A horrible accident when he was goofing off made him think deeply about what people need when dying.

He was just goofing off with friends as a young adult.

BJ Miller was a young adult hanging with his crew. They decided one night to climb onto the top of a parked commuter train — just one of the dumb things people do when they're bored and looking for adventure. When he reached the top, an "electrical current entered through his hand and blew out through his feet." It resulted in him losing the lower parts of his legs, as well as one of his hands.

How a snowball changed his entire perspective


After that, he spent a few months in a hospital burn unit, where he received great care at every turn. He tells the story of how one night it was snowing, and he had no windows. He could hear the nurses discussing their treacherous drives in the bad weather, and he could only imagine the snow from where he was situated. The next day, one of his nurses smuggled in a snowball and brought it to him.

He just held it in his hand, marveling at the sharp cold against his hot skin, watching it melt, and feeling connected to the world around him in a way he hadn't while pent up inside the hospital.

“In that moment, just being any part of this planet in this universe mattered more to me than whether I lived or died. That little snowball packed all the inspiration I needed to both try to live and be okay if I did not." — BJ Miller

Something isn't right if patients are ready to die for the wrong reasons.

Flash forward a couple of decades. BJ is now a physician — due in large part to what he went through. He recounts many patients he's worked with who were ready to go, ready to die, but not because they'd made peace with the circle of life and the impending next step in it.

They were ready to die because they hated how ugly their lives had become as patients.

At a time when a person is struggling with the biggest hurdle of their lives — leaving their lives behind and not existing corporeally anymore — they are often completely cut off from the humanity and experience of life they so desperately are wishing to exercise while they fleetingly still can.

He makes the case that with some real attention to the design of palliative care and hospitals, we can totally transform what the process of dying becomes for people. Instead of a gruesome, clinical, scary process, it can be, by design, a concentrated crescendo of all the things it means to be living, packed into those final months and days.

Think about it: At a time when a person is struggling with the biggest hurdle of their lives — leaving their lives behind and not existing corporeally anymore — they are often completely cut off from the humanity and experience of life they so desperately are wishing to exercise while they fleetingly still can.

Like feeling their dog lying at the foot of their bed with a cold nose against them. The feelings and quick snapshots in time that, strung together, make up a life.

BJ calls this "sensuous aesthetic gratification," putting words to those moments where we're tactilely rewarded just for being alive.

He makes a moving case for why the entire process of dying should be comprised of more moments of pure living.

If you've ever stood witness to a loved one in their final days, you can probably understand how true this is and how important it is to get people to rethink our systems for the dying.

After all, it will be our turn one day. And we'll want the best experience we can possibly have.

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