Where I’ve been:
MAY 2018, UK:
I left you in the third quarter of my Watson year in the cold of Calais. After a nighttime bonfire by the waves of the English Channel, I left for a train going up north, a plane going west, and then a bus to Birmingham, UK.
May 2018 seemed like the right time to be in the UK for my project. The United Kingdom, specifically England, was launching a debate on introducing and implementing an opt-out system (i.e., every adult citizen is assumed as a potential donor) and a campaign focused on improving Black and Ethnic Minorities (BAME) donation rates. In comparison to continental Europe, UK donation rates are low, and the upcoming Brexit would affect the experience of patients, particularly those on dialysis (e.g., they will not be able to access European dialysis centers easily when vacationing). Moreover, in the UK, BAME groups tend not to donate but are in disproportionate need; because of lower donation rates and the fact that matches are more likely within ethnic groups, already long waiting times for Caucasians are exacerbated by factors of three to four for BAME populations. Moreover, London and Birmingham are also incredibly religious diverse; interfaith movements, as conveyed by my Dean at Wellesley, are models. Current tensions with populism and right-wing extremism have fueled interfaith efforts and their adaptations. On a personal note, the UK was the first country to which my parents had immigrated, let alone visited. After leaving in the early 1990s, they never went back. I wanted to know the place of memories they shared with me.
In Birmingham, the quietness of the red-brick industrial town was comforting, contrasting its depiction in Peaky Blinders, as was the pervasiveness of English. Local colloquialisms surprised me. “Are you alright?” asked a man in a convenience store. I mumbled, assuring him I was perfectly OK and not in distress or the wrong place, only to realize that his question was as ingenuine as a New Englander’s “How are you?” He didn’t want a response. People had warned me of the Brummie accent as did my father assure me I wouldn’t stand out in B’ham—more than half of the city belongs to an ethnic minority, where Pakistani British was a common identity. Uber drivers wore Pakistani kurtas and blasted Bollywood music. One goodbye I received went along the lines of: “If I don’t see you later, I’ll see you in heaven.”
In Edgbaston, I stayed in the apartment of a kind relative who I knew by name only. Most of my time in B’ham was exhausted in countering the teasing of my two housemates: both the British-kind of medical residents. During my first two weeks, I shadowed under the innovative transplant cardiologist Dr. Sern Lim in Queen Elizabeth (QE) Hospital in Birmingham. I followed the work of different members of the cardiothoracic transplant team at QE: one of the most reputable transplant centers in the country. Shadowing gave context to conversations on organ donation, but also introduced me to the complexity of transplantation and donation. As I went on daily rounds in the ICU, observed open-heart surgeries, and sat in on clinics and multidisciplinary meetings, I realized the ethical and medical obligations physicians and patients balance in pursuing healthcare. For example, if a transplant patient can receive mechanical support instead of a heart, what are the pros/cons they’ll face? How does a medical team decide who gets a transplant? How does the resource-stricken NHS justify using ICU beds for organ donation or investing in bridge therapies for transplantations? Recovery varied dramatically for patients, where some were confined to the ICU for weeks while others could walk after one. How much should a doctor tell a transplant patient regarding the recovery? In interviewing doctors and specialist nurses, as I followed the stories of patients and saw patients my age die waiting for a transplant or painfully recover from one, I realized that while transplantation is transforming, it is demanding. After my work experience ended, I traveled across Birmingham and the surrounding towns, such as Stoke-on-Trent, to interview doctors, bioethicists, religious scholars, and legal experts on organ donation. My interviews brought a social context to my clinical experience, where I began to understand the concerns around trust, body integrity, and religious education. Interviewing pioneers in promoting dialogue or combatting trafficking helped me notice that communities cannot encourage organ donation without recognizing the religious, cultural, and social obligations affecting conversation around the ethical dilemma.
