Disruptions

This final report has been looming over my head since my return to the United States in March. I had been tempted to write it soon after my return. Despite my best intentions to try to remain engaged with my project, I felt as though my Watson was truly over after that first night spent in my childhood bedroom. Even as I mourned the end of my Watson, I could not bring myself to write about my Watson journey with any air of final reflection. In March, I still was clinging onto some hope that I might get to return abroad, convincing myself that in August I would somehow have more to write about death and dying. Now, as I still sit in my childhood bedroom, I find myself wishing I had written this final report five months earlier, the distance between myself and my project growing vaster and vaster. Yet somehow, as my Watson continues to fade into the past, I still feel unprepared to write this final report. 

In moments of utter complacency, I convince myself I have learned most there is to know about the delivery of palliative and end-of-life care. From the importance of early, continuous support to the power of community health systems to the need for bereavement services after death, my Watson experiences covered many different aspects of caring for the seriously ill or dying. At other times, however, I feel like I now know even less than I did when I first landed in Quito, where I immediately was introduced to a hospice center that pushed my understanding of the word hospice. Traveling to new healthcare settings throughout India caused me to continue questioning what the purpose of palliative care is, which patients are in need of this specialty, and if palliative care should even be its own specialty. 

As I neared my sixth month of medical shadowing, my experiences began to feel redundant. I often felt guilty about feeling bored on my Watson, torn between accepting the fact that not every day can yield a profound revelation and pushing myself to make the most of each day and each opportunity. Amidst the redundancy, however, there inevitably would be one day or even one single conversation that rejuvenated or reframed my passion. Perhaps not surprisingly, since returning home, these “gems” (my journal name for an exceptionally good day) have taken a very different form. 

My last quarter Watson activities were largely academic in nature. One of my last experiences I had abroad was attending the Indian Association of Palliative Care Conference (IAPCON), unofficially marking the transition of my Watson to its academic application. Instead of working along the bedside of doctors or nurses, I was listening to these same professionals teach about the development of palliative care in India through evidence-based medicine. The conference followed the same pattern that much of my Watson did, monotony interspersed with moments of inspiration.

At IAPCON, I met Dr. Stephen Connor, the executive director of the Worldwide Hospice Palliative Care Alliance. As I marched across the lawn and accosted Dr. Connor as he waited in line for his lunch, I had not prepared to meet the global expert in palliative care. At most, I expected Dr. Connor to appease my fan girl moment and wish me well with my project. Instead, he invited me to speak with him after lunch. We stood outside the main auditorium, echoes of the spotlight afternoon sessions in the background, as he spoke to me about his experiences with palliative care around the world. We discussed the inconsistencies surrounding the definitions of palliative care, hospice care, terminal illness, and even serious illness. I had become too conscious of trying to consistently use these terms correctly, but Dr. Connor reassured me that these definitions are so different only because palliative care itself is so different across cultures: “there is no one model that fits all.” Furthermore, Dr. Connor patiently answered my questions about practices of nondisclosure and deftly pushed me to realize that nondisclosure is not a uniquely Indian issue. Rather than a cultural issue, it is a psychological issue resulting from our almost inescapable human fear of death. 

In addition to this impactful conversation with Dr. Connor, I was fortunate enough to meet Dr. Karl Lorenz, a palliative care physician and researcher from Stanford University and Davidson College alumna. Although our meeting was brief, Karl encouraged me to reach out if I ever wanted to continue palliative care research state-side. I did not realize how fortuitous this meeting would be when just weeks later the coronavirus pandemic began to sweep across the world. Faced with the difficult decision of returning home or braving the pandemic abroad, I asked myself what the “Watson” decision would be, holding myself to some contrived standard. On a whim, I reached out to Karl, asking if there was any domestic research with which he could use my assistance. 

Just weeks after my return home, we arranged what would soon become a common Zoom meeting featuring several palliative care researchers. We began an ongoing and rewarding systematic review about teamwork in healthcare, analyzing which team characteristics help create the most effective interventions to improve outcomes for patients with chronic pain. Although not exactly in line with my proposed Watson topic, because palliative care is such an inherently team-based and interdisciplinary field, I was happy to shift my focus. Admittedly, I was also happy to have such a tangible and easy way to tell myself I was fulfilling my Watson commitments, even as I avoided more profound engagement and reflection. 

