Category Archives: BIG thoughts

seeing i-to-i means reflecting on this crazy world A LOT. So here’s where we’ll share all our fireside chats with you… grab a cup of coffee and snuggle in, these posts will take you a while :)

day 6&7: written bare.

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“I get lost sometimes

like everybody else

lose track of my lifelines

lose track of myself

and there’s all kind of reasons

to be scared and run away”

There are many miles between each town we visit and so I have some time to think. To stare at the hills. The mountains. The muddied grass turned brown in the heart of winter.

On the road, you can see life pass you by in a way that you just can’t when you’re in the middle of it, living it.

And so it’s made me think about this blog. How a lot of what I throw out to this space are the moments I want to write down, how a lot of those moments are the happy ones, the rays of light that shine through. I have a selection bias you could say. But that doesn’t mean that there aren’t low points. Moments when I think to myself, wait, what exactly am I doing here?

Continue reading day 6&7: written bare.

that question.

IMG_2562As part of our trip with Glamour’s Top 10 College Women, we got to visit a group of high school girls. Here’s a picture of us with them. It was my most favorite Glamour moment.

Gabrielle stared across the room and straight at me.

“The article says you go to Harvard,” she began.

“So, how did you get in?”

There it was again, that question. Deafening silence enveloped the room. It was awkward, uncomfortable, unbearable. Or maybe it’s just me. I’ve been asked this question a number of times. Usually I just shrug it off. Sometimes a sarcastic remark will do. In the space of 30 seconds I figure I don’t have near enough time to explain that I have no earthly idea how I got in, how I never really planned on getting in (or for that matter, going) to Harvard, that it was all just a grand serendipitous mistake… that had changed my life forever without my even knowing it at the time. But all that is not something you can articulate in the space of 30 seconds, least of all when you have a little girl staring you down, hope glistening in her eyes as she tells you a piece of her story, how she hasn’t had the easiest family life, how all she really wants is to go to Harvard because they have the best Economics program around.

I stumbled in my response.

I still don’t know what to say when people drop the H-bomb around me. On campus, it doesn’t matter. It’s easy to forget. I’ve found that good or bad, helpful or hurtful, nearly everyone has some relationship with Harvard – whether they’ve grown up with it or read about it in Catcher in the Rye, whether they’ve seen Legally Blonde or met someone who went here.

Harvard to me was always that fictitious entity, that place in a novel that I could read about. I’ll be honest, I never really dreamed about it. At all. I knew no one who went here. It was the stuff of dreams – not good or bad dreams, just dreams. I didn’t expect that in the real world people would assume things about me based on the name of the school I go to – or maybe I expected it but just didn’t understand then how it would impact me.

There are moments when I am really really proud of the fact that I go here. When I get to take my uncle through Widener Library and show him and his friends the Gutenberg Bible. When I first met my homestay mother in Japan and her face lit up; we didn’t speak the same language but she could place where I came from on a map because she knew where Harvard was. When I walked into that classroom last Friday and met Gabrielle, when she looked at me and said I’m proud of you – no little girl has ever told me that – and when she said I inspired her.

Truth is, I’m not exactly sure how I got into Harvard. I believe in hard work – and good luck. I believe that we end up where we’re meant to be, or if we don’t, that we find ourselves back to where we should be. I am convinced that I’ve hit the lottery in many things in my life – with my parents, my friends, my family, and yes, Harvard. And I know that with all these blessings comes a responsibility not to burrow in and hide, wishing that the world would disappear when a little girl from Brooklyn, New York asks me of all things how I got to where I never thought I’d be. My responsibility is to own up to what I am responsible for – successes and failures- and to embrace them, to live in them, to share them. Gabrielle reminded me of all this that day. In the 30 seconds I had to tell her how I got in, I ambled to reframe the entire question. I wanted to tell her that she could work hard and get somewhere (even though as I get older it’s harder to believe that hard work alone is enough.)  I wanted to tell her that Harvard very well might not be where she ended up – but that too would be ok, that she would end up where she needed to be. I wanted to honor her big dreams and leave her with hope, but I also wanted to keep reality in focus.

