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Optimal minimal.
Did this altitude I can run flat out for a half mile before
my hands start shaking?
Can I also your personal question?
Now I just sit in the perfect time.
What if I did the opposite?
I'm a cyber nanny organism living this show
where metal and pistol are.
Laying in the air,
fairies show.
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 10th year anniversary, which is insane to think about,
and past one billion downloads.
To celebrate, I've curated some of the best of the best,
some of my favorites,
from more than 700 episodes over the last decade.
I could not be more excited
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.
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,
you can find that and more at Tim.log slash combo.
And now, without further ado, please enjoy,
and thank you for listening.
First up, Dr. Gabor Mate,
Twitter at Dr. Gabor Mate,
and Dr. Gabor Mate.com.
Gabor is an addiction and trauma expert,
and bestselling author of,
in the realm of hungry ghosts,
when the body says no.
And that's that I hated,
which of course means I'm hating a part of myself.
And that included anger, rage responses,
use of stimulants, you name it.
I always applied 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,
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,
what approaches have you found to help?
What tools?
I call it compassionate inquiry.
So inquiring in a compassionate way.
Not why did I do this, but,
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.
I wonder why I did this.
Ah, it's with my pain.
And so what your friends said that it served you.
So thank it.
Love it.
But let go of it.
It's absolutely right.
I call it the stupid friend.
The stupid friend 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.
Right.
It's helping.
Now it's hurting.
So it's a friend, because it's really trying to help,
but it's stupid, because it's not learning
that you're no longer that three-year-old,
that that five-year-old, that 15-year-old.
You know?
So now this leads to the question of trauma,
because it's one thing to recognize
that all this originates in childhood pain,
it's quite another to transform that pain.
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,
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.
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,
what happens inside you is you get disconnected
from your emotions and you disconnect it 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
and a defensive view of other people.
And these perspectives keep showing up in your life
in the present, because they're the stupid friends.
And so the issue is not just to recognize what happened
at 10, 15, 30, however many years ago,
but to actually recognize their manifestations
in the present moment and to transcend them
and how do you do that by reconnecting with yourself,
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,
because what does it mean to recover something?
It means to find it again.
So what does it that people find when they recover
to define themselves and the loss of self
is the essence of trauma.
So the real purpose of addiction,
treatment, mental health, treatment,
any kind of healing is a reconnection.
For people who are listening and 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 something else,
what recommendations.
So I'm sure I am 100% sure,
because I've had people come on
and for the very first time on this podcast talk about
sexual abuse of the endurance as children
and what they did to help recover from that.
Many people listening, I am sure,
have addictions, both traumatic past experiences
and trauma.
What recommendations could you make for them?
So I want to say first of all that 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.
Good things didn't happen that should have happened.
Look at the trauma of a mission.
Trauma of a mission with a 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 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,
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, 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.
And so that there's a reason for it.
So that, 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's not in my deepest character
and it's not who I am
and I don't have to be that way.
That's a relief to know.
It's also not that I'm generically 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,
my friend Peter Levine and his somatic experiencing.
Walking tiger?
Is that one of those?
Waking the tiger.
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, brilliant.
There is EMDR, eye movement, desensitization, reprogramming,
which is a way of bypassing the conscious mind
and getting to the emotional brain
and quicker than 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 motor sensory integration techniques.
Then there is the traditional therapies like yoga.
No yoga was not simply a physical modality
when it first developed.
Yoga actually means unity.
So the variations of yoga 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 get to go to work out,
that's great.
I'm not against it,
but I'm talking about 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 with my ADHD,
I'm not a yoga person, I can't do it.
Until you're not half a go,
I met actually a yogi.
His name is Sat Guru.
He's an Indian yogi with a big following.
I was very skeptical, but I met the guy.
I now have a 50 minute daily yoga practice,
which I did this morning before coming to the end to you.
And this made an enormous difference in my life.
With my ADHD mind, I really have trouble just sitting there.
When I sit on the meditation cushion,
my mind is like all over the place.
But with the yoga, which is more body-based,
I can stay much more present.
There is a meditational component to it.
And so the answer is yes, if you asked me 18 months ago,
I would have said no, I supported, but I don't do it.
But now I'm actually a very committed practitioner.
And it really has made a difference.
Is it a particular type of yoga that people could
Google or learn more about?
So I'm not a yoga expert.
And as many forms of yoga that other people,
more knowledgeable than I am, could recommend.
But the one I learned is called inner engineering.
And it's taught by either Sadhguru or his followers.
And you can look up inner engineering online.
In your engineering.
When I recommend it to friends and others,
everybody's been only being grateful.
So I can highly recommend it.
Typically, there's to me what seems to be a cult
around the guy, which I don't take too particularly,
but he's the genuine article in terms of
having 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.
No, no, it's just my fans appreciate.
Yeah. Well, you know, I'm not going to blame it
on my fans. I like specifics.
Yeah. So it's an inner engineering.
You can look up online and it's taught here in the States,
and in Canada, internationally, actually.
But I did interrupt you.
You're about to mention, I think, another technique
or modality that can help talk about, for instance,
the somatic experience EMDR emotional freedom tapping,
motor-centric integration technique or techniques yoga,
and then there's something coming up after that.
Well, about 10 years ago, I began to work with psychedelics.
Now, if you're 15 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, I became aware of the
potential role of psychedelics in healing.
And I've been doing work with them for 10 years.
And they're another potent method.
They're not for everybody.
And I have to emphasize that whatever modality you choose
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 can be like a super high-weight self-awareness.
Not in isolation, but it opens doors.
Otherwise, might take years.
And so it's not unusual for me to conduct the psychedelic
session with somebody or a series of sessions,
either in a group or individual setting,
and have them say, that was like 10 years of psychotherapy
in 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, your personally,
where there's an increasing movement amongst psychologists,
therapists, psychiatrists, medical doctors,
other healers to find ways of incorporating
psychedelic healing in the larger therapeutic scheme.
So, Godmore, you mentioned a series of events leading you
to psychedelics or to consider psychedelics,
potentially, as a healing or medical modality.
If you're able to, could you describe any of those events?
Sure.
