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COA Magazine: Vol 9. No 1. Spring 2013
COA The College of the Atl antic Mag a zine Volume 9 . Number 1 . Spring 2013 WAYS OF WELLNESS COA The College of the Atlantic Magazine Ways of Wellness Letter from the President 3 News from Campus 4 Food for Thought • Surya Karki '16 7 Wellness 11 The Yin and Yang of Peter Wayne '83 12 Human Ecology on Steroids • Three Alumni Doctors of Emergency Care 15 Bloodlines and Bodywork • Carmen Bedard-Gautrais '07 18 An Integrative Life • Christopher Todd Kitchens '06 21 The Art of Honnie Goode, MPhil '06 23 Re(de)fining Global Health • Rachel Snow '81 26 My Brain Cancer Diary • Bogart Salzberg '96 28 The Search for Balanced Imbalance • Perspectives from Student Life 32 Research Successes • Steven King '80 and Clifton E. McPherson '84 34 Aoife O'Brien '05 • Babycatcher 37 Discovering Cures 38 A Life of Kindness, A World of Hope • Father James M. Gower 41 Alumni and Community Notes 44 To Err is Human • Year After Year Donors 53 Japanese Beetles • Poetry by Anneke Hart '16 56 John Anderson's History of Natural History 57 COA students Rachel Drattler '14 and Will Fuller '16 practice tai chi (see page 12). Photo by Becca Haydu '16. COA The College of the Atlantic Magazine Volume 9 · Number 1 · Spring 2013 Editorial Editor Donna Gold Editorial Guidance John Anderson Sarah Baker Marni Berger '09 Rich Borden Lynn Boulger Dru Colbert Ken Cline Michael Griffith '09 Sarah Haughn '08 Helen Hess Jennifer Hughes Katharine Macko Danielle Meier '08 Editorial Consultant Bill Carpenter Alumni Consultants Jill Barlow-Kelley Dianne Clendaniel Design Art Director Rebecca Hope Woods COA Administration President Darron Collins '92 Dean of Admission Sarah Baker Dean of Institutional Lynn Boulger Advancement Associate Dean for Faculty Ken Cline Administrative Dean Andrew Griffiths Academic Dean Kenneth Hill Dean of Student Life Sarah Luke Associate Dean Sean Todd for Advanced Studies COA Board of Trustees Becky Ann Baker Dylan Baker Ronald E. Beard Leslie C. Brewer Alyne Cistone Nikhit D'Sa '06 William G. Foulke, Jr. Amy Yeager Geier George B.E. Hambleton Elizabeth D. Hodder Philip B. Kunhardt III '77 Anthony Mazlish Suzanne Folds McCullagh Sarah A. McDaniel '93 Linda McGillicuddy Jay McNally '84 Stephen G. Milliken Philip S.J. Moriarty Phyllis Anina Moriarty Hamilton Robinson, Jr. Walter Robinson Nadia Rosenthal Marthann Lauver Samek Henry L.P. Schmelzer William N. Thorndike, Jr. Cody van Heerden Life Trustees Samuel M. Hamill, Jr. John N. Kelly Susan Storey Lyman William V.P. Newlin John Reeves Henry D. Sharpe, Jr. Clyde E. Shorey, Jr. Trustee Emeriti David Hackett Fischer Sherry F. Huber Daniel Pierce Helen Porter Cathy L. Ramsdell '78 John Wilmerding The faculty, students, trustees, staff, and alumni of College of the Atlantic envision a world where people value creativity, intellectual achievement, and diversity of nature and human cultures. With respect and compassion, individuals construct meaningful lives for themselves, gain appreciation of the relationships among all forms of life, and safeguard the heritage of future generations. COA is published biannually for the College of the Atlantic community. Please send ideas, letters, and submissions (short stories, poetry, and revisits to human ecology essays) to: COA Magazine, College of the Atlantic 105 Eden St, Bar Harbor, ME 04609 firstname.lastname@example.com www.coa.edu There is little that has given me as much pleasure over the past nine years as talking to students about a project, a play, a future, or simply hearing their enthusiasm — their love — for this college. But what does it mean to love COA? Yes, there are the moods of Frenchman Bay, the shifts in the ocean's color; there are the friendships begun, and the insights gained. But I think loving COA is more even than that — more akin to loving something sacred within ourselves — a love of learning, yes — but also a recognition that learning is about awareness, about attending to the world with our whole beings: mind, body, soul. It is working hard, and laughing hard — usually about ourselves; it is heading into Acadia National Park for a brisk bicycle ride and returning to work and think and talk and laugh some more. This fluid intensity shaped at COA is what ultimately forms the healthy balance of a human life. This