Jan. 14, 2022 -- Bruce "BJ" Miller Jr., a 19-year-old Princeton University sophomore, was horsing around with friends near a train track in 1990 when they spotted a parked commuter train. They decided to climb over the train, and Miller was first up the ladder.
Suddenly, electricity from nearby powerlines struck his metal watch, shooting 11,000 volts through his body.
An explosion ripped through the air, and Miller was thrown on top of the train, his body smoking. His terrified friends called for an ambulance.
Clinging to life, he was airlifted to the burn unit at Saint Barnabas Medical Center in Livingston, NJ.
Doctors saved Miller's life, but they had to amputate both of his legs below the knees and his left arm below the elbow.
"With electricity, you burn from the inside out," says Miller, now 50. "The voltage enters your body -- in my case, the wrist -- and runs around internally until it finds a way out.”
In his case, the current tried to escape through his chest, causing more burns, but did not spare his legs.
“I think I had a half-dozen or so surgeries over the first month or two at the hospital,” he says.
Waking Up to a New Body
Miller doesn't remember much about the accident, but he recalls waking up a few days later in the intensive care unit and feeling the need to use the bathroom. Disoriented, he pulled off his ventilator, climbed out of bed, and tried to walk forward, unaware of his injuries. His feet and legs had not yet been amputated. When the catheter line ran out of slack, he collapsed.
"Eventually, a nurse came rushing in, responding to the ventilator alarm bells going off," he says. "My dad wasn't far behind. It became clear to me then that this was not a dream and [I realized] what had happened and why I was in the hospital."
For months, Miller lived in the burn unit, getting countless skin grafts and surgeries. His feet were amputated first, and later, his legs.
"In those early days from the hospital bed, my mind turned to issues related to identity," he says. "What do I do with myself? What is the meaning of my life now? I was challenged in those ways. I had to think through who I was, and who I wanted to become."
Miller eventually moved to the Rehabilitation Institute of Chicago (now called the Shirley Ryan AbilityLab), where he started the grueling process of rebuilding his strength and learning to walk on prosthetic legs.
"Any one day was filled with a mix of optimism and good fight and, 5 minutes later, exasperation, frustration, tons of pain, and insecurity about my body," he says.
His family and friends offered support, “but a lot of the work was up to me. I had to believe that I deserved this love, that I wanted to be alive, and that there was still something here for me."
Miller didn't have to look far for inspiration. His mom had lived with polio for most of her life and acquired post-polio syndrome as she grew older, he says. When Miller was a child, his mom walked with crutches, and she needed to use a wheelchair by the time he was a teenager.
After the first surgery to amputate his feet, Miller and his mom shared a deep discussion about his joining the ranks of "the disabled," and how their connection was now even stronger.
"In this way, the injuries unlocked even more experiences to share between us, and more love to feel, and therefore some early sense of gain to complement all the losses happening," he says. "She had taught me so much about living with disability and had given me all the tools I needed to refashion my sense of self."
From Burn Patient to Medical Student
After returning to Princeton University and finishing his undergraduate degree, Miller decided to go into medicine. He wanted to use his experience to help patients and find ways to improve weaknesses in the health care system, he says. But he made a deal with himself that he wouldn't become a doctor for the sake of becoming one. He would enter the medical world only if he could do the work and enjoy the job.
"I wasn't sure if I could do it," he says. "There weren't a lot of triple amputees to point to, to say whether this was even mechanically possible, to get through the training. The medical institutions I spoke with knew they had some obligation by law to protect me, but there's also an obligation that I need to be able to fulfill the competencies. This was uncharted water."
Because his greatest physical challenge was standing for long periods, instructors at the University of California, San Francisco, made changes to ease the strain. His clinical rotations, for example, were organized near his home to limit the need for travel. On surgical rotations, he was allowed to sit on a stool.
Medical training progressed smoothly until Miller completed a rotation in his chosen specialty, rehabilitation medicine. He didn't enjoy it. The passion and meaning he hoped to find were missing. Disillusioned, and with his final year in medical school coming to an end, Miller dropped out of the program. Around the same time, his sister, Lisa, died by suicide.
"My whole family life was in shambles," he says. "I felt like, 'I can't even help my sister, how am I going to help other people?'"
Miller earned his medical degree and moved to his parents' home in Milwaukee after his sister's death. He was close to giving up on medicine, but his deans convinced him to do a post-doc internship. It was as an intern at the Medical College of Wisconsin that he completed an elective in palliative care.
"I fell immediately in love with it the first day," he says. "This was a field devoted to working with things you can't change and dealing with a lack of control, what it's like to live with these diagnoses. This was a place where I could dig into my experience and share that with patients and families. This was a place where my life story had something to offer."
Creating a New Form of Palliative Care
Miller went on to complete a fellowship at Harvard Medical School in hospice and palliative medicine. He became a palliative care doctor at UCSF Health in San Francisco, and he later directed the Zen Hospice Project, a nonprofit dedicated to teaching mindfulness-based caregiving for professionals, family members, and other caregivers.
Gayle Kojimoto, a program manager who worked with Miller at UCSF's outpatient palliative care clinic for cancer patients, said he was a favorite among patients because of his authenticity and his ability to make them feel understood.
"Patients love him because he is 100% present with them," Kojimoto says. "They feel like he can understand their suffering better than other docs. He's open to hearing about their suffering, when others may not be, and he doesn't judge them."
n 2020, Miller co-founded Mettle Health, a first-of-its-kind company that aims to reframe the way people think about their well-being as it relates to chronic and serious illness. The team provides consultations on a range of topics, including practical, emotional, and existential issues. No referrals are needed.
When the pandemic started, Miller says he and his colleagues felt the moment was ripe for bringing palliative care online to increase access, while decreasing caregiver and clinician burnout.
"We set up Mettle Health as an online palliative care counseling and coaching business, and we pulled it out of the health care system so that whether you're a patient or a caregiver, you don't need to satisfy some insurance need to get this kind of care," he says.
“We are a social service, not a medical service, and this allows us to complement existing structures of care rather than compete with them."
Having Miller as a leader for Mettle Health is a huge driver for why people seek out the company, says Sonya Dolan, director of operations and co-founder.
"His approach to working with patients, caregivers, and clinicians is something I think sets us apart and makes us special," she says. "His way of thinking about serious illness and death and dying is incredibly unique, and he has a way of talking about and humanizing something that's scary for a lot of us."
’Surprised at How Much I Can Still Do’
Since the accident, Miller has come a long way in navigating his physical limits. In the early years, he says he was determined to do as many activities as he still could. He skied, biked, and pushed himself to stand for long periods on his prosthetic legs.
"For years, I would force myself to do these things just to prove I could, but not really enjoy them," he says. "I'd get out on the dance floor or put myself out in vulnerable social situations where I might fall. It was kind of brutal and difficult. But at about year 5 or so, I became much more at ease with myself and more at peace with myself."
Today, Miller's prosthetics make nearly all activities possible, but he concentrates on the activities that bring him joy.
"Probably the thing I can still do that surprises people most, including myself, is riding a motorcycle," he says. "As for my upper body, I'm thoroughly used to living with only one hand, and I continue to be surprised at how much I can still do.”
It took a while, he says, “to figure out how to clap! Now I just pound my chest for the same effect!"