I’ve postponed writing this fourth quarterly report more than any report that came before. Perhaps that’s because it is hard to fathom closing this chapter, despite how eager I may be to begin the next one. Or perhaps it’s that formulating a reflection that somehow encapsulates all of the last year seems nearly impossible — not because the year was too big to capture, but so small. When I look back on the past year, my memories are episodic. Not one continuous stream of moments and insight, but fragmented pieces, each with their own weight.

I spent the final quarter of my Watson year in Bangalore, India. I arrived at the airport at nearly two in the morning, and was picked up by a taxi driver who, after learning it was my first time in the country, told me in broken English, “big mistake.”

This year was a stretch for me in many ways. With only one trip outside the United States under my belt, even the simplest of international journeys was a challenge to overcome. For me, choosing to go to India was a moment I could look back and realize how far I’d come. My project was leading me there, and I was to follow.

I worked with an NGO called Noora Health that trains caregivers across India to reduce hospital readmissions. I came across the organization and their noble, and some might say altruistic, mission through the Design Lab podcast with Bon Ku. Listening to that podcast one day on a walk in Rome led me to send an email which led me to set up a call which led me to book a flight to Bangalore. This cascading series of events made me wonder, was this what Watson was all about? Was I finally in the flow of my Watson year at the final leg of my journey?

It seemed like all year was an uphill struggle to both find and maintain contacts. I was turned away more than I was let in. I learned more about resilience than persistence.

And so, I arrived to Bangalore. Sweaty, but proud.

I had spent so much of the previous nine months shadowing, observing, immersing — stuck, by my own design, in the “empathy” stage. I had started to develop an itch for action, and at Noora Health, I had the opportunity to work with The Caregiving Lab. More than fitting my shtick for the year, the Lab instantly felt familiar. We bonded over a shared love of sticky notes, and I envied home libraries of service design handbooks. It was disorienting to feel at home in a place so far away. I thought that my three months in Bangalore would be disorientingly unfamiliar, but if I’m honest, my time in Bangalore felt most like my “real life” back “home.” (Two concepts I’m no longer sure even exist.) My days were structured - I was part of a team, a community. My purpose could be spelled out on paper. And just like the places that came before, I learned that joining a team still required the same powers of observation, immersion, and shadowing, even though I was given the chance to contribute.

One project I worked on during my time with The Caregiving Lab was focused on oncology. Eventually named Project Marlin, after clownfish’s caregiving tendencies, the project set out to better understand how Noora Health might be able to meet the needs of cancer patients and their caregivers in India.

I was immediately put off by the scope.

I had worked in oncology projects before, and even the most open-ended ones still focused on a particular setting, or persona, or cancer type. I was frustrated by the lack of respect it seemed to suggest. Who were we to think that we could tackle “oncology?” Perhaps that is going against my early HCD optimism, and perhaps it demonstrates a touch of hypocrisy (I mean, who am I to look at the notion of caring over curing?) But my good intentions of wanting the project to be successful ultimately hindered any progress as we were stuck in deliberation without any guiding principles to shape our shared decision making.

I also had the chance to visit a hospital where one of these caregiver training programs was taking place. I had learned so much, and inspired by their mission, was eager to see it in action. As I disembarked from the auto, and timidly approached the gate where a woman with a stick determined who could be let in, I quickly realized this was not the hospital experience I had envisioned. The high-risk maternity ward, where the training session was set to take place, was crowded, hot, and dirty to paint a picture with adjectives. But perhaps more vividly, I wasn’t sure I was even in a hospital. A tilted shelf poorly bore the weight of a few cardboard boxes labeled “supplies.” Heavily pregnant women sat on the floor beside the more or less fortunate ones in hospital cots. The room was all concrete, and the air was muggy. I left a few hours later with three mosquito bites as souvenirs. The women semi-attentively listened to the training session, but many were clearly uncomfortable or disengaged. It made me wonder is there even a place for this caregiver training when so many fundamentals are missing?

I learned so much about the Indian public healthcare system that completely appalled me.

The first of which was that the hospital I was taken to visit was allegedly one of the best in the state.

I suppose I knew that hospitals like this existed. I’ve seen pictures from MSF doctors, photos in news articles online — all that to say I’m not completely unaware. But I couldn’t shake the somewhat icky and overwhelming feeling. Who are we to think we can fix this? And how is this okay?

