The Journey So Far

Originally, when I decided to begin a blog for my Watson year, I imagined writing out my first thoughts as I sat in the airport preparing to leave. However, sitting here exactly 20 days before I am set to go (and procrastinating the laundry list of preparations that still need to get done), I am reminded of just how long this journey has been so far. It only felt right to begin my reflections for this year by sharing how I now find myself facing 365 days of international travel and exploration concerning how people die around the world.

How It Started

Last August, I sat in the dining room of my roommate’s home in Massachusetts studying for the MCAT and working an internship for the Wolfe Lab, a palliative care research group out of Dana Farber and Massachusetts General Hospital. Between exploring electrical currents and amino acids, I flipped through patients’ charts and tracked data for a study concerning treatments for breathlessness in a pediatric palliative population. Due to the nature of the research project, and when medication is prescribed for breathlessness, chart after chart was stamped with a deceased label at the top. Children younger than me, younger than my little sister flickered on and off my screen, their charts being converted to survey answers and numbers.

My entire undergraduate academic journey I had been committed to finding a way for my interest in creative writing and narrative practices to mix with medicine and science. In my free time, the poetry and stories I wrote were reflections and dreams of how narratives could be used to amplify patients’ voices and treat the whole human instead of only the disease. And yet, here I was, numbing my own emotions and forgetting the humans that lay within the charts I had the privilege of reading. Not even a medical student, facing years upon years of further medical education, I looked in the mirror and saw how ready I was to become less human in the face of death and dying.

Frustrated, I returned to the place where writing and science tend to meet  – I started by asking a question. Do others in the US healthcare system feel as though, when it comes to end-of-life and palliative care, there is a tendency towards avoidance and numbness? When the answer was an overwhelming yes, I looked further. Most of my inquiries led me to the following conclusion: there is a culture of fear surrounding death that echoes loudly within the healthcare system and trickles down throughout the rest of society. In a medical system that emphasizes saving and cures over healing holistically, it was clear that people in the United States do not feel they are dying well. As I would soon discover from a publication by the Duke Global Health Institute, this was not just a feeling but rather an evidence-based truth; the United States ranks 43/81 countries in terms of quality of end-of-life care, far below countries of varying financial and medical resources.

So, what set these top countries apart and why were we in the States not emulating their successes? And more importantly, why weren’t more people talking about how we should be doing better in this specific arena? I began to jot down some of these thoughts and growing concerns, speaking to my mom often about how they might find their way into a future research paper or my statement for medical school. It was during one such conversation that she suggested I look into Middlebury’s fellowship programs and see if there was some such funding through which I could pursue this exploration.

The Watson Fellowship...and the Ides of March

When I found the Watson Fellowship, I was immediately attracted to its open-ended invitation. The fellowship website called for applicants looking for “a rare window after college and pre-career to engage your deepest interest on a global scale. Fellows conceive original projects, execute them outside of the United States for one year, and embrace the ensuing journey. They decide where to go, who to meet, and when to change course.” It sounded to me as if Watson would be the perfect platform to pursue what it means to die well. At the same time, I was coming up with a million reasons to not apply – the application process was arduous, I was fearful I would not get it, I was fearful I would get it. But my interest in my potential project propelled me forward, towards submitting an initial application for Middlebury’s internal review.

One of the first steps of the application was a brief interview with Middlebury to decide if your project would be a Middlebury nomination. Within these interviews, and interviews that would come later in the process, I would have to establish project feasibility, meaning contacts would have to be made. I got busy cold emailing organizations all over the world that were concerned with end-of-life care or traditions, anything that would further elucidate what different countries interpreted dying well to entail. And then, I waited. After a few days of constant cold emailing, I concluded that I would likely never hear back from anyone. But in the very first lesson (of thousands) in patience, I would find this to be the opposite of true. Doctors, coffin makers, death doulas, bereavement specialists, and nonprofits from all over the world reached out, confirming the possibility of an adventure that would only grow from here on out.

My project progressed from a frustration to an idea and slowly but surely to an inkling of a reality. It went from a possible Middlebury nomination to a Middlebury finalist and still, I assured my friends and family that there was no way I would be leaving the country come July. When my graduation came in February, I artfully avoided any discussion of what my plans may be, insisting I would also be traveling with the bulk of my roommates to Boston for work come this summertime. And yet, on March 15th, I excused myself to the bathroom during my shift in the emergency room as a patient care technician to check an email that read “Watson Update.” Words can’t adequately describe the mixture of excitement, pride, and mostly fear that swirled instantaneously in my brain. I knew there would be time to process later and was grateful to be somewhere that provided a distraction for how my entire world had just changed. I sent the news quickly to all who were awaiting, shut down my phone, and proceeded to work. Later, in the private space of my car, I switched on my phone to overwhelming messages of love and excitement from my family, friends, peers, professors, and even previous Watson fellows who took interest in the project. It was the first of many moments in the past couple of months where I was in awe at the community I was beginning to form and the community I already have supporting me.

How It’s Going

I wish I could say that since that day in March, the nerves settled, and I have processed the trip I am about to embark on. But that would be a lie. Not a day has gone by where I haven’t woken up in some form of semi-awake shock, shook it off, and gotten to work chipping away at all the preparations that go into a year of traveling. This prep has been both logistical and mental. Logistically, I have been on endless Zoom calls with contacts around the world, gathering visas (which has proved to be QUITE the task), getting so many shots my left arm is still achy, and generally trying to pack all that I may need for a year into the least amount of luggage possible. Mentally, I have been taking the time to prepare myself for the road ahead. I have been reading, writing, and reflecting on what I hope to learn, all of which I imagine will find its way to a post here before I leave. What I didn’t expect, though, was to find a way to assure myself that I am on the path toward something that energizes and excites me enough to push past the fear and nerves I still feel.

Over the past couple of weeks, I have been speaking with amazing doctors here in the U.S. who are already working on innovative projects and programs that are aimed towards a new way of approaching death care. From a lab rewriting the script on how to have end-of-life conversations with patients to others who are opening the storytelling scene to fellow palliative physicians as a way to discover deeper meaning in this field, I find myself incredibly excited to see the avenues that my learning during this year could take me to. I have been humbled not only by the amazing work of those already well into their careers exploring this very same problem but also by their willingness to listen to me, a freshly graduated and aspiring physician, and encourage my journey ahead.

I’ll end by saying that my hope for this blog is for it to be a place where I can speak candidly and reflectively. This year is about space – space to explore, learn, and not worry about having polished work but rather having a million first drafts. Already, I’m resisting the urge to edit this extensively and add a million more thoughts but that is not in the spirit of this year; it is not embracing the same hard fact I am faced with - no matter the gazillion hours of planning I have done, I must be open for the ways that this project and I will inevitably change. I’m excited to share, in the next few weeks before I leave, some of the first thoughts I have had while having initial conversations with organizations abroad, reading books from experts in the end-of-life field, taking a death doula course in preparation, and doing lots of writing. More to come soon!