I’ve been all over India since the last update, traveling to Rajasthan (vacation), Bangalore (conference), back to Kerala (convenient stop-over that afforded a few days for administrative work), and lastly to Mumbai (to shadow a pediatric palliative care team for two weeks).
In recent months, I’ve been drawn towards memoirs recounting thru-hikes and mountain climbing expeditions. Though I’ve always indulged the idea of one day completing a long distance thru-hike, at present there’s something about the narrative of a transformative, personal journey that resonates (wink).
Beyond describing all the ways one grows after living life out of a backpack and with only a few changes of clothes (I, for the record, have a few changes more than just a few changes of clothes), integral to any thru-hike tail are the instances of ‘trail magic.’ The Appalachian Trail Conservancy defines trail magic as, “an unexpected act of kindness, [that] is a quintessential part of the Appalachian Trail experience for many long-distance hikers.” Trail magic is unpredictable, unannounced, often exactly what you needed when you didn’t even realize how much you needed it. I’m convinced that this sort of serendipity isn’t limited to those on the trail—there also seems to be a special type of ephemeral providence that punctuates this experience.
The most recent and almost unimageable instance of ‘Watson magic’ came by way of a familiar accent. On a whim, I booked a ticket from New Delhi to Bangalore two days after learning about a conference entitled ‘Death and Dying in India: Navigating the Maze’ set to take place four days later. I had made a strong connection with an NGO that provides home-based palliative care—and had even spent a few days shadowing them— but I was beginning to feel restless. Much of what I would be doing with that NGO was similar to what I had just spent a month experiencing in Kerala; and, though there are many differences between Delhi and Kerala that could have led to fruitful investigation, once I caught myself naively thinking ‘I’m not sure there is much more I need to learn about palliative care in India,’ I knew it was time to start looking down other avenues.
As I settled into my seat at the conference, behind me I heard whisper in an unmistakably American accent. Almost subconsciously, I turned around and asked, “Where are you from?”
“Pennsylvania,” she responded.
“Oh, I’m from Ohio!” I answered, somewhat surprised to have found someone not only from a neighboring state, but who also appeared to be approximately my own age.
We continued chatting, uncovering that she had actually also lived in Ohio for a period of time, but most recently found herself based in South America. Then, for reasons I still can’t quite understand, I said to her, “You’re a Watson Fellow?!”
“Yes!” she responded, equal parts surprised and confused at my ability to somehow identify her.
There are very few rules to the Watson Fellowship, though one that they stress is to refrain from connecting with other fellows during the year. The idea behind this rule, I believe, is to guard against the very human tendency to compare. This year is all about learning to calibrate your own compass then to follow it confidently; seeing how another is engaging in the same task (particularly in a moment of self-doubt) runs the risk of distorting your own sense of direction.
However, when you’ve met one of the only forty other individuals in the world—who could be anywhere in the world—engaging in the very same intense journey that you are, it’s impossible not to ‘talk shop.’ We spoke of our projects, but more so about what it means to be a Watson Fellow, about recognizing that you are living a year that is equally incredible and difficult; about acknowledging the extreme privilege inherent to this opportunity and the perceived burden felt to rectify it.
Despite allowing our time together to drag out just a bit longer than we perhaps should have, we eventually partook in the ritual we’ve both come to know too well this year: saying goodbye. As we lingered in the doorway, exchanging an elongated farewell and promise to compare notes again at the returning fellow’s conference in August, we agreed that meeting each other had been ‘a nice break,’ verbiage that I didn’t think much of in the moment, but have thought much of in the time thereafter.
‘A nice break’ implies respite, relief from the learned rhythm—or the lack thereof. In wondering what was meant by it, I was reminded of a conversation I had with a British expat while traveling with my friend in Rajasthan. She’d been living in India for two years but was eager to talk about how I’d been adjusting after two months. With a bit (too much) gusto, I told her that while I was certainly overwhelmed the first day—something I attributed mostly to having not slept for about 24 hours en route to India yet still choosing to start work the same day—since then I’d felt the transition was quite easy.
Perhaps put off by my cavalier attitude, she pushed back, asking the question again but with a bit of an accusatory tone. Feeling defensive, I doubled down on my initial response. Sensing a point of tension, we wisely let our conversation fade into the larger one being had by the group. Worried that I’d come off as arrogant or just plain ignorant, I leaned back onto my elbows, giving myself space to think. While reclining, I could see the molten flicker of my friend’s cigarette out of the corner of my eye, the same friend who’d coordinate this entire trip to Rajasthan, carefully crafted our itinerary based on my interests, and had been consistently checking in to make sure I was enjoying myself.
In that moment, I realized that I haven’t felt overwhelmed because I haven’t been doing this alone. Due to good luck (or a bit of Watson magic), since arriving in India I’ve met, or been introduced to people, who have been extraordinary generous with their advice, their time, and their care.
With every new project-related opportunity I’ve been asking myself the same question: ‘Why does palliative care matter?’ Asking this question allows me to think critically about what palliative care is and what good it does, probing that I hope comes to guide some of the work I do in the future.
As I’ve argued before, I think palliative care matters largely because what it is and what it provides can be tailored dependent on an individual’s needs in that moment (though always limited by available resources), even and especially when those needs are outside of the scope of traditional curative medicine. However, the two conversations I recounted reminded me of another reason why palliative care matters: it facilitates, as my friends in India have done for me, a ‘soft landing.’
I can’t take credit for coining the term ‘soft landing,’ its rights belong to a friend who has often reminded me to think of ways to land softly when I switch countries or settings. Controlled landings are important because they prevent against the worst—a crash landing—while also mitigating peripheral damage. Palliative care can do this for individuals when a diagnosis makes a crash landing seem like the only possible outcome through working to rewrite their story, to define their goals, and, often, just begin to understand what is happening.
Last post I wondered, “am I really going around the world to conclude that we all generally want the same things—to love, to be loved, to feel valued, to be free of pain?” I’d be lying if I said I didn’t feel a similar worry while writing this post: am I really going around the world to discover experiences, particularly unfamiliar or overwhelming ones, can be made manageable, easy even, we are met with kindness and compassion? Does it take a trip around the world to realize that? Does it take a separate discipline within medicine expressly dedicated to those values to integrate them widely into care?
The answers to each of those questions is a definitive yes-no. Yes, you sometimes need the nudge from outside to challenge latent, guiding norms; no, needing a nudge doesn’t imply that those norms are inherently bad or incongruous with what the nudge hopes to accomplish.
There is always much more that I’ve learned and thought about than I can ever include in a post, so I’ve used this space as a place for me to wrestle with the difficult topics or questions that emerge. Some are eloquent, some (like this one) seem to ramble. Either way, it’s my hope that they do this experience even 1/10th of the justice its magic deserves.
I’m just finishing my two weeks in Bombay, heading next up to New Delhi and then Varanasi. It’s hard to believe that I have less than a month left in India and that my original itinerary had me in Australia by now.