So, in 2008, my book on addiction in the realm of
Hungry Ghosts, Close and Converse with Addiction,
was published in Canada and very quickly became a number one
national bestseller, subsequently published in the States
as well.
And I was in a book tour.
And people could ask me, what do you know about addictions
and ayahuasca as a treatment?
Ayahuasca being a proven, or Amazonian,
vine that's made into a brew that has psychedelic properties
and you're nothing.
The next speech, the next event, somebody also asked,
what do you know about ayahuasca into addiction?
I finally started getting annoyed with it.
Like, leave me alone.
I've used to read in the book, I've spent years researching it.
My life experience and all kinds of scientific exploration
went into it.
Ask me about something I know about.
And then I realized that maybe the universe was knocking
on my door.
And somebody said, did you know you could experience it here
in Vancouver?
There was a proven shaman leading some ceremonies up in Vancouver.
So who might have said no?
And I jumped right in and I sat in this tent
with 50 other people.
50.
Yeah, it was that's how they set it up.
It's not what I recommend, but that's how they set it up.
They played beautiful music.
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 cooling away.
And tears started flowing down my face.
And these were not tears of sorrow.
There were tears of joy.
And I got in touch with such profound love
that I had never consciously experienced before.
And there were tears of love.
And it wasn't love for anybody 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.
And how it betrayed love in my personal relationship
with my spouse and my children and in other ways.
So I just got this experience of love
as something profound and universal and life defining,
but something from I just been cut off in so many ways.
And I got it because I closed my heart against love
precisely because when I was vulnerable and small,
I'd been so hurt going to my mother's States of mind.
She couldn't respond to me.
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, which is a huge explain
that for a second.
So again, this Buddha-Pershtungry, Second World War, January,
the Russians are circled Buddha-Pasht and are fighting
the Germans.
The government in power is a right-wing, fascist,
anti-Semitic military force.
And even though the deportations of Jews
had stopped, the Germans had annihilated
half a million Hungarian Jews in three or four months,
but now the Hungarian fascist for killing Jews in Buddha-Pasht.
And including in the house where my mother and her living.
So my mother gave me to a stranger in the street
a Christian woman, but she didn't know
she'd be there to her life next day.
Well, or that I would be.
And that 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?
So my heart closed this against love.
And I got all this.
And so I got that if this plant 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.
Now, 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.
Nevertheless, they'd opened the door for me.
And I got right away.
Now, 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 in its 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 Western engineers.
A lot of learning involved.
We made mistakes, but it evolved.
And the essence of it is that people don't come to it cold.
They come into the preparation in a safe setting,
where 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, basically I tell people, guess what?
You're back and you found your virgin.
And everything you've heard about your virgin
is going to show up here.
But in the context, we're safe for that to happen.
Right.
And so I've seen a lot of great healing.
I've had people with multiple suicide attempts,
heal from depression.
I've seen people get much better with their autoimmune diseases.
I've seen people deal with all kinds of addictions
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.
Well, can I again give you a quote?
Yes, please, which I love.
It's one of my favorite teachers.
And his name is A.H. Almas.
And he says, your conflicts, all the difficult things,
the problematic situations in your life
are not chance or have hazard.
They're actually yours.
They're specifically yours designed specifically for you
by a part of you that loves you more than anything else.
The part of you that loves you more than anything else
has created roadblocks to lead you to yourself.
You're not going to 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.
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've got to see, what is the teaching here?
So 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 two self wants to do.
Now, two things.
One is you talk 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.
Traditionally, we've had terrible times
during holidays.
Partly because my work at Holidays
and once I go into a holiday, I just collapse
and now my wife is dragging a corksour on it.
You know?
Because I'm a workaholic.
You know, in a head and clear space.
So this time, we actually wanted to do a holiday
with intention.
This is nothing but it's like deluxe.
Just to do that, we said an intention.
What is an intention?
And if we have an intention, I've learned
from a couple of very wise teachers,
what structures we want to set up to support our intention.
And how are we going to handle
when there's kind of disagreement or conflict?
We had a beautiful holiday
because it was the first intonation of holiday
that we've had.
So that intention in life in general
is absolutely essential.
Like every morning, what is my actual intention?
So the problem is the upset.
So want to do a bit of an exercise?
Sure.
OK, 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 when I teach.
I ask people to tell me some recent episode
when they're upset with somebody with their lives
and something that they open to sharing.
So it doesn't have to be anything stored either thing.
But just something, whether it's your spouse, partner,
or a bus driver, I don't care.
Sure.
A friend.
OK, so are you willing to go there?
Anything.
OK, I can share anything.
Just where you upset with somebody.
OK, yes.
OK, so what happened?
Describe it.
What happened?
All right, there were a number of issues
in my home broken aspects of the home,
things that were falling apart or needed to be fixed.
Physically.
Physically, yeah.
Right.
And I had hired someone to do these things
while I was gone.
OK.
And I came back and none of them were fixed.
OK.
And your emotional reaction was?
Anger.
Rage.
Anger.
OK.
Anything else besides anger?
I think they're close cousins.
Frustration.
Frustration is anger, yeah.
Yeah.
I was disappointed.
Just disappointed is sadness.
Yeah, it's a different feeling.
So it's disappointed.
Myself also, because I started to look at how maybe,
well, this appointed is not so much an emotion.
There's a state of mind.
I'm asking what the emotions were.
What's inside disappointment?
Something didn't happen.
I wanted to happen.
How do I feel?
Isn't there sadness there?
Sure.
Yeah, there's sadness.
I'm not talking into it.
I'm just asking.
Well, I suppose I might be confusing state of mind
and states of mind and emotions.
Yeah.
I'm not sure how to do it.
I'm looking at the role emotion.
Yeah, sadness.
So there's anger and sadness.
Those are the emotions.
Let's go with that.
OK.
So I'm going to ask you a silly question.
What were you said in anger about?
Well, I suppose the answer, which is not the right answer,
I'm expecting was I was angry that someone had made
commitments to me and not fulfilled those commitments.
And that's what happened.
They had made the commitment in the phone.
But that doesn't tell me what you were said or angry about.
What does that mean that they didn't fulfill their commitments?