may have been something I knew — but it took a conversation with five wise students — resident advisors all — to articulate it. Actually, I believe it took the conversation "The Search for Balanced Imbalance" (see page 32), for all six of us to articulate it. This very possibly explains the essence of a COA education, and why we appreciate it so much. None of us knows where learning will emerge: From books? Solitude? Classes? A moment on Dorr Mountain? A talk with friends? Some painful hurt? A joyful recognition? At COA we recognize that the spark that generates comprehension most likely comes from some combination of all of the above. COA's idealism, the belief that lives can be creative, useful, productive, lovely — and healthy — has had a powerful impact on many, including me! With this magazine, I am choosing a different form of balanced imbalance, leaving my full-time position as COA's public relations director, retaining only my role as editor of this magazine, on a very part-time basis. Thanks in part to the constant reminders by students that life is about more than working, I am choosing time to notice the ocean, take walks, read long novels, write, tend plants, and talk into the night with friends, as I so often did when I was a student like them. I hope in this way, I can better shape and model my own imbalanced balance. Donna Gold, COA editor Front cover: Witch Hazel (Hamamelis virginiana) by Lilliana Demers '13, from her senior project "A Study of the Local Healing Plants: Form, Color, and Spirit" The bark and leaves of witch hazel are used medicinally primarily for their astringent and cooling properties. Witch hazel is a potent painkiller, has antioxidant properties, and is one of the best wound herbs, used to stop bleeding and soothe internal and external inflammations. It is particularly useful for intestinal bleeding, bruises, varicose veins, hemorrhoids, dermatitis, sunburn, diarrhea, and more. Difficult to prepare, it is best to buy. From the President: Darron Collins '92, PhD On a recent trip to Australia, some malicious virus found its way into my lungs and left me with one of the worst coughs I've ever had. Weeks passed but the cough didn't. I reached out to the COA community for help. Within thirty minutes, I had fifty-eight responses in my inbox: change your sleeping position, brew this herbal concoction, consume this quantity of alcohol (and a bit of honey), pray, rub Vicks on your feet and in your nostrils, go to the doctor and get a prescription for codeine and sleeping pills. The most important revelation from the experience was the sheer volume of interest in and (real or imagined) expertise in health. The democratization of information in our new digital world clearly has spawned a democratization of information College of the Atlantic Magazine about the subject. Everyone seems wrapped up in issues of health and well-being: how to achieve it and how to hold onto it, how to improve it and how to foster it among larger social groups. We experiment on ourselves, we reach out to socially recognized experts, we anoint ourselves as experts. More COA students are going into medical and health professions now than when I was a student twentyplus years ago. But interest in the relationship between human health, community health, and ecological health has been a cornerstone of our teaching and learning and practice since our inception. This issue of COA demonstrates that we've been applying human ecology to human health and well-being for four decades. The articles that follow indicate that there are many avenues to medical school and other medical fields beyond a formal pre-med major. Our students excel at graduate level work and within the profession because of human ecology, not in spite of it. They bring the hands-on experience, the interdisciplinary perspective, the selfdesigned curriculum, and the passion for making large-impact changes, just as every human-ecologist-as-marinescientist, human-ecologist-as-graphicdesigner, and human-ecologist-aseducator does. Enjoy the issue and feel free to send me your own remedies for a pernicious, enduring cough. 