I have had an unconventional journey to arrive as a Chaplain and Spiritual Counselor in the Geriatric and Palliative Care Division of Weill Cornell Medical Center. I am also a Lecturer in Medicine in the Division. My first career was as an investment banker at Goldman Sachs. After a decade at the firm, I decided to leave to care for my young children. Telling the partners in my department was difficult, which turned out to be a through line in my career: having difficult conversations.
Shortly after I left Goldman Sachs, a young teacher of one of my daughters was diagnosed with Acute Myelogenous Leukemia on an emergency basis. Pia was 26, a first-generation South Asian American, and she needed someone to help her navigate the complexities of the healthcare system. I became that person. I should punctuate this with a spoiler alert that Pia is now fine and thriving, 20 years after her diagnosis and 19 years after a stem cell transplant at Fred Hutchinson Cancer Research Center in Seattle. In the course of our medical odyssey, I was repeatedly struck by how challenging it was for clinicians and others to talk to Pia about her fears about death and dying and, as a result, how alone Pia felt in those fears and concerns.
My experience with Pia moved me to train as a Hospital Chaplain. Difficult conversations were central to my daily work. But these difficult conversations were also often beautiful, and I began to realize how critical it was in caring for patients and their loved ones to really know their personal stories as well as their medical history. For that reason, my next stop was in the Master’s Program in Narrative Medicine at Columbia, which teaches practitioners to elicit patients’ stories in order to care for them more holistically.
At Columbia, I focused on death and dying. All the available research was clear: having honest conversations about our end-of-life choices, and then actually completing healthcare proxies and advance directives, reduces suffering for both patients and their families. Yet although almost all of us understand this intellectually and acknowledge the importance of filling out advance directives, only a tiny percentage of us actually do it. Clearly, research alone has not been enough to overcome the substantial psychological obstacles to having these important conversations. The whole topic, both the end of life itself and planning for it, continues to carry a huge stigma.
Shortly after I started training as a Chaplain, I was invited to become a Facilitator and educator in what has become a national program called “What Matters.” What Matters focuses on facilitating Advance Care Planning conversations in religious and community settings. What Matters Facilitators instruct other community members on how to complete their Health Care Proxies and name a Health Care Agent. My involvement in What Matters highlighted the need to find new, innovative ways to address the issue of people’s reluctance to have Advance Care Planning conversations and to complete their Advance Directives.
Through What Matters and through a Fellowship in the Columbia Narrative Medicine Program, I created Never the Right Time. Never the Right Time is a mini cartoon anthology that uses humor as a gentle, psychologically non-threatening way to disarm people and ease them into these sacred but scary and difficult conversations. I thought that if I could tap into the funny aspects of our fears about dying, anxieties about family conflicts, and the ordinary desire to procrastinate, I might be able to overcome people’s natural resistance to this forbidding topic.
After leaving the Narrative Medicine Program, I felt that my focus on end-of-life care would benefit from a deeper grounding in theology and spirituality and additional psychodynamic training and supervision. I enrolled in the doctoral Ministry Program at Hebrew Union College. For my dissertation, I piloted Never the Right Time to see if, in fact, it enabled people to more readily enter into advanced care planning conversations. It was gratifying to learn that indeed it did, and it’s gratifying to share that today approximately 10,000 copies of Never the Right Time are in circulation.