During May, the holy of month Ramadan also began and added structure to my day and also an afternoon lethargy. Evenings breaking of fasts introduced opportunities to explore local cuisine—including a spicy curry eating challenge that debilitated me with pain the next day. On weekends, I visited friends whom I met throughout my journey in London, found llama farms, and spent time with relatives I met once. Towards the end of May, I had the privilege of presenting local and national challenges in boosting donor rates: a collection of observations and opinions from my travels at the National Black Transplant Alliance, under the invitation of Kirit Mistry. And then, a day after that presentation, Ainee, who was like an older sister to me, dropped me at Gatwick Airport for a flight to Marrakech.
JUNE 2018, Morocco & Madrid:
I decided to go to Morocco towards the end of my time in France for several reasons. The first reason was to attend a World Festival on Sacred Music—an interfaith celebration of the different ways people artistically interact with spirituality. A friend in France had mentioned the Festival, and I, wanting to explore more with interfaith, was interested in seeing how religion was presented. A second was because in speaking with a handful of Moroccan Muslims in France, I wondered how migrant communities brought their understanding of healthcare systems and organ donation with them as they integrated within European communities that could realize the medical innovation in practice. Moreover, Morocco recently introduced dialogue on developing organ donation system, and I was wondering what some of the opinions were, and how they may contrast from other Muslims to whom I’ve spoken. The third was to spend a bit of Ramadan in a Muslim majority country, which I had never done but imagined could be inspiring. The fourth was admittedly, three months in the UK is budget-unfriendly.
Marhaba, which means ‘welcome,’ was the most common word I heard and well defined Morocco, a country full of contrasts. I was super thrilled to be in Morocco. Conversations on Islam and fasting with others who understood Ramadan limited the need for baseline conversations and allowed more in-depth discussions into the spirituality. The sound of the athan pulled me into a broader recognition of what Islam meant to Muslims: unity, community, and meaning. But also, it taught me a sense of leniency in Islam, where I realized that while my Islam did differ from that of some Moroccan friends, but that the core set of values remained the same. Conversations on organ donation reminded me of the privilege of transplantation; it requires a medical infrastructure and robust education system. Seeing the contrasts between British and Moroccan medical centers reminded me of the need and privilege-difference of global health, and that organ donation is not readily acceptable to me.
In Morocco, I also reunited with a few Moroccan friends, who I met in Malaysia and France this past year, on Eid and for coffee in Fez. Whether befriending a storekeeper or a fellow train passenger, I found that making friends was a bit easier and spontaneous in Morocco (…albeit I’m glad I trusted my gut and did not join a road trip with a new friend and his bros (I don’t always get into cars with strangers and without drivers-for-hire). The heavy medical bag my dad bequeathed me finally came into necessary use. I caught bronchitis and sinusitis simultaneously at the end of Ramadan, and while on a massive antibiotics course, I decided to learn how to surf under the instruction under a very strange man with a personality and questionable tactics. And finally, the Fes Festival reminded that though some may argue that religion is man-made, cultural innovation meant to create of the baseline of trust, it doesn’t preclude the meaning that religion has for people. The spiritual music I heard from the corners of the world brought me back to the places I went to this year, but it also taught me that religion isn’t a series of habits of a rule. It’s a way to salvation for people, seeking to find meaning and community.
At the end of June, I left for another contrast: to attend the Transplantation Society (TTS) Conference in Madrid. A bi-annual conference, I lucked out in having it near where I chartered my year to end and during my Watson year. At this conference designed for hotshot transplant doctors and big-name policymakers, I was a mere plebian. Yet, with a conference badge and an ironed suit bought in haste, anyone can get through the door. TTS was an incredible experience to hear about different facets of transplantation debated: gender equality, opt-out vs. opt-in, mechanical support, xenotransplantation, organ trafficking, and more. I networked with various physicians and researchers from around the world and returned to some of the conversations I had in Southeast Asia. I wondered about how my year might have been different had I had the opportunity to go to TTS at the beginning, but I appreciate the way my year unfolded. I was able to more critically engage with the discussions at TTS having a foundation of conversations. While most of my 5-day foray into Spain was in the IFEMA convention center, I enjoyed talks with my Airbnb host, running into college acquaintances, and exploring Madrid during Pride. Also, a contact from Croatia had kindly arranged a meeting with the national organ donation program in Spain (ONT), where I learned more about why the Spanish model is considered the most successful in the world.
