From War Zones to Waiting Rooms: What Global Conflict—and Cancer—Taught Me About Being Human

This talk, recorded at the Cholangiocarcinoma Foundation’s annual conference in May 2023, traces the arc of a life shaped by two seemingly distant worlds: international conflict zones and cancer wards.

For years, my work carried me to the front lines of diplomacy and human rights—from the chambers of the United Nations to the borderlands of North Korea. Then came a diagnosis: rare, terminal, and nonnegotiable. The gaze I had long cast outward, bearing witness to global crises, was suddenly turned inward—toward my own body, mortality, and the question of how to live when time is no longer assumed.

Below is the video of the talk, followed by a written reflection.

In March 2021, life threw me a curveball. Until then, my days were consumed by the work of human rights and conflict resolution, often in places where the ground was still warm from the fires of war. From Rwanda to Bosnia, I moved through the aftermaths that genocide and war leaves behind, trying to make sense of what remains. In 2009, that path led me to China, where my son and I made our home for five years. I worked across the region, often with him in tow. I’ve always been drawn to the world’s most enigmatic corners—places like North Korea, Iran, Zimbabwe, and Myanmar—where paradox lives in plain sight, and nothing is quite as it seems.

In search of steadier ground, we made a home in New York City. I was 51, immersed in a life of yoga, cycling, and kale-fueled discipline, when the ground gave way beneath me. Out of nowhere, I was handed a diagnosis that belonged to another world entirely—stage 4 cholangiocarcinoma, a terminal cancer of the bile duct so obscure it sounded more like a misprint than a sentence.

I approached this new journey as I had so many others—by charting a course and adapting to the terrain. Only this time, I wasn’t boarding a plane at JFK but descending into the depths of the New York City subway en route to Memorial Sloan Kettering. There was no visa stamped into my passport, just a newly issued Medical Record Number, marking entry into a different kind of expedition. My suitcase, once packed with clothes for Kabul or Kinshasa, now carried the tools of treatment: a heating blanket, ginger chews, crossword puzzles. And the language barriers changed, too. Gone were the dialects of conflict zones; in their place came the dense vocabulary of oncology—terms like 'fibroblast growth factor receptor' and 'Stereotactic Body Radiation Therapy' becoming my new lingua franca.

Just as no journey unfolds exactly as planned, this one, too, was riddled with detours—hospital stays, paused treatments, and abrupt shifts to daily life. The words of Holocaust survivor Viktor Frankl echoed through the chaos: 'Between stimulus and response there is a space. In that space is our power to choose our response.' I couldn’t control the diagnosis or the disruptions, but I could choose how to meet them—how to move through each moment with intention, even when the map dissolved in my hands.

Looking back on travel mishaps, I see them now as early lessons in choosing presence over panic. Once, during what was meant to be a routine visit, I found myself accidentally locked inside Kigali Central Prison. I knew that calling the UN on my radio could set off an international alarm, so I stayed put, passing the time with the prisoners—talking, laughing, waiting for the warden to return at dusk. Another time, at the China–North Korea border, our assigned guide failed to show. With my young son beside me, we calmly found our own way across, aided by border guards and the kindness of fellow travelers. In both cases, it was conversation—human connection—that transformed tension into insight, uncertainty into story.

“Of all the books in the world the best stories are found between the pages of a passport.” (anonymous)

In embracing my cancer journey, I've uncovered the remarkable beauty that resides within vulnerability, the strength found in dependence on others, the warmth of a supportive community, and gratitude for the gifts my body has provided throughout my lifetime. Illness has compelled me to slow my pace, to perceive the world through fresh eyes, and to be receptive to a myriad of new experiences and connections. It has illuminated the joy of deep relationships with cherished loved ones.

Furthermore, even in the face of the rigors of chemotherapy, I've found a sense of beauty. In addition to the amazing MSK nurses who shepherded me through each infusion and with whom we celebrated when I hit my 50^th, I engaged in a gratitude practice at the outset of each infusion to send thanks to the unseen collective effort necessary to bring life-saving medications to those in need—scientists, researchers, doctors, nurses, donors, trial participants, and every link in the pharmaceutical supply chain.  

The courage, resilience, and generosity I have witnessed in traveling through Cholangioland have been every bit as inspiring as the unexpected love, grace, and laughter I witnessed in my professional travels in the darkest of situations: in prison cells, massacre sites, bombed out buildings, even as survivors recounted to me some of the most vulnerable and terrifying parts of their lives. As I sit with these ever intertwining emotions of joy and pain, greater peace has developed. Desmond Tutu said : “Discovering more joy does not save us from the inevitability of hardship and heartbreak.  In fact, we may cry more easily, but we will laugh more easily too. Perhaps we are just more alive. Yet as we discover more joy, we can face suffering in a way that ennobles rather than embitters. We have hardship without becoming hard. We have heartbreaks without being broken.”