I’m not sure if I succeeded. In any or in all of this. But on Friday a little girl in Brooklyn, New York reminded me that when that question is asked, for the sake of little girls like her who look like me, I can’t shrug it off. Because shrugging it off would mean telling her that getting here isn’t as important as maybe she thinks it is – or worse yet, that it is near impossible. Shrugging it off would mean not answering her real question. And to that question, there’s only really one answer that I want to give: you know, I did get into Harvard and maybe you will too. But more than anything I believe that if you do work hard, really hard, if you follow your passions, and if you dig in, deep, you’ll end up where you’re meant to be. Even if you don’t quite know it at the time.

Long live.

swinging

My guidance counselor in high school used to have this quote on her wall: Friends are the family you choose for yourselves, it said. I’ve been thinking a lot about that quote these past few weeks. If you haven’t noticed, I haven’t been posting as much. It’s been a ruff month you could say. Tumultuous. And I’ve realized – for better or worse- that with this blog, I often post a lot of the good stuff. The hard stuff isn’t so fun to right about – go figure. I’ve realized I’m an incredibly private person. Counterintuitive I know when you document your life with a very public blog. That doesn’t exactly scream introvert. But I am, an introvert that is. In the most extroverted of ways. But still, an introvert all the same.

So this past March with its wave of angst and relief and anxiety and tumult all mixed in one weren’t exactly the stuff with which I wanted to take to the blogging sphere. My friend puts it this way: Inesha, you’re a groundhog. I hate to admit it but she’s sort of right. When things get tough, I’d rather dig in and hide away. I run up my swinging mileage. I find solace in lyrics. I don’t speak. At least, not very much. I go into my hole and dig, dig, dig. I process – a lot. I internalize… everything. I wait it out. I swallow pain, I gulp down tears, I call few. It’s a coping strategy that is not the best even as it is my own and even as it is incredibly hard to admit. The last few months have taught me this much at least.

I tell you this because it creates context. Because now that I am coming up to the surface, this is what I do want to put down in words. This past month and a half has reframed in so many ways what I consider to be friendship and what I’ve found to be the fundamental values I treasure most. In a contest between honesty and loyalty, it is close, but I value loyalty so. And when it comes to friends, letting them in close, means giving them permission to hurt us, to leave their mark, to enter into our lives. But knowing all the same that it is in our power to revoke that permission at any time. It’s a power that I’d like to forget we hold sometimes, one that has made me realize just how tenuous friendship can sometimes be.

Friendship means facing my fear of disappointment in the face — my fear of being disappointed, of disappointing myself.

And it means fighting.

At the beginning of March, I don’t think I knew that last one about myself — how important it was to me. But I believe in fights. In dinner conversations that are uncomfortable. In cold wars that lead to stand offs where you have to set everything on the table and deconstruct your friendship, what it means to you, and why you won’t ever stop fighting for it. For the person who ought to give 50 some of the time but more often than not gives only 10 (and to be clear, more often than not, that person is me.)

I had someone tell me recently that he didn’t think there was anything such as fundamental values because values are always changing. It’s an interesting point, but I have to disagree. Values do indeed evolve; they are stretched; they are challenged; they come into contact with others and you eventually have to define where one value stands on the hierarchy, the spectrum of them all. But if this month and a half of digging in has taught me anything it is that in friendship, as in love and as in family, the one thing I will always value is fighting, fighting for what you believe just as much as you would for the person on the other end. Even as this month has been hard, really hard, it’s shown me again and again how many fighters there are in my life, how many people put aside minutes, hours, days of their time just for me. Who fight for me – when the chips are up, and down. And that, that means more than I can say.

Here’s to you, friends. Thank you for being a part of the family I’ve chosen for myself. I love you so.

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Will you take a moment?

Promise me this.

That you’ll stand by me forever

But if God forbid fate should step in

And force us into a goodbye

If you have children some day

When they point to the pictures

Please tell them my name

Tell them how the crowds went wild

Tell them how I hope they SHINE

Long live the walls we crashed through

I had the time of my life, with you

Long, long live the walls we crashed through

How the kingdom lights shined just for me and you

And I was screaming long live all the magic we made

And bring on all the pretenders

I’m not afraid.