I wondered to some extent if I should have stayed in the UK for three months straight, but in hindsight, I am glad I didn’t. Visiting Morocco and Madrid allowed me to explore my project further but also to nuance it. More so, I am grateful for the memories and the people it brought me to.
JULY 2018, UK:
After a short stint in Madrid, I flew back to London on one of the craziest adventures to pick a room key. My host left keys, before leaving the city, in a supermarket that closed around my original arrival time, which was doable had my flight not be dramatically delayed. Without an alternative of where to stay, I held my breath and made it with 2 minutes to spare. The remainder of the month went more smoothly. Day One was filled with crazy street raves resulting from England’s success in the World Cup. Days In-Between included a schedule booked with interviews, given high response rates to emails (wow!), with various stakeholders from across England and Wales (which already has an opt-out system). These conversations further nuanced my understanding of the state of organ donation, as managed by NHS, in the UK, while also helping me figure out how I might want to share what I learned with my communities back home.
I also took the month to reflect. In parks and cafe shops, I wrote, read books, submitted medical school applications, and hung out with friends. Exploring London introduced me to a city that I only knew of through my father’s stories and popular culture. It’s a remarkably sophisticated, diverse, and fast-paced city. But I also took more time to slow down and lie down in the fields near my apartment in Hackney: to write lyrics with my flatmates, go on walks with friends, try weird foods, explore museums, and take trains to nearby cities that I knew only through friends or books. I wanted to spend my month thinking of what happened these past 11 months, but also to reflect on how my values, priorities, and perspectives changed. To begin to think of what my life means to me know and what I dream to do with it, having seen that life can be lived so meaningful and happily in ways, I never considered before.
AUGUST 2018, Home:
After London, I flew to the Returning’s Fellow Conference at Pomona College. If this is but a beginning, then the Conference was a transition I needed from my Watson Journey for whatever these next few years entail. Anything I say about who I met is a candle to their sunlight; the people I met at the Conference, from the staff to interviewers, Board, and fellow fellows, are truly extraordinary people. I felt privileged and honored to know and be among them. The opportunity to share what this year felt like and meant with people who can be empathetic is rare. More so were the conversations we had on our struggles, personal reflections, and dreams. After a year of good-byes or unpromising see-you-laters, the Conference was a relief in its promise of a community and a space to reflect with people who understood.
And then, on August 6th, I finally returned home. Homecoming felt more like walking out of a wardrobe than the fanfare of a long-anticipated return. The previous twelve-months seem surreal, in that they were days I experienced alone while coming home felt like nothing changed. It’s a secular purgatory: an uncertain, in-between something. In the past few weeks at home, I think the days have passed slowly. I visited my twin’s law campus in Charlottesville; embarked on medical school interviews; caught up with professors and mentors at Wellesley; played with my little sister; and, enjoyed the company of long family walks. My conversations about organ donation haven’t ended. I spoke to a few more people, including professors and doctors in the area, through happenstance meetings. I also hosted a well-attended seminar at my mosque, in which I shared my observations on religious beliefs around organ donation on a panel with the Imam. Many people approached me afterward and mentioned how they had been undecided or hesitant to be organ donors. They had left the box unchecked when renewing licenses or deferred the question until later. I felt happy that I could share something beneficial and necessary for my community.
This month also brings more transitions, as predicted by Merlin Trotter, the tarot card reader in Leicester Square. The day after tomorrow, I’ll move for a 9-to-5 fellowship on empirical biomedical ethics at the Mayo Clinic, and also take post-graduate classes. I don’t know where I’ll be living yet or what it will be like to work in a conservative environment like Mayo, but I know this year has taught me to flourish in ambiguity.