3 NEWS from campus Lindsey Nielsen '12 Blum show combines science and art Student "pop-up" dinner raises $801 for Share the Harvest Dan DenDanto '91 turns whale bones into art in portland November December January The Chronicle of Higher Education features the title, "Tiny College Nurtures Big Ideas." The subject, COA! A $146,032 grant from the Davis Educational Foundation enables science faculty members John Anderson, Don Cass, Sarah Hall, and Nishanta Rajakaruna '94, along with Gordon Longsworth '91, GIS lab director, to create interdisciplinary courses featuring hands-on research on the entirety of the 25-mile watershed of Mount Desert Island's Northeast Creek. Students transform Gates for a "Reverie" february Calling COA a place where students are "focused on creating positive change," Princeton Review includes COA in its The Best Value Colleges: 2013 Edition. That's the third time in four years. COA's solar electric car charging station opens to the public with great fanfare — including a notice in the New York Times. COA now has a fossil fuel-emissionsfree route between our two farms and the college; we also offer free solarelectric charges to anyone in need on campus and at at Beech Hill Farm. 4 COA's 12-member Earth In Brackets delegation apply their learning and passion to organizing and communicating at the United Nations Framework Convention on Climate Change in Doha, Qatar. Six students and alumni survey birds, mammals, and Great Duck Island itself during COA's first winter study on the island. With high winds, huge snows, freezing temperatures, and rafts of purple sandpipers, the six name their time "The Best Journey in the World." Alex Borowicz '13 heads to Mount Desert Rock to launch a multi-year grey seal population survey, finding 550 seals in residence. He also assists a sea-spray study by folks from the Cold Regions Research and Engineering Laboratory and NorthWest Research Associates, with Chris Tremblay '03. COA teams up with the international social media platform Project Noah to enhance nature education and citizen science. www.projectnoah.org Dec, Feb, and April images by Sune Anderson '16. launch of meetmeatthewhaleskull.tumblr.com March COA divests from all fossil fuel investments! Erica Georgaklis '14, Will Batt '14, and Ian Medeiros '16 receive Maine Space Grant Consortium Research Fellowships for botanical research. Will and Erica also receive Garden Club of America scholarships. And Erica, fascinated by medicinal plants, joins nine other COA students to present to the Northeast Undergraduate Research and Development Symposium at University of New England. Earth Day 2013 April Louis Rabineau, COA's third president, is remembered in a celebration and dedication of The Lou Rabineau Educational Studies Center in The Turrets. New York Times education editor collaborates with COA for a "pop quiz" in its Earth Day edition of Education Life. On Earth Day weekend, Kyle Shank '14 organizes a Conference on Cooperation, Community, and Complexity: Imagining a New Economy for the 21st Century, in conjunction with the New Economics Institute. Check out more stories and photos at newsworthy.coa.edu Camden Challenge When time opened up at February's annual Camden Conference on world affairs, ten COA students were ready. Well-versed in the topic from taking The Arab Awakening and Emerging Issues in the Middle East class with political economics faculty member Gray Cox and political science lecturer Lucy Creevey, they proposed a twohour session, "Alternative Middle Eastern Voices Heard through Social Media." The students presented video clips, followed by an hour of open discussion. The give-and-take was intense says Gray, "tears and all." Throughout the conference, continues Gray, "the students asked lots of thoughtful, penetrating questions that demonstrated that they could push issues in respectful but forceful ways." They even took the moderator, former ambassador and current Harvard professor Nick Burns, to task with some challenging questions regarding the human cost of sanctions on civilians in Iran — sanctions the ambassador helped design. Instead of being irritated, he publicly praised the COA students for their example of asking tough questions that challenged authority. Next year's conference is "The Global Politics of Food and Water," and COA is planning another social media session. Stay tuned! COA participation at the Camden Conference: top, from left, Marissa Gilmour '16, Christina Tellez '16, Nada Zidan '15, Michael Santivasci '15, Brittany Cooper '15, Graham Hallett '16; bottom: Kyle