Finding Myself: A Korean-American Adoptee’s Reflections on Identity, Loss, and Purpose

By: Elizabeth Lilley, MD, MPH

Many people are surprised to learn that I am both a surgeon and a palliative care doctor. Although the number of surgeons pursuing fellowship training in palliative care continues to grow, it remains a rare combination, with fewer than 100 American physicians carrying dual board certification in surgery and palliative medicine. For me, this dual professional identity is rooted in my heritage as a Korean-American adoptee.  

I left a foster home in Korea – the country of my birth – when I was three months old to join my new family in America. Growing up, my dual identity as a Korean daughter to white American parents felt natural and right, and also led to some confusion. As a young girl, I once used modeling clay to sculpt myself a Caucasian nose so I could look more like my mother.  On the other hand, when I was with my Asian friends my outward appearance blended in, but I could not fully relate to their experiences growing up in Asian American homes. Despite belonging to two worlds, I sometimes felt like an outsider in each.  

Over the years, I have met many other Korean-American adoptees. We shared a common background, so there was never a need to explain.  Through these friendships, I found myself.  When a dear friend was diagnosed with advanced cancer and died far too young, it sent a shockwave through our small community. I was 18 at the time, and will never forget when he called and told me that the chemotherapy had not worked and he was starting hospice.  Weeks later, he died at home surrounded by family. Through this devastating loss, I began a path that led me to my career in surgical oncology and palliative care.  

During medical school and residency, I kept this memory in my heart as I cared for patients with cancer. My goal has always been to provide care to patients and their families, regardless of whether a cure is possible. And so, after finishing my surgical residency, I was excited to complete a fellowship in hospice and palliative medicine. Although I knew that not all surgeons were comfortable and familiar with palliative care, it had never occurred to me that not all palliative care physicians would feel comfortable and familiar with surgeons.  Before long, it was clear to me and everyone else that my identity – my tribe – was firmly rooted in surgical culture.  Although I was welcomed and wanted in the palliative care community that had adopted me, I was also representing foreign people.  

An early lesson in communication from my palliative care faculty involved switching from using “but” to “and also.”  For example:

• “Mrs. Smith has been adamant about getting more treatment, but she has had multiple hospitalizations with infectious complications.”  
• “Mrs. Smith has been adamant about getting more treatment, and also she has had multiple hospitalizations with infectious complications.”  

It is a small change that allows space for seemingly conflicting ideas to be equally valid and important. A patient can simultaneously want more treatment and be greatly suffering from it.  In surgery, we so often deal in absolutes. We strive for precision and perfection. The cancer is resectable or unresectable. The margin is positive or negative. But in palliative care, we need to make space for uncertainty and complexity and contradiction.  

The lessons of my childhood, embracing and integrating the many aspects of my identity, are echoed now.  I am an orphan from Korea. I am a daughter to loving American parents who do not look like me, but share my heart. I sit in quiet sadness with those who are facing their own mortality. I use my hands to cure cancer. Rather than let these many sides of myself come into conflict, I draw insights and inspiration from all of them to become the doctor and person I am today.

Elizabeth Lilley, MD, MPH is a surgical oncology fellow at The University of Texas MD Anderson Cancer Center. She received her undergraduate degree from Lafayette College, her master’s degree in public health at the Mailman School of Public Health at Columbia University, and her medical degree from Rutgers Robert Wood Johnson Medical School. She began her General Surgery residency at Rutgers, then transferred to Brigham and Women’s Hospital to complete training.  She did fellowship training in Hospice and Palliative Medicine at Massachusetts General Hospital and Dana Farber Cancer Institute.  Following this, she began a surgical oncology fellowship at the University of Texas M.D. Anderson Cancer Center where she is currently in her final year of training.  Next year, Dr. Lilley will join the staff at Brigham and Women’s Hospital and Dana Farber Cancer Institute, where she will specialize in sarcoma and melanoma.  Her research focuses on the palliative care needs of surgical patients.