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Rethinking Technical Solutions

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Sitting in the corner office at Dialog, I was glad that I had taken Microeconomics. After a lot of time up north, I’d returned to Colombo for a bit to meet with some folks and chart out a path forward for GrowLanka. It’s really important to Ishani and I that this service project be sustained in the long term. So in Colombo I was busy meeting lots of people to figure out if there might be a fruitful partnership we could wager with an organization on the ground who shared our vision and commitment to bridging the information gaps in the labor market, an objective that I was able to achieve — but more on that later :)

Dialog (a mobile carrier akin to Comcast, AT&T, etc.) has a job alerts system for their users that is similar in function to ours’ so they seemed like a good place to go to. I got to meet with an executive at the company – and the 30 minute meeting we had was probably my most productive in the city. Boy did I learn. A lot. Dialog specializes in technological solutions. Hearing this executive talk, I was blown away not by just how business savvy they were but also by how committed to sustainability they seemed. Granted, my conversation was not really based in the business world — as this guy told me, “this is far more theoretical stuff.” Still, to know that people at the top tiers of organizations as expansive as Dialog are thinking long term about not just about how to do business but also about the right way to do it was really comforting. You need good leaders to move a country forward — in the political realm, in civil society, in the community. I was lucky to find them too in the business world in Sri Lanka.

It’s hard to boil our conversation down, but here are some of the takeaways — ones that really helped me rethink how I approach technological solutions to social problems and hopefully will help you rethink them too.

(1) You can’t just release your code into the world. A lot of funding these days goes into building the technical infrastructure for new apps, services, you name it. But less thought and follow through goes into how that service will be implemented, rolled out, scaled. We spent a year developing and iterating GrowLanka – but that wasn’t the end of it. We’ve been working on promoting our service, talking to people about it, campaigning for more than 5 months now and we’re not done yet. Eventually if this system is to sustain itself, we have to figure out a way to “create demand” for it but in the initial phases there has to be some momentum, there has to be enough of a critical mass of people using the system thinking, woah this is really helpful. Once you get that critical mass into the system, you get what some might call the hockey stick — suddenly all those people are telling there people about your system and your subscriptions skyrocket. The thing is it’s a rare day when you just get to that critical mass over night. So, even if you have the most brilliant app in the world, you have to figure out how to get the word out, how to tell people about it. And that’s not as easy as it looks! The point being, technology in and of itself isn’t enough. An app can be perfectly built but may gain no subscriptions – the rollout and active deployment of the app may just as well determine it’s success.

(2) Market Failure. A good way to think about where a technological solution might be useful is to think of market failures. Take the case of GrowLanka. There’s a labor demand and a labor supply – but somehow there’s a market failure, a mismatch such that the two aren’t lining up and feeding the other. The system isn’t working so there’s a better way to fix it, to get a more equatable and efficient allocation of that labor. Thinking about GrowLanka in terms of market failure helped me to think about why that market failure was occurring, among the most pressing reasons: a lack of trust, an information gap, distance, a skills gap, culture.

(3) Fulfillment. The data shows that technical solutions work best and are subscribed to most when they get the closest to fulfilling whatever need the user has. For users of GrowLanka — the need was getting a job. But GrowLanka wasn’t giving them a job, it was giving them information about a job, a crucial difference. A better GrowLanka might build on our initial layer of getting job alerts out to also then connecting people interested in a given alert directly to the employer or giving them an edge in the application process, an automatic interview if they expressed interest, for example. We had considered this before – the idea of matching people to jobs not just information about jobs is however an optimistic goal at best. There’s a plenary of challenges– technical, ethical, and practical– that come with trying to match people technologically; hence why human resources (emphasis on the human aspect) still exists!

