Watson Conference Presentation

The following is the presentation I gave at the Watson Conference at Bryn Mawr College

I realized I was going to die when I realized I was going to go bald. Of course, I’d known intellectually, but looking in the mirror at a brand new, and steadily growing, widow’s peak, catching the thinning spot on the crown of my head in pictures, was the first time I understood my invincible body was not eternal, that it would continue to change, and eventually decay, and eventually stop.

I’m half joking, but I can guess everyone here has had a moment, whether a dramatic near death experience or mundane fading or sagging or shifting, that brought our end into focus. In a sense, that was what my Watson was about.

That was the more existential side, and I’ll come back to that. At its heart, the day-to-day of my project focused on how we care for people close to death. I worked as a nursing assistant for hospice when I was younger, and I hope to go on to a career in medicine, maybe in palliative care. When we talk about medicine, we focus on how we treat broken bones and heart attacks, things with defined beginnings, middles, and ends. But so much of health and healing is a process, without easy conclusions. Spending so much time around palliative physicians taught me a few things. First, you’ll never meet a kinder community. Thousands of miles from home, I got hugs and open ears from strangers. Second, palliative care is far more revolutionary than I ever knew. It breaks down our earliest assumptions of what domains fall under healing, opening the frame to include every aspect of our selves, and in doing so, removes the primacy of biomedicine to be replaced with an interwoven quilt of disciplines and approaches. I saw how in caring for those close to death, we can reimagine our care all the way down the line.

The Watson is greater than the sum of its anecdotes, but let me offer a brief illustration. I remember when I was at a hospice in Soest in the Netherlands. Almost all care was provided by volunteers, with only a few critical pieces conducted by nurses. I spoke with the director about how they dealt with the very end, when I imagined the need for medical care was greatest. She stopped me in my tracks: “There’s nothing wrong with them. They’re just dying.” Sure, sometimes a nurse had to issue morphine, but generally, people wanted someone to sit with them, not do anything in particular.

The lynchpin of this realization came when I was at Pallium India in Kerala. There, I saw a clinic without resources, struggling to provide basic medicine, and yet moving above and beyond what we can accomplish in the States. The community provided most of the care, and because it was the community, they knew of all the pain the families suffered. The family gossip was a critical part of patient contact, a genogram in every case history. Pain was seen beyond a 1 to 10 scale, and the patient relationship couldn’t end at the hospital door.

It was a different kind of medicine than I had seen in Europe or the States, particular to the context and culture of Kerala, but its vision aligns with the heart of palliative care. Holistic and interdisciplinary, but not just as buzzwords. Your allegorical heart taking the same priority as the one that pumps blood.

But despite my breathless enthusiasm, there’s a limit to palliative care. Even at Pallium, the relationship is bounded, centered on a case or a discrete set of symptoms. There’s a deeper pain tied to the very fact of death, that is a part of every life even in the absence of illness. Or maybe pain is the wrong word. Pain is what we feel when we lose someone. Anxiety is what we feel when we realize that one day we will be lost. As I heard from a man in a pub in Dublin: “every couple weeks I wake up and realize I’m going to die. And it’s…terrifying.”

In my travels, I found the spaces that had done the most work to address this anxiety are religious. My spiritual background is complicated, to say the least, and it seemed time to sort out my relationship with the whole thing.

There’s an idea that religion is a balm for this fear of death, offering an easy comfort, a crutch, an opiate in line with those used by palliative care. But in every religion I encountered, death was seen as a violence upon the world. From the Bible: “Therefore, just as sin entered the world through one man, and death through sin, and in this way death came to all people, because all had sinned.” In Hinduism, a sign of this age’s degeneracy is our short life span. African traditional religions have multiple narratives for the origins of death, most at their heart stories of human foolishness or greed.

Certainly, all of these faiths offer comfort of some kind, but it’s a complicated comfort from staring the terrible reality right in its face. And it’s a comfort based in particular contexts.

The Hindu nexus of the extended family, the Netherlands staunch agnostic individualism, these approaches are so different that trying to describe the nature of the comfort each offers really would go beyond the time I have here. Even nominally the same faith, Christianity, is reshaped by country’s needs. In Ireland, Catholicism is tied to nationalism. One can be an atheist Catholic, because to stop being Catholic is to stop being Irish. Whereas Botswana, a far more explicitly religious country, they navigate a narrow trail, coming to terms with the faith’s colonial origins while at the same time adapting it to fit the existential pain of the HIV/AIDs crisis.

All of which is a bit tough to cover in ten minutes. So what can I say? I’ll stick with what ended up being the big takeaway for me. I’ve learned to love cliches, sayings whose meaning is obscured through unreflective repetition, transforming the profound into trite. Here’s my favorite for right now, one that has specific ramifications for a 23 year old who has spent the last year surrounded by the morbid: Live in the moment.

It can be tempting in a year studying death to see life as an interlude between two states of nonbeing. Look ahead a bit and the scalp is shiny, regardless of its current coverage. But this year, when I talked to people who seemed to have managed to quiet their minds, who actually seemed to have found peace, they seemed to delight in the part of life they were living. In my moment, a 20-something, the flirtations and uncertainties of so many possible futures are the grist that will reshape me, in the same way I see my past leading to the self I am right now. The unpredictability of the future matches with an ordered sense of progression, moving from ambition and adventure to stability and contemplation. The theologian Richard Rohr talks about a move in life, one that should come with age, from chronological time, the sequence of one thing after another, to deep time, a sense of consciousness based in contemplation. It’s a move from dualistic thinking, imagining life as a series of either/or choices, to an experience of being. If the Watson has given me one thing, it would be the capacity to seek out this sense of unlabled existence.

I’m not sure I’m getting myself across, and maybe it’s moving away from the core question of how we live with mortality. Let me let someone else speak then. Here’s a poem I read my first week in Dublin, that kept popping into my head all year, that says it better than I could hope to.

Meditation on a Grapefruit

by Craig Arnold

To wake when all is possible

before the agitations of the day

have gripped you

                    To come to the kitchen

and peel a little basketball

for breakfast

              To tear the husk

like cotton padding        a cloud of oil

misting out of its pinprick pores

clean and sharp as pepper

                             To ease

each pale pink section out of its case

so carefully       without breaking

a single pearly cell 

                    To slide each piece

into a cold blue china bowl

the juice pooling       until the whole

fruit is divided from its skin

and only then to eat

                  so sweet

                            a discipline

precisely pointless       a devout

involvement of the hands and senses

a pause     a little emptiness

each year harder to live within

each year harder to live without

“Precisely pointless,” a devotional to the little moments of grace we have every day. Boundedness, temporality, these are the forces that give us an instant in the reality of the infinite. Without hyperbole, those moments are the gift we are given by death, the ability to make a moment count. Thank you. And without hyperbole, the gift of that understanding is what the Watson gave me. Thank you.


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