As I sit in my father’s garden, I see the memories of my childhood before me and the wonders I had of who I would be: to know the world beyond the books that told stories of unprecedented horizons. I used to live hundreds of different lives through reading, and now I am thinking of what just happened in mine. I remember reading Paulo Coehlo’s The Alchemist under a nightlight by the window of the room I shared with my twin. I don’t know how many times I read it or whether it was me who found it or my English teacher who brought it to me. I’m probably not the first Watson Fellow to refer to Coehlo. Regardless of the trite, this year brought my mind back to the words of Coehlo, a traveler himself—whether I was walking alone in the Probosci monkeys’ forest or on Mehdia Plage or along the Brighton Pier.
In particular: “And, when you want something, all the universe conspires in helping you to achieve it” (Coehlo, The Alchemist). I believe this as remarkably accurate after considering all the serendipity of this year, particularly the spontaneity of finding people who were kind and generous, willing to help me without knowing who I was but merely because I was passionate about understanding organ donation and their lives.
And now, I think of, “It’s the possibility of having a dream come true that makes life interesting” (Coehlo, The Alchemist). When I think of this past year, it is terrifying and empowering that I lived a dream of mine. What the Watson Foundation gave was not finances to travel the world, but a possibility to set aside predispositions and hesitations to explore the communities and places that build this world. A self-exploration that empowers the fellow to know their self in the context of identity, culture, natural wonders, and dull moments. To walk thousands of miles, write hundreds of pages, stay in dozens of homes, cities, and beds, capture countless memories, and speak with hundreds of people – otherwise unrealized. The world is truly breathtaking, and I think it’s the people who breathe life into it.
In the months to come, specific memories will come and go like waves, and the banality of moments will pull me back to where I was. Yet, I cannot live a day without feeling the gratitude this year taught me appreciation: to the donor and their family; the people who opened their homes or took me out for food; those who shared their love of life; individuals and organization spent hours and days with me in brilliant conversation; the strangers who directed me safely; and, to the people who smiled in their generous warmth. Thank you never seems enough: how could two words, eight letters suffice?
When I was younger, a second cousin told me her dreams were limited by the fact that she was born into the rural areas of Pakistan. She aspired to be a physicist but what her fate promised her amounted to motherhood and a part-time job as a school teacher. She told me to dream big. My cousin helped me notice that what I have in this life has been productive of a zip code allotted to me. She helped me realize, that in inequity, inequality, and unfairness, the best way I could be grateful is to be intentional in my actions and dreams. The years after my dreams evolved from ensuring others the same level of opportunities I had to protecting dignity and respect during a patient’s vulnerability. This past year broadened and changed my dreams, as I grew confidence to realize the unimagined.
I could only guess why Coehlo’s shepherd traveled so long and uncertainty to find the universe in his backyard. I think I might understand now. In my father’s garden, I used to dream of what I could do, be or bear witness. I didn’t know what it felt like to realize a dream or to pursue one wholeheartedly until I left. Travelling broadens possibility; living among difference teaches compassion and resiliency; and, being at the grace of others instills the most human love. It shows us to fail, to have faith, and to believe in the wonder of the people around us. I think realizing a dream helps us feel at home in this world. Dreams don’t have to be grandiose or revolutionary; they can be as subtle as a question or sound or sight. I think if a home is where we know love and if love is believing in the potential of something or someone, then dreams bring us to closer to love. A testament of love of the possibility of the people, institutions, places, and things around us. Following conversations on religion and organ donation taught me what selfless love was. So, did the generosity of the Watson Foundation and the people who enabled me to put one foot in front of the other this year and before.
I hope that the pursuit of my future dreams embodies the gratitude that this year and fellowship instilled in me. I hope they bring me closer to the love in this world and the people in it. And, I hope that whatever I do, may it be in love with this world and its people.
Thank you for reading this, your time, consideration and support. Forgive the cliche, but it really did mean the world to me.