Checkpoint – Month 10: May in Review

With my recent arrival in Ireland, my return home has become increasingly “real.” With the two-month countdown beginning, I have experienced a flood of often opposing emotions. The pull of home versus the desire to never stop travelling. The need to begin to focus more completely on what’s next versus savoring every second of Watson I have left. Immense pride for all I have done versus knowing I have just begun to make my way in this field and I have a lifetime of discoveries to go. The excitement to be more permanently reunited with my friends and family versus the intense independence and clarity I have gained through being alone. If I am being honest, it’s all a little too overwhelming and personal to describe in this moment and I am aware that I will be continuing to process this experience for years to come, so there is no rush to have all the answers now. But time does seem to be my main constraint this month. I was struggling to find the time, in between my project demands, being in the “moment,” and applying to medical school, to write this post. I told myself that I shouldn’t be forcing myself to do reflection right now that only adds to my growing pile of items to attend to. But writing this, especially when I’m not sure the next chance I’ll have to reflect or how inclined I’ll be to use my last two months reflecting on my time at large, seems like an act of defiance against time running away from me.

Different from my last few posts, I am not going to reflect on the month as a whole but rather the past handful of days during which I have had the privilege to attend the 19th World Congress for Palliative Care hosted by the European Association for Palliative Care in Helsinki, Finland. I had the honor of having a poster presented on a systematic literature review I completed as a visiting researcher at the International Observatory for End-of-Life Care during the first few months of my Watson. The conference brought me so many things: the chance to showcase work from the beginning of this fellowship, opportunities to speak with people around the world including those in palliative care in the US, special time with many of the individuals I had worked with this year and said goodbye to, unsure when I would see them again, and, for better or for worse, forced reflection on “what’s next.” I hope to share just a few of my thoughts in this post, but forgive me as they are still half-baked.

Robots Vs. Humans

The theme of this year’s World Congress was the future, which feels apt given that just about all my free time in recent weeks has been focused on my future. What happens after Watson? Will I know what school I’m attending this time next year? Where do I see myself within palliative care and/or global health? How do I continue the momentum of this year? As I consider my future, I am aware that in doing so, I am reflexively imagining a future of palliative care that includes me and other hopeful healthcare professionals who are intent on making waves within this field. But the question we are all asking – and perhaps all, including people generally, not just those interested in medicine or palliative care – is what type of future are we heading towards? I have all but flushed my phone down the toilet to avoid the barrage of news headlines that grace my screen each day. Despite not being in the US, I am acutely aware of how each news update on my screen signals the earth-shaking changes that are taking place that will make home unrecognizable. The conference theme highlighted this tension with references to research cuts, the undermining of scientific knowledge, and the unprecedented violent attacks on centers for healthcare and healthcare professionals in countries experiencing humanitarian crises around the world. For palliative care specifically, these shifts are coming at a time when “baby boomers” are reaching an older age, increasing the need for palliative care exponentially. And, as Dr. Lorna Fraser so expertly addressed in her keynote presentation on pediatric palliative care, an increase in complex chronic illnesses among young children that boomed in years passed will now see those same children transitioning to adult palliative care, emphasizing the need for a focus on how we move pediatric palliative patients into adult systems without overwhelming the patients or hospitals.

In simple terms, a lot is going on. On the second day of the conference, a different kind of keynote speaker was welcomed onto the stage. Jan Romportl is the CEO of Elin.ai, a Czech AI startup that began as an investigation into how AI could tackle mental health. To preface this conversation, I must admit that I am rather AI-adverse; I fall into the camp of people who firmly believe that just because you can do something doesn’t necessarily mean you should. So, just because we can teach computers to do human-like things or design creepy robots doesn’t necessarily mean we should. Call me old-fashioned. Suffice it to say, I came into this talk a bit apprehensive and worried that the lecture would be about how to implement AI within palliative and end-of-life care.

Jan spent much of his talk painting a picture of the future of AI, which, as he made pointedly clear, is imminent whether we like it or not. According to the most recent projections, which are growing exponentially every day, AI will reach superintelligence within the next 10 years. Essentially, this means that AI will be able to do things that humans can do better than humans can do it. This also means that 51% of jobs will be made redundant. It was around this time that I started laughing to myself because a world in which we interact with AI more than we do each other sounds like something out of a Black Mirror episode. But I suppose there’s nothing to be done about it since we seem insistent on continuing down this path.