Ment that they didn't care about 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 carried away respected?
I might need a lifeline here.
Don't know.
Someone who doesn't deserve to be cared for or respected.
Exactly.
It's going to be unworthy, right?
Sure.
Overrespect and care.
OK.
Now, if two other people here, which there usually are
when I do this exercise, I would ask them, OK,
we just listen to him tell us about this experience.
Other other reasons why this other person might not
have done the work 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 in one.
A million.
Yeah.
He could have, he could be in the hospital.
He could have been in hospital.
What a part of her.
Her cared one could have been in a car accident.
Exactly.
He had a flight delaying at Codan, Puerto Rico during a hurricane.
Yeah.
He's got ADHD.
Yeah.
And he can't follow through.
He's under stress.
And he couldn't do that.
OK, OK, OK, now.
The email that I was supposed to send to sitting in drafts,
and I thought I'd sent it, but in fact, he never received it.
I mean, OK, any number of possibilities?
Yeah.
No.
Of all the possibilities that you've just outlined,
including they don't care about your respect,
which is the worst one.
The one I immediately defaulted to.
Right.
Well, I mean, the worst.
Well, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
Yeah, internally the worst assumption is the one that I immediately made.
Exactly.
So let's notice something.
Hey, you, I should say we, because we're all like this, we don't respond to what happens.
We respond to a perception of what happens.
Right.
OK, that's what the Buddha said.
It's with our minds you create the world.
So that if you'd fund at the ADHD or he was stressed, or you know, you might have been
sad for him, but we're not of an angry and you will 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.
The two, 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, well, multiple choices, option D.
Oh, no, he doesn't care about me.
He doesn't respect me.
You didn't do that.
You brain jumped there automatically, right?
Well, the question is why?
Now, here's the learning.
You know, you know, you know, you know, you know, you know, you know, you know, you
know, you know, you know, you know, you know, you know, you know, you know, you know,
you know, you know, you know, you know, you know, you know, you know, you know, you know,
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you know, you know, you know, you know, you know, you know, you know, you know, you know,
you know, you know, you know, you know, you know, you know, you know, you know, you know,
you know, you know, you know, you know, you know, you know, you know, you know, you know,
you know, you know, you know, you know, you know, you know, you know, you know, you know,
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when folks are struggling, going to war with their disease, engaged in that fight,
whether it's chemotherapy or whatever, that's the kind of personnel 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 10 years old.
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 powder of care phrase had
too much baggage around it.
And his palliative care, I'm just going to plead ignorance here.
Is that synonymous with hospice care or is there those different things?
They are, they're related but different.
And thank you for asking that question, Tim.
I mean, this is part of the drum beat.
So hospice is that portion of palliative care that's at the end of the road.
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, far in advance of their death.
So yeah, all hospice is palliative care, but not all palliative care is hospice.
Got it.
All right, so palliative care just to kind of make it do this basically, the, you know, within the context of dealing with illness, palliative care is the pursuit of care.
Is the pursuit of quality of life period.
That's it.
So the fulcrum in palliative care is suffering, you know, are you suffering in some intractable way more than you struggling more than you need to.
And if so, then, you know, come see us in palliative care will help.
And in palliative care, you can receive our support and continue on with your more aggressive, invasive life.
Sustaining interventions as well.
You don't have to give up one type of care to add palliative care to the mix.
Whereas once rendering hospice because of its insurance details and vagaries, you do have to, in general, you have to give up curative intended care to qualify for hospice.
And we can spend a lot of need to and we'll dig into the learnings and philosophies and so on that you've cultivated.
But so let's say they have gone through the paperwork in the process to get to the Zen hospice project.
What does their first day look like?
So first day at Zen hospice is usually there's always the folks by almost by definition are pretty fragile state.
So just the ride getting to the house and into the house is often plenty overwhelming.
So very often the resident will just sleep much of the first day. But as soon as they're beyond the logistics of the trip over, the first day is generally our nurses, our volunteers, the kitchen crews are swarming around that resident and their family and just getting to know them.
That's where all the potency comes is it's inherently a relationship.
So there's some details around medications and so on, 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 going to be dying soon, but they're here to live until they die.
So it's a very an expect a much more comfortable and peaceful deaths at Zen hospice project and places like it.
That's what the all 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 of Tim, you know, so the person dies and very briefly the more sure it needs to come and retrieve the body.
And we have this ritual that we offer people, which is on their way out the building, you know, the mortuary guys have picked up the body. And if there are family or friends around and certainly staff and nurses and volunteers will gather around it, we'll all gather on the porch.
And we will do this our flower ceremony, which is basically we gather around and the mortuary 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. You know, it's just a very simple, gorgeous moment.
Then the body bag is zipped up as it has to be by law and the body heads out the door.
But you know, it's just this very stunning, poignant, gorgeous, simple moment.
And you can feel everyone entering into this sort of grieving phase more fully, especially of course the family.
And you can watch folks have this little bit of closure perhaps.
But more the point is you watch them swarmed with warmth and love and easing into the grief process because they're space forward 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 but can do so with some imagery that's sweet and beautiful to remember rather than traumatic.
So counter that with the typical hospital deaths. And by the way, Tim, I'm looking to talk about all sorts of things to you. I hope you 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 worked on a lot of work in hospitals as a patient, but also as a physician and a typical hospital death is is in a more sterile room usually lined with a bunch of machinery and all the sounds and lights 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.
And there's no ushering in of grief. There's a sort of a stuffing 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 kind of on to the next. And it's a stark stark contrast.
And since you began your work with palliative care and hospice care, how many 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 guess now, I've finished my final bits of training and there's all the deaths during residency and fellowship, of course, but I've been out of my final training now for 10 years.
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? This is a huge question. So we can certainly find slice it and feel free to tackle it anyway you like, but what has observing?
Simply to squander that time because we have all these so remarkable, vicarious deathbed moments with our patients and their families.
And you can learn a lot. And one of the things I love thinking about a real organizing theme for me is, is avoiding regret essentially.
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. 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 drumbeat. Why do we want to talk about this? Well, there's some systems issues or some economic issues.