Shank '14, Jane Nurse '13, Rachel Wells '15, Taggart Wass '14, Gray Cox. Come graduation, seniors Lisa Bjerke and Graham Reeder will be packing for a world journey, each equipped with $25,000 from the Thomas J. Watson Foundation and the title of "Watson Fellow," as they spend a year on a project of their dreams. Lisa will look at composting systems in Germany, China, Bangladesh, and Japan for the voyage she calls, "It is a Waste to Call it Waste: Exploring the Culture of Compost." Graham will head to Malawi, Burkina Faso, Bangladesh, Malaysia, and the Maldives for his project, "Preparing for a Changing Climate: CommunityBased Adaptation Strategies." For her quest, Lisa asks, "What would happen if we adopted nature's model that nothing is ever wasted; therefore, there is no such thing as food waste?" She will be investigating traditional and modern municipal composting systems "to understand how Photo by Becca Haydu '16. COA's Two Watson Fellows composting might become an integral part of human culture so we can continue to create this life-sustaining resource." While Lisa has been a hands-inthe-dirt activist, Graham's focus has been on diplomatic efforts to reverse climate change. This year, however, he'll be hands-on, assisting small, vulnerable communities in projects geared to addressing the rising sea levels, increased temperatures, decreased rain, and overall unpredictable weather patterns of climate change. "If every Check out more stories and photos at newsworthy.coa.edu UN negotiator or NGO worker started their day thinking of a time they spent participating in a community adaptation project … I am convinced that the decisions made in cities like New York and Geneva would move a lot faster and in a much healthier direction," he writes, explaining his longing for hands-on work. The two are among this year's forty fellows chosen by the foundation from thirty-one colleges. Since 1984, COA has sent thirty-two Watson Fellows off on dream journeys — including President Darron Collins '92. 5 Energy Framework The word is out. COA is no longer "carbon neutral." While the college works hard to reduce and avoid carbon emissions, mostly we achieved neutrality through purchasing offsets. Spurred by students, COA came to realize that as useful as offsets can be, they were making us lazy — we weren't really working on getting our campus up to snuff. We also realized something else: COA's greatest contribution to the environment is our students. So our energy framework focuses on eliminating the use of fossil fuels on campus while involving students in each step of the process so they can head out into the world as energy-savvy proponents of change. "Our goal is to make COA a laboratory where students, faculty, and staff can explore the diverse prospects of a more sustainable future," reads the preamble to COA's new energy framework. "A central part of our energy plan will include classes and project-based learning where students practice the interdisciplinary skills needed to promote responsible energy use. Students will be involved in the design, construction, maintenance, and monitoring of all necessary changes on our main campus, islands, and farms." It continues, "These experiences will prepare students to become advocates for the ecological integrity of the climate and the planet [helping] to shape a sustainable world for countless generations to come." First step? Installing 204 photovoltaic panels this summer on the Kathryn W. Davis Student Residence Village and at the Peggy Rockefeller Farms to provide about 7 percent of our annual electricity. Healing Turrets COA's beloved icon, The Turrets, is ailing. The very turrets for which it is named are cracking; its slate roofing shingles are slipping off. And the energy efficiency, well, when Curry Caputo '95 of Sustainable Structures Inc. measured the building he discovered that it operates as if we had a 61" x 61" opening to the great outdoors. Naming opportunities, original roof slates, and Save Turrets bumper stickers are available as a means of supporting the project. E TURRETS V A DU ! EG LL 6 COA first restored and renovated The Turrets in the 1970s after years of disrepair. Originally, one hundred men spent two years building this stone treasure, quarrying the 42,500 cubic feet of granite from near Eagle Lake, using draft horses to drag the