For a long time, no visitors were allowed in his hospital room; the burn unit was a sterile environment. But on the morning Miller’s arm was going to be amputated, just below the elbow, a dozen friends and family members packed into a 10-foot-long corridor between the burn unit and the elevator, just to catch a glimpse of him as he was rolled to surgery. “They all dared to show up,” Miller remembers thinking. “They all dared to look at me. They were proving that I was lovable even when I couldn’t see it.” This reassured Miller, as did the example of his mother, Susan, a polio survivor who has used a wheelchair since Miller was a child: She had never seemed diminished. After the operation, when Miller was rolled through the hallway again, he opened his eyes as he passed her and said: “Mom, Mom. Now you and me have more in common.”
It wasn’t that Miller was suddenly enlightened; internally, he was in turmoil. But in retrospect, he credits himself with doing one thing right: He saw a good way to look at his situation and committed to faking that perspective, hoping that his genuine self might eventually catch up. Miller refused, for example, to let himself believe that his life was extra difficult now, only uniquely difficult, as all lives are. He resolved to think of his suffering as simply a “variation on a theme we all deal with — to be human is really hard,” he says. His life had never felt easy, even as a privileged, able-bodied suburban boy with two adoring parents, but he never felt entitled to any angst; he saw unhappiness as an illegitimate intrusion into the carefree reality he was supposed to inhabit. And don’t we all do that, he realized. Don’t we all treat suffering as a disruption to existence, instead of an inevitable part of it? He wondered what would happen if you could “reincorporate your version of reality, of normalcy, to accommodate suffering.” As a disabled person, he was getting all kinds of signals that he was different and separated from everyone else. But he worked hard to see himself as merely sitting somewhere on a continuum between the man on his deathbed and the woman who misplaced her car keys, to let his accident heighten his connectedness to others, instead of isolating him. This was the only way, he thought, to keep from hating his injuries and, by extension, himself.
Miller returned to Princeton the following year. He had three prosthetics and rode around campus in a golf cart with a rambunctious service dog named Vermont who, in truth, was too much of a misfit to perform any concrete service. Miller had wanted to work in foreign relations, in China; now he started studying art history. He found it to be a good lens through which to keep making sense of his injuries.
First, there was the discipline’s implicit conviction that every work is shaped by the viewer’s perspective. He remembers looking at slides of ancient sculptures in a dark lecture hall, all of them missing arms or noses or ears, and suddenly recognizing them for what they were: fellow amputees. “We were, as a class, all calling these works monumental, beautiful and important, but we’d never seen them whole,” he says. Time’s effect on these marble bodies — their suffering, really — was understood as part of the art. Medicine didn’t think about bodies this way, Miller realized. Embedded in words like “disability” and “rehabilitation” was a less generous view: “There was an aberrant moment in your life and, with some help, you could get back to what you were, or approximate it.” So, instead of regarding his injuries as something to get over, Miller tried to get into them, to see his new life as its own novel challenge, like traveling through a country whose language he didn’t speak.
This positivity was still mostly aspirational. Miller spent years repulsed by the “chopped meat” where his arm ended and crushed with shame when he noticed people wince or look away. But he slowly became more confident and playful. He replaced the sock-like covering many amputees wear over their arm stumps with an actual sock: first a plain sock, then stripes and argyles. Then, one day he forgot to put on any sock and — just like that — “I was done with it. I was no longer ashamed of my arm.” He became fascinated by architects like Louis Sullivan, who stripped the veneer off their buildings and let the strength of their construction shine through. And suddenly, the standard-issue foam covers he’d been wearing over his prosthetics seemed like a clunky charade — Potemkin legs. The exquisitely engineered artificial limbs they hid were actually pretty interesting, even sexy, made of the same carbon fiber used as a finish on expensive sports cars. “Why not tear that stuff off and delight in what actually is?” Miller recalled thinking. So he did.
For years Miller collected small, half-formed insights like these. Then, he entered medical school and discovered palliative care, an approach to medicine rooted in similar ideas. He now talks about his recovery as a creative act, “a transformation,” and argues that all suffering offers the same opportunity, even at the end of life, which gradually became his professional focus. “Parts of me died early on,” he said in a recent talk. “And that’s something, one way or another, we can all say. I got to redesign my life around this fact, and I tell you it has been a liberation to realize you can always find a shock of beauty or meaning in what life you have left.”
One morning in July 2015, Miller took his seat at a regular meeting of palliative-care doctors at the University of California San Francisco’s cancer center. The head of the team, Dr. Michael Rabow, started with a poem. It was a tradition, he later told me, meant to remind everyone that this was a different sort of hour in their schedule, and that, as palliative-care physicians, they were seeking different outcomes for their patients: things like comfort, beauty and meaning. The poem was called “Sinkhole,” and it seemed to offer some sneaky, syntactically muddled wisdom about letting go. When it was over, there was a beat of silence. (It was kind of a confusing poem.) Then Rabow encouraged everyone to remember any patients who had died since their last meeting. Miller was the first to speak up.