Despite the loss of my Watson experiences abroad, forming this new systematic review team has created meaningful opportunities back at home. Not only has this research position turned into my full-time position for the 2020-2021 year, but I also deeply appreciated learning from from champions in the field. Additionally, the virtual Watson meetings allowed me to connect with other Watson fellows which has been so helpful through what has undoubtedly been the most difficult transition of my Watson. In moments of grief, I have found comfort in my new network of inspiring peers. As a research assistant with the Stanford-affiliated Veterans Affairs, I will be continuing palliative care research, specifically seeking to understand the unique end-of-life needs of Veterans. I feel incredibly lucky to have a job that aligns so well with my interests and the themes of my Watson project. 

There are still times when I think of the experiences I could have had studying physician-assisted dying in the Netherlands or engaging with the death positivity movement throughout the UK. Such feelings of longing often lead me to resent my current research position, as it is both rewarding and frustrating to turn such an exploratory and personal project into rigid academic and government work. I am working to combat this resentment by remaining grateful for my committed research mentors, and I am working to learn how to incorporate curiosity into my structured lifestyle. 

This resentment has persisted as I have been working to complete my medical school applications. When I left for Quito in July 2020, I was unsure if I would apply for the 2021 medical school cycle because I thought I would still be abroad. The pandemic obviously altered my plans, perfectly positioning me with ample time to apply. Writing my personal statement and secondary essays forced me to do a lot of the heavy thinking about my Watson that I was avoiding, but it was a biased-reflection. In each medical school essay, I felt like I was wrapping my project up and tying a bow on top, telling a neatly packaged story of my experiences abroad–I was writing about my Watson with the air of finality that I had been so eagerly avoiding. 

Shockingly, this forced reflection helped me outline some of my overarching take-aways from my Watson year. Through my medical school essays, I was prompted to explain my interests in palliative and end-of-life care, and I realized I am so appreciative of this specialty because of the its inherent holistic implications. Palliative care is a unique medical specialty in which people and caring are at its center, creating liberty to incorporate integrative medicine and spiritual healing. Regardless of my future medical specialty, I am committed to applying a palliative care approach. On my Watson, I was exposed to community-level health initiatives, and I am eager to learn more about community health in the United States. My time abroad has led me to interrogate the centralized nature of medicine in the United States–I do not have all the answers yet, but I am thinking about our medical system in newer and more critical ways. Furthermore, I have a greater understanding of palliative care as a human right, and I am more passionately committed to advocating for universal health care in the United States than ever before. As an aspiring physician, I am eager to increase access to quality palliative care and hospice care, which is so often reserved for the middle-class white population. 

While I can currently recognize how formative my Watson has been in identifying and reaffirming my future goals in the medical field, I am still working to fully recognize and understand the ways has influenced my person. In February, as I was exploring the spiritual side of my project and engaging with other travelers, I felt newly confident and excited. My Watson included some definite missteps, but as I traveled to Jordan, I was finally trusting myself and my decisions. Just a month later, I felt like this self-assurance had vanished. Back in Pennsylvania, I felt like I was completely regressing into a 17-year old version of myself. Since returning back to my childhood home, I feel I am in a constant struggle between who I was, who I am, and who I want to be. 

It is challenging to be a new person amongst an old environment. My parents are not used to the more vulnerable and sensitive version of myself, nor are they accustomed to my desire to spend so much time with myself. I perceive resistance to the ways I have changed, and each day I am challenging myself to be who I want to be, not who my parents are used to having in their home. I have to remind myself to trust my decisions, and that it is okay not to have all the answers. Incorporating these Watson lessons into my daily life currently takes active work. I am eager for the day where these influences will be less forced, where I can comfortably be the best version of myself. I am eternally grateful to my Watson year. I feel like this final report is not the profound reflection that my project deserves, but it is what it is. My Watson has taught me that sometimes just being is enough. 

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