I’m in disbelief and denial that six months have gone by. I look back at things I wrote just a few months ago, and I feel like I’m peering into someone else’s mind. Toggling between inspiration and frustration, I continue to marvel at how much there is to explore and just how short a year is.

Over the past few months, I’ve spent more time reading and researching, approaching this project with a renewed academic zeal. I’ve found myself annotating in the margins like my high school English teachers once asked me to. One article I read was about engaging patients with empathy. It said “never answer a feeling with a fact.” As I’ve encountered moments of self-doubt, I find myself explaining away my emotions with reason, managing to deeply convince myself I have no stress, worry, or anxiety. The irony is that in a year focused on “caring over curing,” I believed I was immune to needing to attend to the emotions at the core of this challenging experience.

A question I posed in my last letter was whether or not time was a pre-requisite to empathy. But over the past few months, I’ve come to the opinion that the relationship between time and empathy is two-fold. You need time to form empathy, and giving someone your time demonstrates empathy. When it comes to self-care, we talk about taking time for yourself, and just the same, caring for others is something we cannot do short on time, especially in healthcare, where time is such a valuable commodity. Perhaps this leaves us with a more daunting challenge of how to slow down healthcare. In a system overcome with a desire for efficiency, how might we articulate the value of both giving and taking your time?

Another quote that stuck with me was, “the medicine which convinced people that all pain is curable, made pain unendurable.” As we’ve turned “care” into an industry and “health” into a commodity, we’ve lost sight of the humanity that can’t be disentangled from healthcare. More of us are looking to our doctors to answer not just, “what’s wrong with me,” but “why me?” We turn to our doctors for not just to cure our pain, but to understand it.

When I arrived in London I was frustrated by how much it felt like starting over. This new beginning felt like, well, a new beginning. But I’ve started to find a beauty in the never-endingness of it. If having arrived here felt like the “arrival” I had hoped, it wouldn’t have been a successful leg of the journey at all. I think that so much of our education prepares us for this mindset of reaching the next milestone, and I’m guilty of viewing this fellowship in the same way.

These past few months have made me think more deeply about where I see myself fitting in this beautiful healthcare puzzle. One book I was reading, “What Doctors Feel” talked about how modern medicine relies heavily on general practitioners to filter a common headache from a brain tumor, but rewards specialists with higher salaries and esteem. It made me think about the role of design in healthcare. In a system built around speciality, where does a generalist fit? A term I’ve come to appreciate is being “medium-agnostic,” which I believe is the only way to truly practice human-centered design. Approaching underlying unmet needs without filtering for your skillset allows you to find the best solution, not your best solution. But academia and industry relentlessly ask us to specialize, to become a “T-shaped person.”

I’ve always struggled to identify what that “one thing” is for me, attributing my inability to answer it to indecisiveness. But I’ve come to see this question in a different light.

The other day I had the opportunity to sit down with the director of care for a local hospice. Amidst describing his role and perspective on palliative care, he offered up some life advice.

“Know your legacy.”

The idea of having a “legacy” has always seemed, to me, in opposition of the value of humility, but he spoke about wanting his legacy to be making this hospice the model of quality palliative care for the UK. I could witness how his decision making and approach fit into his personal mission statement — funding research and fiercely advocating on behalf of patients to local councils. His legacy wasn’t what he wanted to be known for, but rather what he wanted to leave behind.

As I’ve begun to consider what might come after this year, I asked myself what legacy I hope to leave on healthcare. If this weren’t a legacy of identity — not who I was, but rather what I left behind, the word love came to mind. How might I approach the world if my “one thing” was to leave behind a legacy of love in everything I did?

The more time I spend focused on this project, the more I realize how much this project is just a microcosm of the way I’ve slowly begun to see the world. It’s easy to talk about creating a healthcare system that can slow down, spend more time with people, listen more deeply, and care with more patience. But it’s also not as if these traits are in ample supply elsewhere. It’s just that healthcare makes us painfully aware of how much we lack them.

In human-centered design we often talk about designing for an “extreme user,” someone whose needs are so amplified that by addressing their pain points you will inevitably address the pain points of a wider demographic. I think that healthcare is this “extreme user” glimpse into our humanity. You have people at their most fragile embedded in a system at its most stretched. I suppose it gives me hope knowing that if we can design solutions that infuse more empathy into healthcare, perhaps we have a chance at designing solutions that infuse more empathy into the world.

These past few months have left me optimistic in the fact that every little bit counts, whereas in the first few months, I couldn’t seem to get past the “every little bit.” I’ve spent my time here in London volunteering with an adult hospice, children’s hospice, and brain tumor charity. Immersing myself into the everyday of these organizations was an emotionally complex adjustment. I found that making meaning out of each day was a slow process, one that required reflection, conversation, and space. I entered this year with the mindset that the more I did, and the more people I talked to, the more I would get out of it, but have come to realize there isn’t a linear relationship between what I do and what I learn.

I recently applied to a graduate program in healthcare design. In preparing my portfolio, I wrote a mission statement of sorts on the cover page. It reads as follows,

My design philosophy is that empathy is not a stage in the design process. Empathy isn’t a step that requires completion, but rather a beautiful measure of the growth that can emerge from engaging deeply and intentionally in human-centered work. I don’t aim to create things that are just beautiful, just useful, or just effective. I aim to design things that help people feel understood.

Sometimes, this comes in the form of products, sometimes, this comes in the form of services, and often, this comes in the form of experiences. The following six projects tell stories of work that deeply expanded my capacity to feel. I hope that this portfolio serves as a testament to the way I aim to leave behind a legacy of empathy in the work I do.

I don’t think I’m there yet. I don’t think I’ve “arrived” at leaving behind a legacy of empathy. But perhaps that’s the beauty in it - the never-endingness of it all.