It was at this point that I began wondering how palliative care fit into this schematic. When Jan was first introduced, I assumed the talk would be about how AI can make the jobs of healthcare workers easier. Instead, I was sitting there, curious if he was going to try to argue that AI would make the jobs of healthcare workers obsolete in a room full of healthcare professionals. He continued to say that soon there would be robots performing completely autonomous surgeries and supercomputers dictating medical records. Then he got to palliative care and he made quite the impact. In short, he said that in a world that is becoming increasingly more computerized, palliative care will remind us all to become increasingly more human.

Jan’s talk resonated with me deeply, not just because I want the satisfaction of one-upping a robot, but because I think his point applies more generally to something I have been coming up against throughout this year. With all that is going on in the world, I have often found myself questioning, as you have all read in my many blog posts on this topic, whether or not what I am doing is “important” in this current moment. Being so far from home, as so many horrible things are happening, has left me feeling inconsequential. Simultaneously, I am unsure where to begin once I do get home. When I talk to family members or friends, we all sound like chickens with our heads cut off, running around trying to find where we can make the most difference, but unsure if that will be “enough.” But I think Jan makes a good point. As the world around us becomes increasingly more unrecognizable, the greatest act of resistance has to be remaining human in the face of so much horror.

I think palliative and end-of-life care have the promise of being the epitome of this humanness within medicine. Mainly because, to me, it’s not about the medicine. It’s about the ability to step within someone’s most vulnerable moment and share it with them, remain with them, and make meaning from it. Having now spent over 10 months around death and dying, I can confidently say that the way we come around those who are dying, the way we show them kindness or fulfill their wishes or simply provide a hand to hold, says the most about who we are as humans. As Jan says, this is something AI will never be able to do, and I believe him. There’s something beautiful about this notion: being human as the most radical act of rebellion. It’s a lesson I think we will all have to keep close as we move into a very uncertain future.

The Future

While the future of palliative care may be safe from robots for now, I find myself thinking a ton about my future within this field as I near the end of Watson. Unfortunately, so much of my time lately has been devoted to this question of “what’s next” between climbing the steep mountain that is medical school applications, to job hunting, to the calendar’s imminent reminder every morning that I have seven weeks of Watson left. I have been having an internal panic about so many things having to do with the future, but mostly, I have been concerned about how to not let the momentum I have built this year dissipate. This year has taught me an entire ocean’s worth of possible ways to advance end-of-life care in the US; I could devote every minute of my time from this moment forward and still not have tackled each possible path I have learned about this year. And more so, that feels clunky and disjointed. I have been trying to reflect on everything I learn, hoping that something will jump out at me as the way forward from here. However, this reflection, combined with the worry that anything I do from here will only pale in comparison to this year and ultimately be disappointing, has proved unsuccessful.

However, at the conference, while listening to the myriad of speakers, browsing the poster presentations, and speaking with palliative professionals from all over the world, I felt myself taking mental notes of the moments I felt most engaged and excited. Surprisingly, Jan’s presentation was one of these moments. Simultaneously, presentations on symptom management or the use of psychedelics to treat demoralization at the end of life were fascinating, but I didn’t feel that same magnetism I did when Jan was discussing what it means to be human. Slowly, I started arriving at the fact that while the clinical practice of palliative and end-of-life care excites the scientist and hopeful future physician in me, I ultimately know that this will not be solely what my future career is about. Instead, I felt most pulled during the conference to presentations about system-level changes and shifts in the culture we associate with medicine.

During this year, I have come to see end-of-life/palliative care as a place of genesis where we have the opportunity to move towards a future in medicine that transcends cultural, linguistic, and geographic boundaries. I have felt the need to resist the notion that medicine must be framed from a Western, capitalistic perspective, not just because this serves no one but those in power, but because it tries to make “care” less than the very human thing it is. Caring is innate; we see it in almost every species of living thing on Earth. Care at the end of life, specifically, can be found all around us. Elephants carry dead companions, dolphins keep dead members of their pod afloat, chimps clean their dead and have even been noted to drape leaves over the bodies in a pseudo-burial ritual. Overmedicalization has hindered, not promoted, this very natural part of living. More and more, I think my future is drawing me towards dismantling or, at the very least, exposing and understanding why this might be, working to shift culture back towards what it means to be human.

How will I do that? Still unclear. Luckily, I have lots of time on the other side of Watson to reflect on all I have seen and how I intend to use what I have learned this year to get me there. But, the conference has made me more assured that there’s a niche out there that I think I fill best, that I ultimately think combines all these things I believe myself to be – a future physician, a writer, a very stubborn resistor, a fierce companion, and very unapologetically human.