these books, that a publisher wanted to publish it, etc. All these signs are very hopeful to me, but we do have a ways to go.

David Abend: You guys are walking the walk. You were talking before about the regrets. What are you doing to make sure you don’t have any, or as few as possible?

BJ Miller: I hadn’t realized that here was like a cache, a stockpile in me, of regrets that I hadn’t really been aware of. I thought I had kind of metabolized them and the book kind of ginned them up. I’m kind of working through them. For me one of the lessons, what is my viscera trying to teach myself by pulling up all this old stuff? What am I missing? What am I supposed to be learning?

I’m hot in the middle of that question. I don’t have an answer right now. A lot of these regrets seem kind of silly, but yet I’m having these ruminations. There’s something going on in me that I got to figure out, so I’m in the midst of that. I consider that walking the talk. The idea here is not to be so at peace that we have no problems and no hard feelings. That’s not our goal. We’re trying to make space for all the feelings, including the regret, including the shame. Walk and talk here is making space in myself for my own gnarly thoughts and hoping to metabolize them and learn from them, but I’m in the midst of that. I will say too I’m in the middle of redoing my estate plan. I had done it before and thanks to the When I Die File now, I’m redoing it. It’s overdue, but I still have a lot to do to populate my When I Die File. I’ve got a little ways to go, but for me most of the walking the talk does not have to do with not shaming myself or others, but has something to do with loving and forgiving others, and that’s where I think the meat is for me. That’s where I’m really trying to be.

Shoshana Berger: That’s amazing. To build on that, I’d say if I’ve learned anything from this book, it’s about just showing up and being there.  You don’t have to do much in life. All people really want from you is for you to show up and be there and listen. I was a fixer. I’ve been a fixer my whole life. I come from a really bad divorced family and my father suffered with depression. There was a lot of stuff to fix. I grew up real fast and started fixing as quickly as possible. There’s some value in that it makes you a very capable person in life, but there’s also the myth that you can really fix anything or anyone. For me accepting that and just being there and showing up has been a real lesson. It’s helped me to feel less regret because I kind of realize that it’s not necessarily my job to fix everything. If you attach to that I can fix it, I’ve got to be the one to save this, that naturally leads to regret because you can’t. Just accepting that has been a big lesson for me.

David Abend: That’s great. I have a bonus question. The reason I call it a bonus question is because I don’t even know what the question is. I just want to talk it out and see if you guys can understand it. The whole concept of palliative care is it’s kind of taking away pain. It’s kind of making you more comfortable to enjoy. The idea of accepting mortality, accepting you’re going to die, is in a way palliative, like saying okay now I can be comfortable, and I can enjoy this. Does that resonate with you? Do you understand what I’m trying to say?

BJ Miller: I think so. I think if I heard you correctly what you’re pointing to is this idea of however you get there, whenever you can manage it, that letting death be part of your sense of reality, is letting yourself get to some level of acceptance. To be clear acceptance is not necessarily a great big hug, acceptance is noting something for what it is. You can accept your cancer and still fight it tooth and nail. I think accepting is just recognizing something. It’s like noting something’s sovereignty, like just the honor of recognizing it and seeing it. You don’t have to love it. You can roll around in the dirt with it, in fact many of us do. I think in so doing the effect is palliative. You will find yourself more at peace with your own nature, with the world around, with all that you can’t get to and all the ways people have failed you. I do think there is a palliate moment waiting for us in that acceptance, as long as we have a very big idea of what acceptance can look like. The word palliative means to ease and much of our work really is about pain management or symptom management, trying to help people feel more comfortable.

That’s just the first part of it. The reason that they were interested in comfort is to turn down that white noise of pain or nausea, whatever loss it is, to make more room to have interesting conversations around meaning, love and other things. The end is not comfort. The end goal is not comfort per se, the end goal is space to have a full and rich life that will include pain, include suffering, include all sorts of things that you cannot fix.

David Abend: Okay, I’m glad that it makes some sense. How can people get the book? I assume on Amazon and all the usual places?

Shoshana Berger: At your favorite book seller, Barnes & Noble, Books A Million independent bookstores, Amazon. We have a couple of places where people are congregating around the book and it’s content. We have a Facebook group. We have an Instagram page. It’s a really lovely community that’s gathering around the book now and having little fireside chats around its contents, which is great.

BJ Miller: Can I throw one more thing in there too? I would request whether it’s like writing a review or reaching out to us via our website, ABGTTE.com, we would love feedback. Hopefully if this book sells well, we’ll have a chance for a second edition. And, we say, Lord knows there’s all sorts of things that we could improve upon, so feedback is very much welcomed.

David Abend: Do you have any questions for me?

BJ Miller: I do have a question. Are you feeling by doing your podcast, by doing The Bucket, is it more about sort of getting the word out about how things that you’re learning, feeling and thinking? Or, are you actively being changed as you do the work?

David Abend: It’s more about spreading the word. I’ve been surprised because I already believe this. My big analogy or metaphor is the zoo metaphor. I don’t know if you read my  interview titled, “My Doctor Told Me I Only Have 25 Years to Live.” You take your family to the zoo and you want to go see all these things, the reptiles, the Apes and you want to go to the gift shop, but you never look to see what time the zoo is going to close. Then at two o’clock the Zoo closes, and you say, “Hey, wait a second I wanted to do that.” It’s like you got robbed but, no, actually you didn’t look up, you didn’t check. I’ve had that belief for a long time, but what has happened in this process is, first of all, it’s finding the other people who believe in the positive outcomes of embracing mortality. As I was saying to you before, about its branding, death is the worst brand in the world. What are the benefits of death and mortality? I’ve gotten to this point where just about everything I do goes through that filter of I’m going die and what decision should I make knowing that. It’s just a filter that’s always there for me now. I’ve read all those books I mentioned, and I’m just amazed at the peace that I get just reading about it. I had this idea for The Bucket, so I’m in the choir, but it’s just not as scary. After every book It just becomes less scary and more of okay, I got to do stuff and not really worry about the failing.

Shoshana Berger: I was just at this really interesting Tech Festival in Copenhagen. I was part of something called an Ending Summit. I was the life part, but they also talked about the end of climate and environment, as we know it, and the end of consumer products and experiences, and the moment of grief that happens and how that process goes. It just struck me that with every ending a window opens, with every ending there’s a beginning. There’s that lovely T.S. Elliot poem, Our Beginning is Our End. If you can just bathe in that cyclical nature of life, we see it in Spring and Winter with the trees losing their leaves and then renewing in Spring. This is the way that the Universe works, rather than being so afraid of it, just kind of inviting it is really exciting.

David Abend: It’s missing the bus.

BJ Miller: I invite you all to miss your bus.

David Abend: Thank you for listening. I hope you got as much out of this as I did. I love that idea of missing the bus. For more about how to get the most out of your life by embracing your own mortality go to thebucket.com. That’s the bucket all one word.com. And, if you know someone you think should be in a future Bucket Podcast. Let us know at bucketfeedback@thebucket.com.