But there's these beautiful, civil 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 for this to be 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 drumbeat. And in the case of 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 like anybody else, I'm 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, you know, I got all sorts of work to do it myself. But as we all do. Yeah, yeah, Amen, brother.
So, but I do think I've gotten a lot better at I'm pretty good as a hyper educated person in rationalizing all sorts of things and behaviors and I can convince myself to stay in relationships or in situations that don't necessarily feed me or that aren't working very well.
And 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. It 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, I feel these lessons in my relationship to nature. So, that's a great stab 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 crazy grandeur of being alive at all. And I get thrilled that I can feel anything sometimes even pain I can if way I deal with my own pain as I just I remind myself that I'm glad to feel anything at all.
So, my relationships, I think are impacted by sort of orientation to mother nature's impacted. I've got a lot that better at forgiveness. So, not holding grudges, you know how we walk around with anger at others and ourselves and it's just unnecessary doesn't help anybody.
So, I've got a lot better. I think I'm letting go of certain things. So, to drill into that, I apologize for interrupting, but yeah, yeah, not 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 bitterness might be a struggle.
Or a bit of bitterness might be a struggle, whatever else or a walk to sort of bleed off the physical anxieties of it, but then I can sort of unspool unwind and maybe even quickly kind of laugh at myself.
And that's great because you've let go of the junk and be it's an exercise in humility and forgiveness, which is always pretty dang useful.
For those people listening, you 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 instance.
You mentioned mindfulness meditation. Do you have a regular meditation or mindfulness practice?
You know, not really. Well, I guess your whole job in a way is a mindfulness practice. So I think that perhaps might be overkill,
they'll just add another session on top of anything else you're doing.
Thank you for that way out, brother.
You're welcome.
But yeah, I mean, it's, you know, there's some truth that it actually, this is where it's another reason why this work is so potent and fun is your personal professional lives are deeply entwined, almost necessarily.
Because so much of this work is just being aware is listening is paying attention and bearing witness and coming in terms with all the stuff you can't control, whether it's on my for my sake, all on sake or my page to say, so there is some real truth that I kind of feel like doing this job well and 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 meditators. I also want to be clear. I mean, I do, I have my own relationship for me.
It's 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 movement or 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 so I feel like I'm doing it a lot in a way, but I also want to honor those folks in the audience and elsewhere, I mean, truly have a meditation practice.
I'm very deliberately, but it makes sense. I think at this point to rewind the clock, could you tell us about the dinky?
Yeah, I'm sorry, I love speaking of absurdity, the dinky, this, what I mean, I lost three limbs to a thing called the dinky.
Sorry, I'm laughing, but your shirt's laughing.
I laughed. No, please laugh. I mean, it is kind of silly, but anyway, so as you know, I love 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 it's a commuter train.
It's called the dinky with affection to some and the dinky runs from Princeton to Princeton junction and commuters can take the trains into Philly or New York or whatever else.
That's what the dinky is. The wide significant in my life in particular is, you know, one night it was November.
I was just after Thanksgiving vacation sophomore year, November 27, 1990.
A couple of friends of mine and I were out just hanging out having fun, not a crazy night, but we were walking, well, you remember the wallow market, Tim?
I do. I was at Forbes, so I walked by the dinky and the wallow every single day multiple times.
Right, so you know, so a late night visit to the wallow market was pretty common.
And so we were heading over to get a sandwich, whatever, you know, and so when we were just walking by the dinky, it was just part there.
So it's not operating hours and you know, it has a ladder on the back and we just walked by 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 that at least we thought, but I just happened to be the first one up on top of the train and that those trains run like the buses in San Francisco,
wires that run overhead and then there's this metal thing called the pantographs, I think it's what it's called and that connects the train itself to the power source. And it's this big metal pole. So when I stood up on top of the train, I had a metal watch on and I happened to be close enough to the power source and the electricity art to the watch and, 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, I pieced it back together, but there's, you know, it's a big explosion and I was thrown some distance and one friend came up on top of the train while the other friend ran and called 911 and I think 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 that couldn't possibly understood and 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 to for all they did for me that night and oh God and so many nights, but yeah, so Pete held me down because I guess I guess at some point I came to and I was just thrashing about and you have,
you know, electricity enters your body and so you've got all this heat you burn from the inside out and apparently it's very common.
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.
So Pete was 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 refused to get on top of the train as they should have but between my friends and and Princeton police officer by the name of officer Dawson, I believe his name was who went on to become was promoted.
I think after that the sergeant Dawson, but anyway, Sergeant Dawson got up on the train with Pete and together with Jonathan, they got me to the stretcher and handed me down to the ambulance guys and the ambulance with me off to the local hospital.
And the local hospital, 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 St. Bonneville hospital in living to New Jersey,
which is New Jersey's one and only burn unit at least it was at the time. And that was that.
And flash forward to when you became fully cognizant of what had happened. You open your eyes with the stories so I will tell it to you anyway.
Oh please do. So your blood pressure is 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.
And it's also in part because it's not totally clear what tissues viable and what tissues not so anyway, it was maybe day five or day six for the first amputations and I woke up the night before I remember this very, very well.
You know that feeling where you wake up from a dream and it's been a bad dream and you there's a moment of sort of panic and then you sort of orient yourself you look around you or yourself and you realize oh thank God that was that was just a dream.
You know that sensation and sure and incredible ball at the end of it that's now inflated so I'm walking the door and they usually clip the cast there in the bag onto the side of the
box. So you know where this is going. So anyway, some walking to the door and the thing runs out of slack and the day.
Of course, and it comes not all the way out, but like partially out.
Sorry to you.
Oh, this is like a wait, are we talking like a small Python that ate a golf ball kind of situation?
A large Python that ate a golf ball. No, that's small. Yeah, so no, that's right.
I mean, this is not as it is.
And the total reverse that total warm bath of relief that you experienced thinking it was a dream.
That just goes totally in reverse and in a millisecond, I realized that all of this was not a dream.
I'm fall down to the floor because all of a sudden I really can't walk either.
I'm falling on the floor and I'm screaming and I'm pulling on that I'm trying to break the rubber tubing of the catheter, which is no way I could.