My odyssey in life as well as in Cholangioland has accentuated the ephemerality of our time here and the importance of each moment. This realization has led me to prioritize the quality of life over its mere duration. Over the past two and a half years, I've wholeheartedly embraced opportunities to spend cherished moments with family and loved ones, pursuing activities that resonate deeply with us, whether on American soil or during our journeys across foreign lands.

Our adventures have included traveling to over a dozen countries during my chemo breaks.  I was also able to undertake an incredibly memorable work trip to Yangon, Myanmar in 2022, amidst a tumultuous military coup.  By supporting and standing alongside courageous Burmese legal aid lawyers who tirelessly fight for justice, on whose behalf I have now started a legacy fund in my name, I have been able to join up my value of engaging in service with my cancer journey in a way that will live on after I am gone.

My cancer odyssey has illuminated the profound beauty that exists within the interplay of adversity and resilience, fragility and strength, vulnerability and courage. It has taught me that life's splendor transcends its length and is profoundly enriched by the depth of our experiences. With each step through Cholangioland, I've come to appreciate that a life lived with purpose and meaning, no matter its brevity, possesses a beauty that a longer life not deeply lived might lack.

Baby’s first passport

Full text of speech

I’m honored to speak to you today. Let me start by thanking all the incredible individuals working with the Cholangiocarcinoma Foundation – the Board, the doctors and researchers working on the frontlines of developing new treatments and, last but never least, my inspiring fellow cholangio warriors and their caregivers.

Given the choice I am sure the instinct of many of us patients would be to be anyplace but here, and facing any challenge other than this disease. But life has a funny way of taking us on journeys to the places that really matter.

Before my diagnosis…in March 2021….I had spent most of my life working on some of the world’s most intractable conflicts. Back in 1994 I was sent by the UN to Rwanda to investigate the genocide….then to Bosnia and Herzegovina by the State Department to monitor human rights in the wake of the Yugoslav war. And after that to various countries wracked by war or human rights crises, mostly in Africa and Asia. After having my son, we moved to China for several years and I traveled all over Asia, working on regional conflict and human rights issues, often with my son in tow….I always seemed to find myself in the countries that were the most challenging and closed off… places like North Korea, Iran, Zimbabwe, Myanmar…

Eventually my journeys led me back to the United States, first DC and then NYC, where we expected to settle down with relative stability.

But sometimes life just asks you to keep traveling….albeit on a different sort of journey.

At age 51, an avid yogi, diver, cyclist, runner, hiker… non-smoker, I was diagnosed in March of 2021 with advanced Intrahepatic cholangiocarcinoma with an unresectable liver tumor of 11 x 8 cm with vascular invasion into the right portal vein, as well as lymph node metastasis.

After getting my head around “chalangioWHAT?” I suspected that this might be one of the most arduous journey out of a lifetime of such journeys into the most uncertain of places.

My medical journey started with GemCis and then GemCis Durvamulab at MSK for almost two years, from March 2021 to December 2022, which stabilized my tumor after some minor shrinkage. When the tumor started to progress again late last year, I transitioned to Pemigatinib, which has, for now, stabilized things again, and given some satisfying shrinkage.

As I traveled deeper and deeper into Cholangioland, I decided to treat this disease like any other trip into an unfamiliar territory. But instead of getting a visa in my passport I was given a Medical Record Number. My suitcase was filled, not only with comfortable clothes, but also a heating blanket, numbing cream for my port, chemo snacks and games …. and instead of learning Mandarin Chinese I became familiar with terms like fibroblast growth factor receptor, biomarkers, T cells, progression-free survival…. (As well as various foreign-sounding pharmaceutical names which now roll off my tongue)

Some of the best parts of travel are all the wonderful, wacky and magnificent people you get to meet along the way. My journey in Cholangioland has allowed me to come into connection with an amazing community of patients, doctors, providers, caregivers….all touched by and/or working on behalf of eradicating this cancer. The determination, focus, resolve, and dedication to moving forward with new treatments are extraordinary, very much like so many of the human rights defenders I’ve worked with all around the world, so committed to saving lives.

