Checkpoint - Month 5: December in Review

View from Butterfly Palliative Home.

December has always felt like a transitory month to me. The anticipation of winter break, the stress of exams, the excitement of the holidays, the very last month of the year. This year has been no exception. So far, every individual month of my Watson has been spent squarely in one country, but in mid-December, I made the journey from Ghana to South Africa, from being a carpentry apprentice in a fantasy coffin shop to working in a hospice orphanage for children with terminal illnesses. I had one foot in and out of both countries for the entirety of the month. The transition was rejuvenating and exhausting all at the same time, but both of these emotions have given me so much to reflect on as I enter the New Year and near the halfway mark of my travels.

When the time came to leave Ghana, the tension between being ready to move on because of my project progress and the immense grief at leaving another family was palpable. There was so much to be proud of about my time in Ghana; after all, I had come to this new and unfamiliar place to learn an extremely unfamiliar skill. In other countries, I knew I would have the comfort of being in a familiar environment, working within or adjacent to the medical system. In Ghana, I had clumsily stumbled into the role of a coffin carpenter and surprised myself by taking on (perhaps more naively than bravely) something entirely outside of my wheelhouse. All of this being said, in the last couple weeks of my time in Ghana, I could feel that I had gotten all I could out of the cultural immersion in a death tradition so unlike anything in the Western world. I knew if I stayed, I would be halting the forward motion of my project.

However, leaving my Ghanaian family felt like a near-impossible task. My host siblings took every opportunity to tell me that they would miss me to urge me to come back as soon as I could. I couldn’t find the right words to explain to them that my return visit if it should happen, would not be for quite some time. If or when I come back to Ghana, my youngest siblings, Walter, Beverlyn, and Benjamin, will all be grown. The brothers who I worked with will likely have children of their own. The puppies and kittens will have fled the compound and will be unrecognizable. I imagine some things may still be the same, like the women’s kenkey business and the coffins in various stages strewn around the middle of the workshop. My coffin, the syringe, will be sitting on the showcase roof, waiting for my arrival, a telling sign that the only true constants in life are that of birth and death.

So, mostly, I am sure it will feel different. It was in sitting with these emotions that I began to feel pre-emptive nostalgia, as I always do before leaving a place. I started making lists of the things that I will miss as if I wouldn’t be able to viscerally feel and remember them after I left: the noise of the traffic on Beach Rd below the window of my room, the smell of burning trash permeating the hot air, the sewage rivers that became commonplace, the heat rash on my legs which would soon fade, the blisters on my fingers from learning how to properly maneuver a vertical saw. Most of all, I reflected on the person I was in Ghana, on who Adjorkor Na Fio Fio is as opposed to Sam now that both of these personas live inside me. Na Fio Fio was filled with joy and gratitude; she did not lose herself to the inner turmoil of bed bugs appearing or drain worms infiltrating her wash space, she brushed her teeth over the toilet and tried every type of Ghanaian food possible. Na Fio Fio was brave in ways that I don’t think I had registered I could be.

When I arrived in South Africa, I found myself back in the land of showers, cool breezes, rain, and slightly discomforting quiet. I had a few days before I made my way up to Butterfly Palliative Home in rural KwaZulu-Natal; I spent this time with Dr. Julia Ambler, the queen of pediatric palliative care in KZN herself (more on her work in a coming post). On my first full day in South Africa, I went straight back to work, which I was grateful for as I didn’t have time to think about the tearful goodbye I said to my host family less than 48 hours previously at the Accra airport. Dr. Ambler took me to see some of her patients in a local hospital in Durban. When I found myself beside the first patient, a young boy known to Dr. Ambler for many years, I felt oddly comfortable, given the emotions at the bedside. This I knew how to do well: to gently stroke the tummy of the patient, listen to his grandmother’s concern, or look over Dr. Ambler’s shoulder as she reviewed her charts. My time in Ghana provided an invaluable framework through which to understand how death is celebrated, but it also unintentionally provided a reprieve from the hospital setting. Now that I had returned to it, I felt that the pull to the clinical side of my project had grown immensely. This was where I was meant to be.