To somehow relieve the pain. And anyway, finally a nurse comes running in and gets me back in bed and that was that.
But so anyway, that's my first real memory.
Oh my god. I can see why it's a bit.
Oh, yeah. I'm sort of bent over as I'm talking to you.
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?
Uh-huh. Could you tell the snowball story?
So a burn unit is, I guess I don't really know, a particular place.
They're gruesome places. They're very difficult environments.
The pain that the patients are going through has got wrenching.
And so working in a burn unit is very difficult. People often don't last in a burn unit very long as a clinician.
It's incredibly difficult work.
And we learn from wars over time, this is my understanding of certain medical history, that the way burns off and kill people, there's no, you know, you're in a little cell.
And even when people are at your bedside, there, 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 rewarns your paying attention to anything.
So it's just, it's not fun.
So this is November at some point in December, maybe as early January.
But honestly, I can't remember who brought me the dang snowball. I can't remember. There were two nurses in particular 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 of our card of poem.
And I didn't 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 she had the right idea of just smuggling in a snowball to me.
So I could hold, so I could feel snow. And man, it was so, man, it was just stunning. You know, what a simple little thing, right?
But to put it in my hand 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 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 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 sensation.
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 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 undergrad or what were you planning on studying or studying at the time? I always forget when people decisions and undergrad even though I went through it myself.
Yeah, well, like you, I mean, I started out, you know, 10, I was a Princeton 89 to 93 and I started out. I went there really high on the idea of learning things that were foreign to me, you know, totally seeing a different world view and really delighting in the liberal arts education.
And with that, a Tiananmen Square had just happened before freshman year and I was sort of China was on my mind. I started studying Chinese language and was heading for a major East Asian studies. But when I was out with this injury, art, which I'd always been interested in, especially music, I became much more interested in art, not just listening to it or looking at it, but the idea of art.
So I switched my major 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 that 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.
We use them as creative grist. So either in our center 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. And that seems to be part of its charm.
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, you know, and like, is that the measure of what it means to be a human being or 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 kinds of questions I was trying to kind of wade through like essentially questions of identity. So, so studying art, the hunch was, well, well, this seems to be a peculiar, the situation I'm in was 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 home.
And it seemed to me rightly placed to focus on 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. I saw myself. That's what art helped me learn and where to focus my energies and it really paid off at the same very helpful.
I'd love to explore that some more because I've been in the last few months in particular asking myself over and over again why do humans.
Care about music create music like a compulsion and dance every every group of humans on the planet just seems so peculiar. Yet unsurprising if you look at say bird song and animal mating calls and.
Mating dances and all this that the other thing but there seems to be 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 teachers books pieces of art that really influenced you.
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 presuppose 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 and help me tweak my eye in my ear.
That was great but on this sort of identity sort of philosophical front like the existential abstract expression is mid 20th century guy made these big beautiful color form paintings non representational quick random anecdote that might be entertaining.
So I grew up on Eastern Long Island where Jackson Pollock basically turned himself into one of his paintings by driving car into 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 showed up like nine o'clock and this man and his wife 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 go oh we're so sorry we can't stay or just on our way to dinner because what would happen is he would stay.
He would forget about the dogs they should all over the car he would take the dogs home leaving the shit intact in the car and then blame it on my relatives to his wife who then had to contend with the whole mess so anyway related but totally unrelated but if we're talking about abstract.
The here if you were this is an awkward transition but here we go that's kind of my mo if you were brought in as a position slash let's just say mentor guide to someone who had just suffered nearly identical injuries to yourself.
20 some years old what would your conversation be like with them or what resources were reading or otherwise would you point them to.
I find myself every once in a while I'll get called by friends in the hospital come visit with someone who isn't similar shoes you know and actually I wish I remember his name but someone did that for me when I was in the burn unit.
He had a similar accident I think he lost two legs below the knee I should say both legs and I learned a lot from how I gained from his visits to me I just sort of reproduced which is basically walk in these rooms was almost no agenda almost no plan to advise in any way the potency especially early on was just seeing someone in similar shoes.
My early questions when I was in the bed was like what do we look like what's it going to feel like to walk on prostheses and that's kind of what you know that it was that nuts and bolts he kind of stuff will well anyone want to date me again you know I mean I don't know it was on that level and so when this guy would come visit me.
He was just seeing him just seeing him upright just knowing that by virtue 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 on the world.
And just seeing him look me the eye with some kinship that was the therapy of it I think I've gone in trouble when I tried to come in with some predetermined idea of advice giving oftentimes that's not really what's needed is more just some camaraderie and the bearing witness and so I'm asking your question when I do go into folks who I'm there not I'll mail myself to any questions I have but I think most of the power visit is just visiting just being together and share.
And sharing this awkward body from what I've heard in red of yours one of the recurring themes appears to be and please correct me if I'm getting this off at all is how powerful simple things can be or maybe are and that our tendency is to perhaps undervalue the things that are not expensive or difficult to obtain.
The snowball could you talk about the things you've noticed that most help people in when you have this excuse to forget all that it can be really liberating a little bit scary to 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 in on a daily way am I doing things I really care.
So back to your question to this point about simple things I mean the simple things the small things ain't so small you know actually the like I say about the snowball there's the joy of feeling anything of having a body at all of being capable of movement at all that is so profound it's so
potent and yet 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 Zenospos who smoke frankly you know or you know anything that just kind of gets to that kind of reorient us and put things in proper proportion relationship to the natural world and rejiggers our priorities I love that.
I love that reorienting feeling 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 where you are of course but you can look up and you're
usually find a star I mean I feel like you know when any of us is struggling with just about anything look up just ponder the night sky for a minute just to realize that we're all on the same planet at the same time and as far as we can tell where the only
life only planet was life like ours on it anywhere nearby and then you start looking at the stars you realize that the lights that hitting your eye is ancient and that the stars you're seeing may no longer exist by the time the light gets to you and just just sort of mulling the bear naked facts of the cosmos for me is enough to just thrill me
all me freak me out and kind of put all my neurotic anxieties in their proper place.
So yeah and a lot of people when you're standing at that you're horizon on death store you know you can be much more in tune with that cosmos and you are with what the body is doing in you know you know in a day to day kind of way.
