Two Months Sans Palliative Care

After spending six weeks in Auckland, I’ve headed to the South Island for a few days of exploring and enjoying its natural beauty. 

I’ve done New Zealand differently than I’ve done anywhere else this year. 

Rather than chasing down different organizations whose work I was interested in, furiously interviewing individuals who may help me understand how palliative care is established in that place, and frequently changing locations, I didn’t leave Auckland proper for six weeks, didn’t interview a single person, and wasn’t even technically involved in ‘palliative care.’ 

Rather than working on my project, I just took a six-week vacation in one of the most beautiful countries in the world! (Kidding! Though at times even a short trip to a beach in Auckland felt like a full-blown getaway). 

The evidence: a beach 15 minutes from my house in Auckland. 

As I mentioned in the last post, I spent most of my time in Auckland volunteering as a hospital companion, a role in which the volunteering individual provides support to patients admitted to the hospital through talking, playing games, or doing just about whatever else the patient may need. The wards that I volunteered on were dedicated to the rehabilitation of individuals who had had a stroke, serving people experiencing dementia or delirium, or supporting soon-to-be mothers undergoing prenatal complications. True that some of these patients may have been simultaneously followed by the hospital’s palliative care team, though I was not privy to that information. This work, which may seem like a deviation from my project as proposed, actually represents an evolution of my topic: as I’ve wondered what palliative care is and why it matters, a burgeoning topic of interest has become thinking about the balance between curing and healing in the medical encounter.   

Linguistically, curing and healing are quite similar. Both are colloquially used to signify the process of recovery from illness or injury.  

In actuality, curing and healing are quite distinct. 

Delineating the difference between curing and healing was not an insight from my Watson, but rather a hard-earned insight I went into this year with. Whilst enduring the multi-year process of rehabilitating a torn ACL and meniscus sustained during my junior year of college, I began to realize that while the surgery and subsequent physical therapy were a means to ‘curing’ my injury, the process of healing from it—regaining confidence in my knee, learning to relive in my world with limited mobility, finding activities outside of sport or physical exertion that provided me with a sense of meaning and vigor, shaking the complicated mix of anxiety and grief that pervaded thereafter—was a much different, more circuitous endeavor. 

One of the best answers that I’ve come up with to explain the importance of palliative care is that, in a medical world hyper focused on curing, it attempts to shift the focus back towards healing. However, despite being an answer that I believe to be true, this thinking is not without its criticism. The criticism (which, in my opinion, is one of the strongest critical views of palliative care) is that in its effort to shift the focus beyond purely curative medicine, palliative care has unknowingly assumed itself to the sole provider of compassionate, healing-centric care. Basically, if we imagine curative medicine and healing-focus medicine in a game of tug-of-war, each striving to be the predominate value system in the provisioning of care, those that espouse this criticism would say that rather than jumping to aid healing-focused medicine’s side, palliative care has engaged in an entirely different game of tug-of-war to see whether it or the other clinical disciplines should be the purveyor of healing.

My feelings on this argument are ambivalent at best. As a non-clinician observer who has spent the better part of year seeing all the different ways this palliative care thing comes to be understood and defined, it is difficult to decide where I stand on the matter, particularly in the abstract, devoid of any situational context. However, in the spirit of the Watson and all its freedom, I decided to spend my time in New Zealand seeing how the ethos of palliative care (dignity, respect, and compassion for all afflicted by serious health related suffering) is cultivated sans palliative care. What better way to do that than volunteer in a role whose position description is quite literally to engage with patients in a variety of ways characterized always by a spirit of dignity, respect, and compassion? 

Being a presence on the hospital floors every day for six weeks allowed me to learn the unique rhythm of the wards. By the end of my tenure I could, with a fair degree of accuracy, guage what time it was by taking note of where the rounding doctors stood in the ward, which patients were being taken to various appointments, or how many rooms the tea cart had already visited.   

I’ve since left Auckland, allowing some time to hike in the South Island before moving onward to the next country. The nagging question ‘so what did I learn from all of that’ has been a near constant companion on my otherwise solo treks. Now, at eight months into the Watson, the finish line in frighteningly close sight, I find myself wondering in a general sense what I’ve learned from all of this and how it has changed me. I sometimes try to list out all the things I’ve learned in my mind, line them up as if they were mere items on some sort of personal growth CV. Though, if I’m being honest with myself, the immensity of the change that I’ve underwent is impossible to quantify, impossible to record. 

It just is. 

And yet, in my innocent way of being human, that knowledge doesn’t stop the part of me that loves numbers and quantification (the part that, to many people’s dismay after I explain my project, had me study economics and math in college) from trying to do so. 

I’m six haircuts, two hair colors, one nose ring, four plain grey shirts, and five countries from the me that last touched US soil. 

I’m also five days away from seeing my family and best friend for the first time since last July. 

And that makes me nervous, 

because if I’ve travelled all these miles, seen all of these things, lived out of just these two bags for all this time, what does it mean to go back to something as familiar as the people I grew up with? To the individuals cast as leads in the all-important, ceaseless drama that is “My very big and very important life”?   

(Tangentially: If I feel this way now, how will I feel when the Watson is officially over? Is it possible that this year has only fed my love for existentialism and the unique sort of distress that it inspires?) 

Distractingly, here’s a picture from one of my hikes this week. 

I’ve become very good at saying ‘I don’t know’ this year. I also think ‘I don’t know’ is the most truthful answer to my ramblings above. However, I do think that I have an answer to what was learned from my time as a hospital companion and think that it may also be an answer to my musings. 

It became very clear to me very quickly while volunteering that indeed palliative care is not the only discipline concerned with healing—that clinicians across the spectrum of specialties are also concerned with the whole person (shocking !)—but the choice to keep the whole person in focus must be a deliberate, conscious one when so many factors (whether that be time pressures, norms, name your favorite constraint here, etc) are encouraging otherwise. Palliative care just so happens to be a discipline whose guiding value is to do just that, to keep the whole person in focus. So, analogously in my view, it just so happens that proportionally more clinicians trained in palliative care are thinking of the whole person than clinicians trained in other disciplines.

But here’s the fun part: change away from previously predominate values or qualities can be encouraged in any setting, by any person, so long as a sustained, deliberate effort is made to do so. 

I am now starting to think about why, if it is the case that dignity, respect, and compassion can be fostered in any setting, it seems as if modern medicine has moved away from them as guiding principles. But, before that, I’ll head to Toronto to spend a week on vacation with family. I’ll pick things back up (in Spanish!) when I land in Colombia in early March.