(4) Ecosystems not value chains. Thinking about your technological solution not just in terms of how it creates value for the users– employers and job seekers in our case– but too how it functions within the greater “ecosystem” (labor organizations, government, confederation of businesses, the unemployed, etc.) allows you to better assess costs and benefits and figure out…

(5) Net Value Creation. Net value creation for GrowLanka, service project and student-headed social venture that we are, is about creating a surplus benefit on the whole for the communities we engage. Metrics are hard and are often murky for organizations like ours. We could measure GrowLanka’s impact by how many subscribers we have, how many text alerts are sent out each week as a business might do – but I’ll be honest with you that’s not really the best metric. A far better one would take into account the costs we’re incurring, how much it takes to maintain our system, the potential negative externalities we might be causing (are we, for instance, pushing out contractors from the labor market — by doing their job are we depriving them of theirs?), and all that considered, the overall value we’re providing. But measuring all that is tough and calls for far more rigorous analytics, such that we might be investing the same amount of our operational costs in running our system — and analyzing it for efficacy. That’s a trade-off that every organization needs to figure out. I will say this though, there’s no point creating an amazing system if there’s no net value creation or, even worse, you’re incurring more costs than you are benefits.

(6) Different forms of capital, different actors. There are many different forms of capital as far as I can see – finance, human, systems intelligence, environment, social, etc. The trick is figuring out which ones you care about most and which ones you need to measure to figure out how effective you’re being. But it’s still not that easy. Some forms of capital — human capital for instance– aren’t as easily measured as others. So you have to develop proxies to measure them. Again, that’s more work – you have to figure out where you stand and walk in knowing that depending on what sector you’re in – private, public, government – the answer and approach will be different. Knowing that and understanding that will help guide your priorities. It might even lead you to believe that a new investment or business model is needed for the kind of organization you want to run. Governments have a really crucial role to play here as well — in incentivizing the right kinds of capital, in regulating those that deplete value, in making sure that those actors that are doing good for the community have a shot.

Just some thoughts/takeaways on my end — sorry I know this post was a bit more technical but I do hope it helps. I sure learned a lot!

Up next: my favorite place in Sri Lanka

the house that built me.

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Too fast, too fast. The world moves too fast, I think as I pace back and forth across the black marble of my grandparents’ house. There in the very living room where my grandfather used to walk, his even, slow steps, one after the other in a trail across the floor with my baby sister in his arms. Patient to the core, he was the only one among us all who would carry her in his arms when she cried. And for a while it was his touch uniquely that would soothe her. Now it is me pacing back and forth, wondering what comfort he must have sought from those walks inside our garden’s gates even as it was his strolls outside it that he relished most. My mind reels back and forth, my thoughts racing, pausing to chuckle only for a few seconds at this memory, one that spurts forth a recollection of many more.

In this living room with its marble floor and paneled window door. In this house on Longden Place. With its garden that my grandmother laid. Gone is the shelf of trinkets she used to collect – the purple hand sized chair with a bouquet placed upon it that I once proudly selected at some random craft bazaar in Colombo. The big bowled plastic red chairs I used to sit in. Gone now just as she is. Memories of her casket laying here in the dining room that lays just beyond where my grandfather used to pace come back slowly and quickly all at once, her passing so quick, her loss so deep, her memory… everywhere. Not just pictures but places and things, thoughts in the air that chase me like memories from long ago. The little magnets she placed on the fridge that are still here. The kitchen where she used to cook lunch before day even broke. The ash trays of my grandfather’s that she kept long after he had passed.

From this dining room I take in the foyer, its tiny prayer room in the corner. Sealed now, it’s where I once spent an afternoon in front of my grandmother’s Buddha statue playing with matches despite all my mother’s warnings (what else, after all, to do on a lazy afternoon?). There’s the table where she once taught me how to draw real fish not just little curves that intersected with abandon. The place where the organ once stood now replaced by a mini bar with my uncle’s dinner party alcohol collection, the chest in the corner that not even time has been able to move – even as I have no earthly clue what lays inside it.

Even as my uncle and aunt have made their own changes, slight additions, a new gate, a new bathroom even (!!), there remains these reminders like so many more just as the mosquitoes are still incessant, the whirring of the fan above still comforting. And I, I still remember the long days and quick nights I spent here as a child in this house, this house that built me.