Does that make sense to make sense it makes perfect sense 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 yeah yeah well you know I mean the smell of fresh brand are for most of us to smell of a chocolate chip cookie does magical things you know 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 in his primal you know you can walk by someone who may be wearing a colon or perfume of someone you knew 30 years ago I still out there's it's been maybe a few years but there's a perfume that I would smell that my babysitter war when I lived in St. Louis as
in preschool and it would throw me back there instantaneously sense of smell is potent in food is primal and potent I mean it's nourish this nutrition it's how we live in some way so there's all this symbolic stuff happening to
me but there's also just a 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 a lie and in the moment smelling the cookies not on behalf of some future state it's great in the moment by itself on behalf of nothing.
You know this is another thing back to art art for its own sake art as part of its poignancy and music and dance is its purposelessness and just delighting in a wacky fact of perhaps a meaningless universe and how remarkable that is that's kind of 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 is to prize those little moments you guys I might be fabricating this but.
Make cookies at the Zenospic center is a size reason right and see mentioned absurdity a few times is something I've been thinking about a lot mean and for reasons that may
inferentially become super clear in a second just the being able to try to laugh at 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
in a way prevents you from doing a lot of the serious work you'd like to do but the question I was going to ask is to get your opinion on a modality will call it or tool and explain this vis-a-vis an anonymous friend I'll keep anonymous so this is a female young woman who used to work in hospice care and she found just as you allude 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 at some point became very frustrated with the insurance policies and vagaries of our health care system and now does something that is illegal but I think should not be which is guided work with
so I'm sure she said now I get to experience people dying every weekend the only differences they come back to life and many people listening to this will have read or should read an article that was titled the trip treatment by Michael Paulin in the New York
yeah yeah the use of a belief specifically psilocybin for those people not familiar which is extracted or the psychoactive compound in magic mushrooms for end of life care in terminal cancer patients I just love to hear your opinion on the use of compounds such as those in end of life care
otherwise yeah well I'm so glad you're asking this question and this isn't so there's all sorts of stuff coming out of the closet these days and it's really wonderful and there's a movement of food to revisit psychedelics from a therapeutic perspective as a rule and where things get
very difficult and in palliative care we talk about this we call it existential distress and basically existential distress is a crisis of of meaning in some way or another so it's particularly potent at the end of life where 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 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 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 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 as a diagnosis of exclusion so 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 then whatever
you just call it this bucket term in this case that bucket term is that existential sufferings not not particularly inspired right but this is where also gets thrilling this is saying existential suffering we have this portal to upload all these other
fields and interests and to keep them to make them relevant this is where it gets thrilling meaning you have a channel because you've wedged your foot in the
palliative care yeah through which you can insert other things that wouldn't otherwise have an easy gateway exactly 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 in somewhere other to the human condition right so all of a sudden there's this huge
invitation or at least possible invitation to the rest of the world besides the medical that sort of narrow medical sciences per se that's really exciting so 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 as we've talked like bearing witness and non abandonment accompanying people in their struggles
self a great south and that's beautiful work 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 or sun on your skin some just to note when you feel happy to be alive
and there's our little toe hole to work from so there's a lot to build around this but what we haven't had is 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
and other things may be radically helpful in fostering a meaning making moment for someone or fostering a sense of belonging in this sort of cosmic way and so in other words we have
a way to respond to this wacky thing called existential suffering so this is just thrilling 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 they're really well organized and comprised of very good MDs and PhDs called the have to research institute H E F T E R it's just have to
work with not only patient focused studies but also research studies using things like F M R eyes and different types of neuro imaging to look at the specific facts of different types of psychedelics whether you call them in the
agents or psychoactive psychotropic whatever it might be so it's a very very a lot of interesting interesting work and you learn a lot about how these compounds function just by looking at 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 I've also had some really fastening conversations with other
folks in this space and another organization of polyglistens to is a group called compass compass compass and they are beginning to do also support research in this vein and also started 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
but it's another group to be aware of and I think their website is compass pathways dot org so just another group in this space that's doing cool stuff cool and you know I'll throw one more in their maps yeah 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
the show notes at where our work week dot com forward slash podcast all spelled out but coming back to your story and your life I mean I really have so much I would love to ask and we'll dig into some of them but we're not
kind of all them 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 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 are practices that you've adopted or developed habits whatever might be that people listening might be able to test drive for themselves.