This feeling of being in the right place only grew when I arrived at Butterfly Palliative Home, an orphanage for abandoned children with terminal illnesses. I spend my days doing basic clinical work where I can be of help, entertaining the older children, rocking the younger ones to bed, and simply facilitating anything and everything that allows these children to just be kiddos. Friends and family have asked recently how I am doing emotionally, concerned that the gravity of living with and caring for dying children would be too much. At first, I thought there might be something wrong with me that I wasn’t feeling as emotional as perhaps I should have been given my day in and day out here. I started questioning whether I was doing exactly what I had gone on this year, looking to unlearn: numbing myself to the very human emotions of disease and death. However, as I have sat with myself more these past few weeks, I have found that it's not exactly that I’m perversely happy here or putting on a fake smile, it's more that I feel more than ever before (this year or in my life generally) that I am where I am supposed to be. Most days, I am exhausted from corralling the kids, coming up with games, cleaning up, preparing PEG feeds, etc. I crash into my bed at night, but as I lay there and journal or fall asleep, I feel truly as if my cup is full. My dad, an ER physician, has warned me to keep an open mind as I approach medical school and explore specialties, and I intend to, but even so, I have a feeling that nothing will compare to the purpose I feel when working with the Butterflies.

The other day, I was given Molly, one of the babies of the Butterfly Home who lives with chronic neuropathic pain secondary to microcephaly, to hold. Her pain is controlled as well as possible at Butterfly, but she has moments where she will not stop crying. On this day, I was given Molly to try to console so that the other children could finish their dinners with the other full-time caregivers. I brought Molly into the nursery and sat in the rocking chair, trying to bob her slowly into a happier state. When she was still wailing ten minutes later, I started to sing to her. I am in no way a good singer, but it felt right in the moment, and I have fond memories of my mom singing to my sisters and me in our rocking chairs at home. I tried all the classic lullabies, but nothing worked. Without really thinking about it, I began to sing John Denver’s “For Baby (For Bobbie),” which was my “older sister’s song,” the song my mom used to sing to her to calm her down or before bed. Almost immediately, Molly stopped crying, and she just looked up at me, watching, cooing a little. I think I must’ve sung the song through three times just to stay in that moment a little longer. I had done practically nothing; I hadn’t administered any medication, but for a moment, I helped to take away some of her pain. It’s a memory I’ll never forget, a moment I’ll carry with me as concrete evidence that practicing medicine is so much more than the technical or the procedural. It’s a moment I could spend a lifetime trying to figure out how to recreate the system we have at home in the USA. It’s everything this project is about and more; it’s the reassurance I’m on the right path.

This is how I feel Adjorkor Na Fio Fio remains inside me; I find in every moment I am ridiculously, almost stupidly filled with gratitude. This approach – leading with joy and finding something in every day to be thankful for – was the thing I was most afraid to lose when I left Ghana. I was terrified that the more practical aspects of my project would demand less loftiness and more of my feet being planted firmly on the ground. Perhaps I wasn’t as scared that it would leave me when I arrived in South Africa as I was afraid that returning home, I would forget it altogether. These moments with the Butterflies and becoming Adjorkor Na Fio Fio would be left a thousand miles away. While I have no way of telling whether or not this will be true, it also makes continuing to work on this person – the Watson version of myself or the person I have found myself capable of being this year – the ultimate New Year’s resolution. The Watson has also inspired several of my other resolutions for this year. I would love to say yes to things more as I’ve been doing here. I often find myself wondering what I would’ve missed if I had said I was as tired as I felt when my brothers in Ghana asked to go for a walk, or the Butterflies asked me to read to them, or when my hosts in Morecambe would ask me to accompany them on hikes. I have whole stories that would cease to exist if I had declined. I also want to take up guitar or play piano again and maybe seriously consider road cycling. My restlessness during my travels has shown me I need a new hobby to fill this hole once I’m home. Maybe I’ll learn how to play the guitar while road cycling – that’d be pretty cool.

I am saying goodbye to 2024, a little uncertain of how a year could be filled with so much – my last semester of college, my last time living with my best friends, getting notification that I was indeed a Watson fellow, saying goodbye to all my family and friends a few months later, the beginning of my Watson through to the end of my fifth month away from home, and the complete and undeniable changes I have witnessed within myself thus far. I welcome 2025 with cautious excitement, knowing it will hold just as much – the last half of my travels that are certain to go by as fast as the first, applying to and (fingers crossed) getting accepted to medical school, starting some type of job in some type of city post-Watson (don’t ask me what yet), transitioning from go-go-going to more sedentary, and bringing Watson Sam/ Fio Fio home with me.

Happy New Year to everyone, and as always, thank you for the support you all have given me during this insane year. I hope wherever you find yourself starting this year; you have something to be grateful for and resolutions to be deservedly lofty about.