I pace back and forth across the floor tears supplanted by memories that force me to laugh in recollection at myself. At how the mischievous miscreant I once was used to get up in the middle of the night, from between the sheets, tucked safely between my grandmother and grandfather, I’d dial the AC to the coldest degree possible. Waking up, shivering, I’d ask my grandmother why it was so cold. And to think! Ishani and I would fight to get up the fastest – racing to see who would get to help my grandmother cook for the day or bother our grandfather as he spread marmalade across his toast or a new concoction of bananas and seeni sambol – gross! Returned from his daily walk, he would settle in his chair to read his newspaper in peace, a prospect unimaginable with two rambunctious three year olds loitering about the place.

We were mischievous little ones, Ishani and I – more likely I was the real troublemaker, Ishani the coerced accomplice. And boy did we haveIMG_1164 adventures in this house–from refusing to eat the fish placed upon our dinner plates (and tip-toeing back into the kitchen to plop it back into its rightful pot) to sneaking behind the house and pressing  our eyes and ears against the back window to our grandparent’s room. From there we would observe quietly as our grandmother watched soap operas– and so did we, from right behind her through the window pane.

Pacing back and forth, these memories like fireflies that I try to catch come back to me. These have been quiet mornings here. Still jet lagged, I get up quite early, rise before the city outside our little gated home alights with the traffic and the birds and the honking. Colombo is a city unto itself. But it is in this house that I feel the most safe. It is here that  I have time, time to pace, to think, to sort out in my mind all that has transpired in these past years and all that has yet to come ahead. It is stressful at times, overwhelming even when I think of the 2014 that awaits. A job? More school? Senior year? Me – a senior in college? These things and so many others as time and the world outside pushes and moves. Too fast, too fast, I think.

It has been comforting, soothing even to start these first few days of the year here of all places, in a country that in the most magical and devilish of ways slows down all senses of time. It’s given me the space to process, to unpack, to settle for a while. If 2012 was the year I finally got my bearings in college, 2013 was the year I finally said to hell with it. I threw myself, perhaps prematurely, into so many new things, different things. We can wait for crises or create our own and this might have been the year I mastered the latter. 2013 was hard. Challenging. But I learned. Boy did I learn. I painted wide brush strokes on the canvas of my life and I’m excited to go back now and fill in the details, big and small, slowly, methodically as I pace back and forth across the contours of this living room and back into the life I lead halfway across the world.

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I thought if I could touch this place or feel it

This brokenness inside me might start healing

Out here it’s like I’m someone else

I thought that maybe I could find myself

If I could just come in

I swear I’ll leave

Won’t take nothing more than a memory

From the house that built me.

You leave home, you move on

And you do the best you can

I got lost in this old world

And forgot who I am

I thought if I could touch this place or feel it

This brokenness inside me might start healing

Out here it’s like I’m someone else

I thought that maybe I could find myself

 

If I could just come in

I swear I’ll leave

Won’t take nothing more than a memory

From the house that built me.

 

19 Seconds to Tell Your Story

Reimagining Global Health_cover

I was rushing because it was 7 past the hour and that meant the standard allotment of “Harvard time” had been used up. And sure enough, as I walked into the first floor Boylston hall classroom, I was met with a room just shy of overcrowded and plenty of pizza boxes that had been discarded in one corner, their contents distributed on plates throughout the room. The evening dinner discussion with Professor Arthur Kleinman, a well known physician-anthropologist and Harvard Professor, was still missing its guest of honor. Good, I thought. I’m not that late. Soon enough though, just as I had finished saying Hi to a few friends and grabbed one of the few remaining seats, Professor Kleinman ambled in with his characteristic corduroy jacket, sauntering gait, and hat tilted slightly to the side atop his crop of graying hair. He had as much the air of a university professor as he did the quintessential grandfather. Taking his seat at the front of the room, he surveyed the crowd and the dull roar of chatter quickly died down. I could sense the audience leaning in ever so slightly, a few stragglers still chewing quietly on their pizza slices–all were eager to hear what the Professor had to say about tonight’s discussion topic: Ethics in Caregiving.

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“You have 19 seconds to tell your story.”