In well see here my friend I'm too I have two answers that question so the one is we know we touched on a little bit but I find myself increasingly interested in the aesthetic domain by aesthetic I mean just the life of the senses not just beauty but just the felt environment at all that is the world of the aesthetic domain and one of the reasons I'm particularly
interested in the aesthetic domain besides just delighting and having a body to feel anything like we talk is it's how it prizes purposelessness so I am offer meaning I see human beings as meaning making machines and we talked about this
a little bit like whether there's some grander meaning in the universe I don't really know and frankly I'm fine not knowing I enjoy the mystery of it and I'm okay if there's meaning I
don't know if there's a grand scale or not 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
sentiment and I also just increasingly want to carve out a space for meaninglessness purposelessness 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
that moment and that is I think we could all benefit from letting ourselves delight in things that don't necessarily had any meaning but just feel good that don't you know and don't hurt anybody else but just 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 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 honoring just the joy of smelling of cookie and that can be enough watching a ball game 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 of us are out there pricing purposelessness but I do well I made me think of
this might be a strange connection but I think of Kurt Vonnegut the writer who actually consider a fantastic philosopher in a lot of ways you read his fiction but one of his quotes that I've always loved is I tell you we are here on earth to fart around don't let anyone tell you don't let anyone tell you
that there's a different and there's a story I think it's actually in a dialogue 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 doesn't scold him but just laughs and ask some why he wasted so much time and he's like no no no no you don't get it I didn't waste time because and he runs through all of these seemingly meaning
seemingly meaningless seemingly trivial but to him very important kind of absurd interactions with multiple people along the way 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 things with sensory inputs are the unimportant things and I am not convinced at all that is the case
in fact it might be quite the opposite and if you had a patient come in that I would put probably any music from Beethoven into their ears and I probably would reserve that third thing for staring into space before they stared into space they wanted to watch a movie
what would you put in front of them and there's so many good ones right to you know I think you know I have a real soft spot for waiting for government not that it has this great meaning per se but by speaking of absurdity I just think it's hilarious
I never heard of it was never heard of waiting for government no wow just a string of ignorance on my part in this conversation although you don't read books I feel that even to
so oh yeah this is good news because man you have so much to look forward to me so this this movie is by Christopher guest and company the guys who did spinal tap
you know best in show sure sir how do you say government or how do you spell go to say they go very well and how we will man to size mother nature can
cuddle us and you know I spent 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 thinking on geologic time and making myself feel very very small and
so is really deeply therapeutic for me when I go out in Utah and I got gotten lost twice walking around this particular area and it's the same feeling I had
watching grizzly men which is mother nature as far as I can tell is pretty indifferent to us you know yeah I would say so so anyway there's my answer for you so that
brings to my two things the first as you mentioned that feeling which is two sides of the same coin almost that of being simultaneously repulsed
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 some such on the ground and the response tends to be breaking out into
the world would be considered by primatologists hysterical laughter and this seems to be something very hardwired so returning to that in some way and it being therapeutic doesn't surprise me the second is just to
tied together a few things you said related to sort of the meaninglessness which may be too loaded in term for some people might come off as
negative but yeah seeming in consequential or small and meditating on that or not even meditative I experiencing it in a very visceral way by
is being in the desert or looking up 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 he said that 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 this expansive geological timeline which puts our like shitty
week into a just hilarious the diminutive perspective makes a lot of sense this is unrelated but what do you think of or who do you
think of when you hear the word successful I think of well you know you just pointed to something the relationship of self
and the silliness of self and the power of the self and I think we do ourselves the services by by playing in the
polemics around you know selfishness or selflessness so there's a lot to say about that but to to
wait for 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
self actualization someone who has realized has played themselves all the way out and that might be seen and
appreciated by practically no one 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 you know insisted on itself all the way to the end to me that may be a version of success so I guess
one part of my answer to questions I think of it as really an internal process but then beyond that too I guess
I'm a little torn here because I agree that that what I just said sort of focuses us and success back into
the self and I suppose 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 I think
probably success may be or the second half of it has to do with and in a way maybe seeing yourself in
others and others in yourself and realizing the unseen connections between us all and this is another is my
love or mortality as it as the potential to be this equalizing uniting force so success may be this
self actualized piece but part of that self actualizing is it is exploding a sense of self and
feeling part of everything around you and vice versa that confidence with the world around you that seems like great success.
Is there anyone who embodies that for you or comes closest.
I'm assuming it exists in others that I walk by on the street in a way you find yourself kind of.
In viewing others with an idea of success that changes how you look at them and how you beat them definitely that's a
sort of a sweet favorite daily exercise of mine so now it's hard for me to say a single person that I would point to is
a body all this so let's you actually touched on a much more interesting answer or point than my
question deserved which is your morning practice so could you elaborate on that please when do you do it how do you do it so you're walking
just to take us through this morning exercise how I did up in the day to start the day know what you just talked about
of assuming it the presence of this type of success you said it's morning exercise of yours.
Oh I'd love to just hear you elaborate on that.
Oh I don't know I didn't remember saying morning that's what trip me out.
Sorry that daily daily exercise perhaps there we go yeah I could have made up the morning part who knows but sure but it's sort of and
any time of day or night.
So this is useful you know it's kind of like just the power of mean of of of meaning well of wanting well of others and when there's a choice
in the matter to see to choose to see good and if you can't know assume good and this kind of builds an argument so your day of
gratitude and happiness and some amount of comfort so I'll catch myself being bitter or I get kind of road rage
I'm very aggressive on my motorcycle and car and actually just today I was really annoying someone by following
them too close and whatever I get I get 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 and it's just I'm particularly
acutely aware of this exercise when walking by someone who otherwise the world would assume in a sense that they
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 whatever they're going through is vital to them and that maybe whatever junk we
project on to them that inside maybe there are right was who they are maybe their way more are right with
who they are than a lot of people I see striving and otherwise looking successful so it's really it's just simply that I actually
learned this my mother took me to a deep pot trope a conference when I was pretty young and was a long long time ago the one thing
I heard that stuck it was really interesting to me was is getting in the habit of saying you know when anyone when you
hear anyone sneeze either say that louder to yourself say bless you it's just a it's like a neural 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 stand out loud even if you don't share it say it to yourself and I got to believe that that
resonates and registers somewhere you know that that land somewhere that that landed something to
a vibe so that's a kind of stop you walk around and you see people and you just project well wishing on to them.