All these words make it seem like my experience at Noora was much less enjoyable than it was. I can confidently say I made friends while I was here. And despite my worst fears, I only had one debilitating case of food poisoning. I got more mosquito bites than I could count, but none that led to a mosquito-borne illness.

I keep telling myself that I’ll look back on this experience and it’ll happen — that moment — when all the insights and epiphanies will come flooding in. But what if that’s not true? What if this is it?

Is it okay to just spend this year? To just spend the time and the money and to not know what it means? Is it still just as valuable if I can’t articulate its value?

In the final days of my year, I wrote:

“I suppose I’m glad that I want to go home. I don’t know what it would feel like to be dreading the end of this year, dreading a return home. I’m fortunate that I have people and things and experiences I’m eager to return to, but I guess I’m just surprised that the feeling of ‘not doing it right’ hasn’t gone away, it’s just changed.”

Admittedly, I’m writing this quarterly report as a retrospective of sorts. Nearly a month after my return, things seem somehow less clear. Did that really all just happen? Am I really home?

My life has surprisingly quickly fallen into a new routine, as I stepped near instantaneously into a full-time job (again, by my own design). I’m plagued with this feeling of inconclusivity. If the job I’m passionate about now, and the program I’m eager to begin are no different than they were a year ago, does that mean I didn’t change?

I ask, because I don’t think so.

I just haven’t quite figured it out yet.

Looking back on the year at large still seems impossible.

It was working as a receptionist at an East London hospice, sitting in the back row of a Schwartz round at St. Mary’s Hospital, applying Odomos in the corner of a maternity ward in Bangalore, walking around New Zealand parks with dementia patients. It was getting coffees with professors who clearly thought I was already an expert in palliative care. It was following an Italian woman around a crowded Vatican hospital. It was sitting in an eight hour meeting to discuss patient representation fully in French. It was so many small moments, that scrapbooked together, make a year.

I draw out these final paragraphs waiting for the big epiphany. Hopeful I can find a way to close out this quarterly report, bringing some intangible moment full circle.

This year is a gift. And, in the month since, it has also felt like a burden to carry. A truckload, or suitcase-full rather of memories I feel stuck carrying alone. The time has elapsed where friends and family want to hear stories or anecdotes. And that’s okay. I can’t, or shouldn’t, expect them to. But I’m left wondering what do I make of this? How does it live on?

Can I write to you again in three months and let you know?

By then, surely, I’ll have answers?

One thing I was anticipating for my return was the chance to read the letter I mailed to myself 365 days before. It was an opportunity to hopefully peer back into the past and know that I had grown. To see, tangibly, that there had been a marked change. I would care about different things. I would see things differently. But fortunately, or unfortunately, depending on how I look at it, that version of me from 365 days ago was smarter than I ever gave her credit for.

I struggled a lot this year.

In more ways than I let on during FaceTime calls, checking-in texts, and even quarterly reports. Part of the year felt like I was spinning in circles, and most of it felt like I was running uphill.

Beyond logistics, a part of the year I have come to accept produces immense growth, I struggled with my faith. I had this idea that I would come out of this year with a much clearer purpose. An experience that would linearly lead me where I was meant to go next. I struggled to accept the difference between what I thought the year might be, and what it actually was.

That struggle is something that looking back now, with full sincerity, I can say, that I cherish.

I’m so glad I got the opportunity to spend a year doing something hard.

It was hard to not know how to spend my days, or sometimes, weeks. It was hard to leave friends behind. It was hard to figure out how to get from A to B, and then C and D… It was hard to not be able to go home. It was hard to know I was missing out on so many hugs and so many birthdays. It was hard to feel so much shame thinking my life was hard when I witnessed the lives of the people around me. It was hard to leave places behind. It was hard to go to new places. It was hard to come home.

But.

I’m so glad it was hard.

Thank you for taking the time to read my rambling thoughts and childish insights. Thank you for being patient enough with me to hear me out, and thoughtful enough to respond. It’s been a gift to put my feelings in words and give words to my feelings.

There’s no way to end this really. I think I’ve hit whatever page count or word limit these quarterly reports might suggest.

But like you said,

Isn’t the Watson really just beginning?