It was clear that he wanted us to let that figure sink in. The discussion had gotten underway and the Professor was talking about the patient-physician dynamic within the hospital setting today. 19 seconds was the average amount of time that a patient had to explain his or her story and symptoms before the doctor would jump in with a diagnosis and prescription, he told us. This was the time allotted despite the fact that studies show that it’s the latter part of a patient’s story that matters most to his diagnosis. And what’s the rush? Well, a patient only has an average of 17 minutes to see his doctor, so by all reasonable logic, the imperative is on both parties to talk quickly.

The Professor threw out a few more figures before he got to the meat of tonight’s talk:

“My contention is that medicine has little to do with caregiving today.”

It was a depressing statement to say the least. Caregiving, after all, is the reason why so many of the eagerly listening pre-meds in the room aspired to enter the medical profession. Caregiving, Professor Kleinman explained, consists of the emotional and moral components of the human response (i.e. acknowledging, affirming, etc.) whereas medicine is often defined purely in terms of the practical aspects of healthcare delivery (i.e. drugs, equipment, physician hours logged, etc.).

So, how do we restore the connection between these two–medicine & caregiving? This was the challenge that Professor Kleinman said he frequently presents to every class of medical students that he speaks to across the country. It’s our very own crisis in caregiving and certainly most medical schools in the country are trying to address it, he explained. “Find for me a medical school that is not undergoing curriculum reform?” he asked skeptically. No one in the audience said a word. “Exactly; everyone is trying to address this.”

That doesn’t mean that we have found success yet, though. Certainly the delivery of health and care depend on the availability of both time and resources. Where either or both are constrained, financial implications come into play that often place hospitals in the position of either turning away patients or seeing more of them in less time–many have chosen the latter. And still, costs have skyrocketed across the country. Especially in light of the current debates surrounding the Affordable Care Act, there is increased discussion about costs and the fact that the American health care system is one of the most expensive in the world despite providing poorer quality of care than systems that are far more economical. This is a problem that many, including surgeon and journalist Atul Gawande, have tried to tackle.

I think that Gawande’s writing has been particularly effective in communicating some of the finer nuances of the debate. Despite the many instances of disjunction between cost and quality of care, Gawande’s writing has presented examples of health centers and systems that seem to have achieved the allusive balance between the two. One such example is the Mayo Clinic. In his 2009 article The Cost Conundrum, Gawande demonstrates that the goals of keeping costs down and increasing doctors’ latitude to spend more time with patients are two ideas that need not be antithetical. He writes:

“I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out.”

It would seem that the Mayo clinic, then, has managed to reconnect medicine and caregiving so as to effectively address the crisis that Professor Kleinman was talking to us about while also responding to the financial considerations that dominate our national healthcare debate. How does Mayo’s model make this possible? Gawande asked Cortese to explain. In Gawande’s words:

“It’s not easy,” he [Cortese] said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.”

Replicability and scalability are key issues of concern with regard to the Mayo model–but the clinic has successfully expanded to places such as Florida where the costs of healthcare are traditionally among the highest in the country. Recruiting physicians who are willing to work for a salary remains a challenge, however, and goes against the “culture of money” that has long been ingrained in some of the places that are plagued by the worst disparities between cost and patient satisfaction. Still, though, Mayo’s ability to achieve a semblance of balance between costs, medicine, and caregiving is promising and suggests that many healthcare systems around our country have much to learn from their model. As medical schools continue to restructure and reshape their curricula in order to re-infuse medicine with the caregiving that is so essential to it, perhaps they would do well to look at examples like the Mayo Clinic which have managed to address the financial considerations that underlie every debate of this nature.

“19 seconds to tell your story.” That was still the fact that stuck with me most as our dinner discussion wrapped up and people began gathering their things to venture back out into the cold night beyond the classroom. I kept thinking about how many words I thought I could get out in 19 seconds, especially if I were meeting someone for the first time. Not many, I decided. Standing in line at Starbucks afterwards, I knew that it would take more than 19 seconds just to give my coffee order. Walking home, I felt fortunate that coffee could help lift the weight of the caregiving crisis from my mind at least temporarily–but I felt determination and encouragement too, in knowing that facing that crisis and working to combat it is something that I hope to one day devote my life’s work to.