Sex is not just intercourse. Connection is the thing.

Just about anything can be erogenous and sexy. Sex is in many ways an aesthetic pursuit in that it comes to us via the senses but also in that it has its own power and exists for its own sake.

You may say that sex is simply intercourse or that sex is purely for procreation purposes, and that’s okay. But even when sex is simply a means to an end there is still something majestic and powerful about the act itself. Therefore, even if we aren’t reproducing, sex is a powerful…


It’s difficult to talk about sexuality and intimacy in our culture, let alone sexuality as relates to illness or disability, but we are still human, and a large part of being human is sexuality.

How To Stay In Your Body When Pain is Present?

I’ve had a lot of pain. There have been moments in my life where my body is screaming at me and the idea of sex or sexiness is the last thing I can possibly imagine. However, it is possible. …


Sexuality is something we take for granted. We all have some version of it. It is a primal part of the human experience and it means different things to different people. Some people have a profound sexual life which is a big part of their daily experience, but many of us may not see that. Sexuality is private, personal, and very important.

Another important point to note is that sex is 90% in our heads. Sexuality is not just about body parts but also about what goes on in our brain, our psychology and who we are as people.

Because…


What blocks people from talking about hard topics?

A key point here is to take a step back from the communication dynamic entirely and remember your foundational relationship to the person you’re speaking to. People are so much more than their diagnosis and often the first step to understanding what may be blocking someone from talking about a hard topic is simply to remember to see them as a whole person.

Try Something Lighter to Start

One good way to approach a difficult conversation is to begin on a lighter note. This may take the form of simply easing into…


Emotionally charged conversations with family members, friends, or clinicians are often very transactional; something needs to be communicated and something needs to be gained from these interactions. This context will always ask for more directness. However, a critical point to remember is that a fundamental part of being human is the need to be seen and heard in the context of communication.

For that reason, the mode of communication for these topics can be a very powerful way to express the many aspects of what you may be feeling. Examples include poetry, works of fiction, or even making your point…


Communication is more than just what you say.

Holding Silence

Silence is really difficult and really important. Holding silence does not mean simply talking more slowly but actually being quiet, taking a deep breath and allowing your nervous system to settle. Doing this puts you in a better position to think through what’s coming out of your mouth. Silence can get awkward, but it’s an awkwardness that pays off in the long run. Therefore, don’t be afraid to be silent in conversations often and to hold silence as long as you can.

Body Language

Our words hold meaning and are…


To preface, it is important that you take this information with a grain of salt. There is no one size fits all with communication. With communication there is cultural overlay, differing vernacular depending on your social situation, and differing habits depending on who you’re communicating with.

Part of the trick with communication is learning how to speak different vernacular with different groups of people. For example, your family and friends may require one mode of communication while clinical care teams may require a completely different mode of communication. …


It’s a good idea to have both an advance directive and a Physician’s Orders for Life-Sustaining Treatment (POLST). They’re a little bit different from one another. The gist of the advanced directive is the same thing as a living will; it is the legal document by which you get to state your wishes for your care, especially at the end of life, and to name your health care proxies.

The most important piece of the advance directive is to name your deputy. If you find yourself in a situation where you can’t communicate or make decisions, having a trusted person…


  1. Understanding Clinical Trials and How They Work

Clinical trials are very much their own kind of world. Sometimes the general treatment pathways are good options for you, but sometimes people look to the latest research in the experimental world that might help.

When you’re interested in a clinical trial, that often means your normal, routine doctor will be replaced by another doctor, often the one leading the research. You might have a totally different team navigating the trial.

A major thing to understand about trials is how they are designed. First and foremost, the point of any clinical trial is…


Whether or not we’re prepared to actually hear an analysis or prognosis is a very important question to ask ourselves.

Here’s a really important key. Some of us might not want to know this “best guess” on how much time we have left because then we have this feeling of a clock ticking. That can be an additional pressure to an already difficult situation versus staying open-ended.

Consider simply taking one day at a time. This one day at a time approach can also be really helpful and wonderful to those on your team; a spouse, a friend, or someone…

BJ Miller, MD

BJ is a hospice & palliative medicine physician who sees people at mettlehealth.com and speaks on topics of illness and palliative care around the world.

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