How a triple-amputee doctor is helping to change the way we die

Jon Mooallem's beautiful profile of BJ Miller tells the tale of how Miller lost three of his limbs in a stupid accident and became a pioneer of palliative medicine: but for me, it's also a story of the very best of San Francisco's blend of technology, optimism, compassion and exuberant weirdness — a blend that has been changing for the worse since the dotcom bubble of the turn of the century.

Miller runs the Zen Hospice project, which has its origins in the AIDS epidemic — it was founded as an alternative way to die in the midst of so much death. In the years since, it has become a model for a new kind of palliative medicine, one that stresses individual dignity and choices about the end of life. Its approaches remind me of Atul Gawande's 2014 lecture about end-of-life care — a lecture that can reduce me to tears even today, and which profoundly influenced the way I think about my own death, when it comes.

Miller's work fits in perfectly with the parts of San Francisco I fell in love with from the first: its heaving diversity, its experimental vigor, its tolerance. The Bay Area's convergence of technology and this ethic is the part of tech that excites me today (even as it is increasingly endangered by a finance/surveillance-centered technology industry).

Reading the stories of how Miller and Zen Hospice are changing lives reminded me that, even in Trump's America, there are people who believe in kindness and solidarity as our first duty to one another, and of that duty as the purpose of our civilization.

The Guest House is a calm, unpretentious space: a large Victorian home with six beds in five bedrooms, vaulted ceilings, slightly shabby furniture and warm, Oriental rugs. There is a large wooden Buddha in the dining room. The kitchen is light-filled and bursting with flowers. There's always a pot of tea and often freshly baked cookies. And while Zen Hospice has a rotating, 24-hour nursing staff, the tiny nursing station is literally tucked into a kind of cabinet in the hall upstairs; the house, in other words, feels very much like a house, not a hospital.

You don't have to spend much time there to realize that the most crucial, and distinctive, piece of the operation is its staff of volunteers. Freed of most medical duties by the nursing staff, the volunteers act almost as existential nurses. They sit with residents and chat, offering their full attention, unencumbered by the turmoil a family member might feel. The volunteers are ordinary people: retired Macy's executives, social workers, bakers, underemployed millennials or kibitzing empty-nesters. Many are practicing Buddhists. Many are not. (Miller isn't.) But Buddhism informs their training. There's an emphasis on accepting suffering, on not getting tripped up by one's own discomfort around it. "You train people not to run away from hard things, not to run away from the suffering of others," Miller explained. This liberates residents to feel whatever they're going to feel in their final days, even to fall apart.

At first, many volunteers experience a confused apprehension. They arrive expecting nonstop, penetrating metaphysical conversations with wise elderly people and instead just wind up plying them for recipes or knitting advice or watching "Wheel of Fortune" with them or restocking latex gloves for the Guest House nurses. But one especially well-liked volunteer, Josh Kornbluth, told me that, after a year working at the Guest House, he understood that the value of Zen Hospice is actually "in the quotidian — the holding of someone's hand, bringing them food that's been beautifully arranged on the plate, all the small ways of showing respect to that person as a living person and not as 'predeceased.' Those are actually deep things. And I say that as the least Zen person!" In fact, Kornbluth was raised by Jewish Communists in New York City, and once, after a woman died at the Guest House and no more-senior volunteer was on hand to take charge, I watched him — adrenalized, uneasy, perspiring — fumble around on his iPhone for something to say over the body before they wheeled it away, then mangle the pronunciation of Thich Nhat Hanh.

Zen Hospice

One Man's Quest to
Change the Way We Die
[Jon Mooallem/New York Times]

(Photo: David Butow/Zen Hospice)