The chemo suite staff have become like family, sharing snacks, stories, laughter and tears together… they even threw me a huge party for my 50th infusion, complete with green streamers, noisemakers, hats, a huge green cake.. and everyone went home with the CCA merch that I had squirreled away from this conference last year and the NY marathon fundraiser! Given that many cholangio patients will never be able to ring these little bells, I figured we need to celebrate our own milestones…and 50 infusions seemed like a big one! I’ve also been particularly grateful for all the wonderful staff at MSK’s integrative medicine center… Including their acupuncture doctors who are on the cutting edge of the latest research in how to apply acupuncture for chemo symptom management, including by boosting blood cell counts and enhancing lymphocyte and natural killer cell activity. When combined with my training in medical Reiki, mindfulness-based emotional intelligence, yoga, and breath-work, all of this support has allowed me to chart a journey of treatment for the whole person….the whole patient….not just for the cancer.

I’ve been able to get advice and second opinions from amazing doctors at MD Anderson, Mass General, Johns Hopkins and Stanford various stages, all of whom have been exceedingly generous with their time and counsel. (A special shout out to Drs. Nilo Azad, Lipika Goyal, Milind Javle, and Ghassan Abou-Alfa).

I began a simple practice every time I received chemotherapy that I now continue when I ingest my Pemigatinib pill. I spend a few minutes thanking all the people who have contributed to the development and distribution of the medicines… from the scientists, researchers, doctors, nurses, donors, trial participants and pharmacy company executives….all the way down to the workers who minede and processed the raw materials and those working along the supply chain to get it into my port, or mouth. Just remembering that so much had to happen to get to this point.

I also send compassion to the those everywhere suffering with this disease and indeed with any illness or loss, remembering that illness and suffering is part of our shared human experience. I take much strength from this notion of our common humanity, because when you scratch the surface, loss and illness afflict all of us sooner or later – and through us, all the people we love.

In fact, when I was diagnosed my son was starting on a journey of his own: he was on a gap year serving as a conservation volunteer on an environmental restoration project in California. When he got my call about a mass in my liver he had just gathered up the nerve to ask one of his fellow workmates out, and they were at a bookstore on their first date. Poor boy! That was just the one part of navigating one of the key parts of this patient journey - how the pain and uncertainty caused by this illness ripples out into our families, loved ones, and communities.

In all my trips to foreign countries, I’ve had a steep learning curve not only as it relates to language and culture but also in the sense that the best travel plans are always getting upended in the moment, reinforcing the widespread and universal law that “Everything changes.” And while we can’t control many of the external events that happen to us, we get to choose how to live with them.

Throughout my journey I have therefore tried to remember to make the distinction between the circumstances of this disease — over which I have little control — and all of the ways in which I can exercise my own discretion and choices. According to Holocaust survivor and author of Man's Search for Meaning, Victor Frankl: Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

As humans we often create additional suffering on top of whatever suffering or illness we traverse by adding what fear, anxiety and/or resistance. This can be called the “Second arrow” or “suffering twice.” Psychologist Kristin Neff said, “Suffering equals pain times resistance.” So I have made it a practice to notice when I’m adding additional psychological distress to the pain or difficulty I’m already navigating .. whether it be 10/10 pain and an ER visit, surgery, debilitating side effects, or even just the frustrating cognitive impairment that comes with chemo. As descendants of nervous apes, we have evolved over billions of years to pay more attention to negative than positive information, because this is what kept us able to assess threats and remain alive. Back to the travel metaphor, this reflex of being “Teflon for the positive and Velcro for the negative” leads us, for example, to notice that there is always someone sitting comfortably in business class when you are squished into a middle seat for 13 hours in economy, or someone who got that coveted reservation at the nice restaurant while you are stuck at a cheap diner…..someone on a sunny beach when you are caught in the cold, rain and wind…. Someone healthy when you have cancer… But back to Victor Frankl, we get to choose how we interpret the world around us. beauty is that we get to choose to whom we compare ourselves! Instead of asking, “Why, me?” I get to ask, “Why not me?” And “What’s here for me in this journey?” That coach seat might actually give me access to a new friend waiting to be made. The seemingly cheap diner may offer some of the most authentic and delicious native cuisine. The bad weather may give quiet time to read an inspiring book. Eventually, everything we encounter becomes our teacher.

I never anticipated to find such beauty in illness. Of course it’s so easy to feel beleaguered by managing our appointments, blood counts, side effects, scans, appeals with insurance companies, changes in plans due to ER visits and hospital stays and so on… but I’ve also experienced such beauty in vulnerability, in dependence on others, in focusing on the problem at hand….of community and connection with beautiful and caring souls within medical institutions….the beauty of gratitude for the things you do have…. the amazing ways your body has served you for your entire life, the body’s ability to heal, the beauty of slowing down both body and brain, seeing things differently, being open to different experiences and interactions…. The beauty of fully healing your relationships with your parents, family, and ancestors… The beauty of savoring and of slowing down to notice and appreciate.