Now I hate to focus on something maybe superficial but you said riding your motorcycle I know
that I apologize if this sounds like a weird question but you have 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 thank you about the logistics thank you well it's interesting you ask is right now
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 mean in his mother Melanie will not be seeing next week actually so
that's one piece of the story but the other is this I'd always I love two wheels I love gyroscopic gyroscopic lifestyle
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 people would sort of look at me and no one got into it I could never find
a mechanic who was willing to take it on and try to help make it happen a fellow named Maul Will who's an
old motorcycle racer champion sort of legendary in that world he happens to live around here lives in Tim
Ron and he built a prosthetic component I don't know what the story that inspired bird to do this but he's a
machinist himself and of handy fellow men in retirement he got him in his business of building this
prosthetic component that lends itself very well to mounting an arm onto a bicycle or a motorcycle
really yeah and I know Honda had made a version this as well but Prilya makes a model the Monna M a
that is clutchless so that was a huge piece to get out of the way so this is essentially an automatic
transmission so that do away with the clutch and gear changes so that's a huge piece of the puzzle out
of the way 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 hold on to the bike I'm doing
nothing with my prosthetic arm except for holding on the bike so all the actions in my right hand
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 in good distance for my thumb to reach him so I have
throttle 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 okay I just
have to pause here for a second and just ask everyone listening what bullshit excuses
you have for not going after whatever is that you want like please right in tell us on
social media why these are really excuses with hashtag bullshit after oh my God
man that's such a great story I'm so glad I asked about it and what it's really
fantastic work around man congrats that's awesome thank you and thanks Randy
and thanks to the folks in Scooteria the bike shop in the city I mean I a lot of people help me
make this come true and it took a long long time trying to find the right folks to make it happen
so amen amen to that's just just a few more questions when we respect for your time and I'm
having a blast here what $100 or less purchase has most positively impacted your life in
recent memory I'm guessing not the motorcycle now I was a little more than not but
holy cow man wow you know I would probably point us to a beautiful Pino noir from
Joseph Swan up in Sonoma County it's like the artwork of Andy Goldsworthy or
anyone who delights in anything a femoral the charm in a bottle of wine the craft all
the work that goes into it and actually the lighting and the fact that it's perishable
and goes away I find really helpful 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 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 some past girlfriend but I have a
small glass jar and I keep the corks from bottles that I finished with friends at home
and I have each of them write something on the cork so I have this collection the bottles
we're on the wine is long gone but there's this vestige right maybe that's not the
right word I'm trying to gerry to sound intelligent but the the corks in this
sit I'm looking at right now it's on this floating shelf on the wall and so I see
it as I walk by it yeah so no matter how sort of lonely I might feel at times I
think we all do at moments it's sort of a reminder of how close by how with
in 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 oh boy that's a doozy
let's say here man well you know it makes me think of as big as billboards are
you cannot make you and only put so much on them and it makes me think of the
my favorite bumper sticker I guess and it seems like set to potent I just love
I love it and so I would love to see it on a billboard which and and the basic bumper
sticker I'm sure you've seen it is don't believe everything you think
that's actually never seen that that's a really good one
what's okay it isn't a sweet hilarious true reminder to not take
ourselves so dang seriously you know it's anyway that's probably my choice
don't believe everything you think I was really waiting for what this was
gonna be I was really wondering I saw one this is 30 year old self and if you
could place us with where you were what you were doing that'd be helpful also
well that was a particularly poignant time for me actually so a lot I was in I was
a deep in med school is my last year med school boy I had kind of really
sort of experimental tour of my twenties and I was sort of settling into a
new rhythm I had finally let go of a 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 this may not be the intention of a
question but 30 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 get you know I this sounds way too tidy but I might have said
something like hey man don't believe everything you think don't you know
let it go don't take it all don't 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
somehow encouraged myself to let go a little bit more and and hang in there
and don't pretend to know where it's 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 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 helping us as a species deal with our and dance with
mortality I had convinced 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 I think in a way man I think I've
let myself get motion I still think of that word and negative with negative
connotations I see bad behavior on behalf of ambition a lot and I'm sure you have
a lot of people in a way 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 but maybe
it's aspiration yeah yeah yeah yeah that's right well on that point
do you have any any last requests asks suggestions or otherwise for the people
listening well thanks me that's such a great invitation I mean one is
folks hey everyone everyone I 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 etc and mortal beings at that and I guess I would ask that we start
looking to make that real I would ask that we prize kindness
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 Ed's and hospice project
these places rely heavily on philanthropy so if you're moved please come check us
out and hospice dot org otherwise think about what's going on in your own
geography support hospice and palliative care it's worth it needs to be developed
and built yeah I'll leave it at that that's that's plenty and I've really
I've been so excited to chat with you for so long and I've had so much fun
in part because it's exciting to me to think that in studying and refining
how to die we can study a Facebook is then hospice project Twitter at zen
hospice and I'll put all this in the show notes of course for everybody
listening 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 and 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 consider supporting but that's
another place to find my work to definitely yeah UCSF is just spectacular
I've done I've also been involved with well the gazali lab and other folks at UCSF
I'm just continually impressed BJ hopefully we'll get to do around 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 on a smaller level of course the time that you
have today for this it's such pleasure Tim I'm 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 you can find the show notes links to everything we discussed at
fourhourworkweek.com forward slash podcast also by Shopify one of my absolute
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tip this episode is brought to you by Viori clothing spelled V-U-O-R-I
Viori I've been wearing Viori at least one item per day for the last few months
and you can use it for everything it's performance apparel but it can be used
for working out it can be used for going out to dinner at least in my case I
feel very comfortable with it super comfortable super stylish and I just want
to read something that one of my employees said she is an athlete she is quite
technical although she would never say that that astra if she had ever used or
heard of Viori and this was her response I do love their stuff and using
them for about a year I think I found them at R.E.I. first for my partner T-shirts
that are super soft but somehow last as he's hard on stuff and then I got
into the super soft cotton yoga pants and jogger sweatpants I live in them
and they too have lasted their stylish enough I can wear them out and about
the material is just super soft and durable I just got their clementine running
shorts for summer and love them the brand seems pretty popular constantly
sold out and closing and I'm abbreviating here but in closing with the
exception of when I need technical outdoor gear they're the only brand I bought
in the last year or so for yoga running lounge wear that lasts and that I
think look good also I like the discreet logo so that gives you some idea that
was not intended for the sponsor read that was just her response via text Viori
against called V-U-O-R-I is designed for maximum comfort and versatility you
can wear running you can wear their stuff training doing yoga lounging weekend
errands or in my case again going out to dinner really doesn't matter what
you're doing they're clothing is so comfortable and look so good and it's
it's not offensive you don't have a huge brand logo in your face you just want
to be in them all this time their men's core short K-O-R-E the most comfortable
line athletic shirt is your one short for every sport I've been using it
kettlebell swings for runs you name it the banks short this is their go-to-land
to see short is the ultimate versatility it's made from recycled plastic
bottles and what I'm wearing right now which I had to pick one to recommend to
folks out there or at least men out there is the Ponto performance pants and
you'll find these at the link I'm gonna give you guys you can check out what I'm
talking about but I'm wearing them right now they're thin performance sweat
pants but that doesn't do the justice so you got to check out P-O-N-T-O Ponto
performance pant for you ladies the women's performance jogger is the softest
jogger you'll ever own Viori isn't just investment you're clothing it's
an investment in your happiness and for you my dear listeners they're offering
20% off your first purchase so get yourself some of the most comfortable and
versatile