Miller, now 45, with deep brown eyes and a scruffy, silver-threaded beard, saw patients one day a week at the hospital. He was also entering his fifth year as executive director of a small, pioneering hospice in San Francisco called the Zen Hospice Project, which originated as a kind of compassionate improvisation at the height of the AIDS crisis in San Francisco, when members of the San Francisco Zen Center began taking in sick, often stigmatized young men and doing what they could to help them die comfortably. It is now an independent nonprofit group that trains volunteers for San Francisco’s Laguna Honda public hospital as well as for its own revered, small-scale residential operation. (Two of the facility’s six beds are reserved for U.C.S.F., which sends patients there; the rest are funded through sliding-scale fees and private donations.) Once an outlier, Zen Hospice has come to embody a growing nationwide effort to reclaim the end of life as a human experience instead of primarily a medical one. The goal, as Miller likes to put it, is to “de-pathologize death.”
Around the table at U.C.S.F., Miller stood out. The other doctors wore dress pants and button-downs — physician-casual — while he wore a sky blue corduroy shirt with a tear in the sleeve and a pair of rumpled khakis; he could have come straight from camping or Bonnaroo. Even just sitting there, he transmitted a strange charisma — a magnetism, people kept telling me, that was hard to explain but also necessary to explain, because the rapport Miller seems to instantly establish with everyone is a part of his gift as a clinician.
“It’s reasonable to say that it’s impossible to describe what it feels like to be with him,” Rabow told me. “People feel accepted. I think they feel loved.” It’s in the way Miller seems to swaddle you in his attention, the way his goofiness punctures any pretensions. (Miller, who has an unrepentant knucklehead side, habitually addresses other men as “Brother man” or “Mon” and insisted to me many times that he hasn’t finished a book in 20 years.) For people who know him, his magic has almost become an exasperating joke. When I spoke to Miller’s childhood friend Justin Burke, he told me a story about Miller running around on a beach with his dog in San Francisco years ago. A man came hobbling over and explained that he was about to have his own leg amputated and that just watching Miller run around like this, on two prosthetics, had instantaneously reassured him that he was going to be O.K. I told Burke to hang on: Someone at Zen Hospice had already told me this story, except that in her version, Miller was running on a trail in Texas. “Ask him how many times it’s happened,” Burke deadpanned.
Now Miller also seemed to be on the cusp of modest celebrity. He’d started speaking about death and dying at medical schools and conferences around the country and will soon surface in Oprah’s living room, chatting about palliative care on her “Super Soul Sunday” TV show. Several of Miller’s colleagues described him to me as exactly the kind of public ambassador their field needed. “What B.J. accomplishes is to talk about death without making it sound scary and horrible,” Rita Charon, a professor of medicine at Columbia University College of Physicians and Surgeons, says. “We know from seeing him standing in front of us that he has suffered. We know that he has been at the brink of the abyss that he’s talking about. That gives him an authority that others may not have.” Vicki Jackson, the chief of palliative care at Massachusetts General Hospital, agreed. Nobody welcomes conversations about dying, she said, not even about making the experience less miserable. “But people will listen to B.J.,” she said. “They want to.”
Jackson pointed to the talk Miller gave to close the TED conference in 2015. Miller described languishing in a windowless, antiseptic burn unit after his amputations. He heard there was a blizzard outside but couldn’t see it himself. Then a nurse smuggled him a snowball and allowed him to hold it. This was against hospital regulations, and this was Miller’s point: There are parts of ourselves that the conventional health care system isn’t equipped to heal or nourish, adding to our suffering. He described holding that snowball as “a stolen moment,” and said, “But I cannot tell you the rapture I felt holding that in my hand, and the coldness dripping onto my burning skin, the miracle of it all, the fascination as I watched it melt and turn into water. In that moment, just being any part of this planet, in this universe, mattered more to me than whether I lived or died.” Miller’s talk has been watched more than five million times. And yet, Jackson told me: “If I said all that — ‘Oh, I could feel the coldness of the snowball ...’ — you’d be like: ‘Shut. Up. Shut up!’ But no one is going to question B.J.”
Now, at the morning meeting, Miller began describing the case of a young man named Randy Sloan, a patient at U.C.S.F. who died of an aggressive cancer a few weeks earlier at Zen Hospice. In a way, Sloan’s case was typical. It passed through all the same medical decision points and existential themes the doctors knew from working with their own terminal patients. But here, the timeline was so compressed that those themes felt distilled and heightened.
And then there was the bracing idiosyncrasy of everything Miller’s staff had been able to do for Sloan at Zen Hospice. Rabow told me that all palliative-care departments and home-hospice agencies believe patients’ wishes should be honored, but Zen Hospice’s small size allows it to “actualize” these ideals more fully. When Miller relayed one detail about Sloan’s stay at the hospice — it was either the part about the sailing trip or the wedding — one doctor across the conference table expelled what seemed to be an involuntary, admiring, “What?”
Everything Miller was saying had a way of sharpening an essential set of questions: What is a good death? How do you judge? In the end, what matters? You got the sense that looking closely at Sloan’s case might even get you close to some answers or, at least, less hopelessly far away.