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BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully.

We discuss:

• The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30];
• What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15];
• How historical perspectives on death contrast with modern experiences of dying [25:30];
• The difference between palliative care and hospice care [30:45];
• The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30];
• How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30];
• The realities of home hospice: challenges, costs, and burdens placed of families [43:45];
• How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30];
• How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45];
• Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15];
• The importance of having an advance directive: defining what matters most before it’s too late [1:23:00];
• The differences between how young and old individuals experience dying from cancer [1:30:15];
• The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45];
• Dying well: the power of self-honesty and human connection at the end of life [1:47:00];
• How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15];
• Lessons from the dying on how to live well [1:57:30];
• The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and
• More.

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View the Show Notes Page for This Episode

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This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies.

We discuss:

• The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00];
• How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30];
• The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30];
• How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15];
• Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30];
• Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00];
• The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00];
• Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00];
• The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45];
• Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45];
• Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00];
• Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00];
• The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45];
• The step-by-step process of IVF [1:19:30];
• The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30];
• Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15];
• Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30];
• Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45];
• How to choose the right IVF clinic [1:54:45];
• Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00];
• Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45];
• Promising areas of fertility research [2:15:45]; and
• More.

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