Just as sometimes when I travel, I decide to splurge by staying in a downtown hotel, rather than pitching my tent, for this journey I decided to prioritize life quality over quantity. The expression that resonates with me is to have “a lot in life in my years”. A really helpful tool I found on this journey is this magical “Cancer Card”, which is like a "get out of jail free" card in Monopoly. It sometimes feels like a secret weapon in my back pocket, and has become quite liberating! “I’m so sorry, I just can’t tonight,” I say, “My body isn’t the same since I started chemo and I’m just too tired.” So these days, everything is either a “heck yes” or a “hard no”! For me, the vistas offered by the cholangio journey, while sometimes only seen from walking the razor’s edge of vertiginous cliffs, have helped me to appreciate that a shorter life of profound meaning has beauty that a longer life not deeply lived might lack.

After my diagnosis, many people asked me about a bucket list. But with visas from over 80 countries stamped into 12 different passports throughout my life, there was no place per se that needed visiting. All that I wanted to do was spent as much quality time as possible with those I love most in this world, doing the thigns we love most. And ironically, this then led to more travel! Because for example I had to giv up scuba diving while child rearing and trying to save the world – it seemed too dangerous to involve a youngster -- but now my son was 19 and there was no better time than the present! Meanwhile, why let all those hard-won frequent flyer miles expire before I did? So on my chemo treatment breaks, we ended up visiting places like Honduras, Peru, Belize, Morocco, Mexico, Switzerland, the UK, the Bahamas, India… where we hiked mountains, visited sacred and historical sites, jumped out of an airplane, scuba dived like crazy (my son and I got certified in advanced shipwreck diving!). We did an intense yoga retreat at a yoga ashram in India… and adventured all around the southern tip of that country just a few months ago. I then did a solo trip to the Amazonian jungle where I engaged in a week-long retreat in complete isolation from humanity and a special diet of plant medicine… I came back to civilization completely reinvigorated and with great looking blood counts! And think I detoxed some of the chemo from my body to boot! With a mentality of “every trip could be my last”… each time we were ending a journey, lo and behold there was the next one to plan! I also did a work trip to Yangon, Myanmar in November 2021 in the middle of the military coup there to support brave Burmese human rights defenders leading the fight for access to justice for the most vulnerable populations in that country…. My doctor was incredibly supportive of all of this travel with the exception of one trip for which he was less than enthusiastic … it was to Cuzco, Peru, which is at high elevation. But he was delighted to see that when I returned, my red blood cell counts were higher than ever…..

On all these journeys….through Cholangioland and in Cuzco….to MSK and to Mysore....I’ve learned that healing is more than just trying to halt a disease or condition; it is learning to nurture ease and well-being within our bodies, hearts, and minds in every moment and welcome mystery into our lives. Rumi said “through love all pain will turn to medicine.”

Life is ephemeral. Acknowledging our transience is completely empowering, enabling and freeing. But we have to embrace the full spectrum….we don’t feel the depth of the joy without the depth of pain.

Desmond Tutu said : Discovering more joy does not, save us from the inevitability of hardship and heartbreak. In fact, we may cry more easily, but we will laugh more easily too. Perhaps we are just more alive. Yet as we discover more joy, we can face suffering in a way that ennobles rather than embitters. We have hardship without becoming hard. We have heartbreaks without being broken.

The fact is that: we’re not dying until we’re dying. And spoiler alert: everyone is terminal. No one gets out of this wild and crazy life alive. And dying is actually all about living. One of the world’s longest studies of adult life, the Harvard Experiment on Adult Development which tracked the physical and mental health of 268 former students throughout their lifetime, confirms that our deep relationships with family, friends, and community not only contribute to healthy and happier lives but are universally invoked on people’s deathbeds as the most important aspect of their lives. As people approach their final hour, they want to tell the story of their loves, passions, and the pain they have experienced; and they want to make peace with it. Not knowing exactly when the end was neigh for me, it seemed logical to integrate this wisdom into any time I have left.

A recent study by Antoine Lutz and colleagues demonstrated the benefits of meditation in terms of stress and reactivity. Compared with novices, longtime meditators reported equal pain intensity during the actual application of a painful stimulus, but much less unpleasantness prior to the application of the painful stimulus, as well as lower unpleasantness after the cessation of the painful stimulus. In other words, the meditators were able to let things come and go more easily, to not add to the stress of a situation with worry and rumination.

Maybe meditation isn’t your way. Maybe it’s seeking out more sunrises and sunsets. Maybe it’s having more conversations with loved ones, more journeys of the body and of the mind, more gratitude, more savoring.

But I invite you to decide on, claim, and implement your loving way, your journey forward. And so I want to leave you with a question: Knowing that our journey to death is inevitable, what is the most precious thing you can do this year, this month, this very day?

Thank you.