blocks over the five miles. It was built in 1893 as a wedding gift by candle and soap magnate John Josiah Emery for his bride, the 18-year-old Lela Alexander. Architect Bruce Price designed The Turrets while also creating the storied Château Frontenac in Québec City. CO Beyond the roof and turrets, ninetynine new windows and a parcel of new doors will improve energy efficiency. Additional work includes a new copper drainage system and roof flashing, twelve-inch repointing of the granite over 40 percent of the exterior and three-inch repointing over another For more on the restoration, or to assist the project, call 207-801-5620, or go to coa.edu/saveturrets. EO .E A $500,000 gift has spurred the college's fundraising drive to cover the necessary renovations. By publication, more than one-third of the $2 million goal has been raised. The remainder of the project's $3.4 million cost will be borrowed. 30 percent, reconstruction of granite chimneys, and new exterior woodwork. S Repairs have begun. While staff and faculty continue inside their offices, granite chimneys are being chipped out, slate roof tiles pried off — and earplugs have become more prized even than a Morning Glory muffin. FT HE AT L AN T IC B A R H A R B OR , M WW A I NE CO W. A College of the Atlantic Magazine Food for Thought Surya Karki '16 and the Maya Universe Academy in Nepal Surya Karki is on a mission. He wants the people in his home country of Nepal to have the resources necessary for a full life. Food, yes. But also education. While still a teenager, Surya, now 21, co-founded the Maya Universe Academy, or MUA, with fellow countryman, and former COA student Manjil Rana ('12). MUA is the first free private elementary school in Nepal recognized by the government — a country where nearly 40 percent of children still do not complete primary school, in part because families cannot afford tuition. There are now Maya Academies in three towns. The hands-on, community-centered approach inspired other COA students to get involved. Urs Riggenbach '12 set up an open-source solar- and steamgenerated electricity system for the first campus. He now serves on the Maya board with Joseph Leyden '11. To support the schools and bring more sustenance to the villages, two of the schools have farms attached. Parents are asked to work two days a month on these farms. Forty percent of the profit from food sales — whether it be coffee, fruit, or cardamom — goes to the community; 60 percent to Maya Academy. This summer, Surya returns to Nepal to create a sustainable farm at the most recent school. His expenses will be paid by a $10,000 Kathryn W. Davis Projects for Peace award. Surya's not stopping there. When he met Nobel Prize winner Muhammad Yunus at the Clinton Global Initiative University this spring, Yunos was so impressed with Surya's dreams that he signed on as an advisor and offered Surya an internship. A few weeks later, Surya was in Bremen, College of the Atlantic Magazine Germany at Jacobs University, as a finalist for a business plan for yet another project. Surya attributes his vision and dedication to his mother, a single mom with no education who taught Surya math by lying on a hillside counting the stars. She insisted her children dream big — up to those stars. "She would say, 'If you don't aim, you are lost,'" says Surya who was barefoot when he left his rural farmland for a boarding school in Kathmandu. There are few roads in the Sankhuwasabha district south of Mt. Everest where he was born. "You walk up a hill, then you walk straight along the hills, then you come down the hill, and walk straight some more," he says, describing his walk to the road that would take him to Kathmandu. He doesn't mention that the "hills" he is describing are the height of Mount Katahdin, the "walk" took seven hours, and that Surya was only eight. The bus Surya climbed onto that day was the first he had seen. Shortly thereafter, a bloody civil war broke out in Nepal and it became unsafe for boys to travel; it was nine years before he saw his mother again. Surya left soon after for Venezuela to attend the former Simón Bolívar United World College of Agriculture, receiving an associate degree in agriculture — while mobilizing fellow students to expand the school's industrial agriculture curriculum to classes in sustainable agriculture. When not raising funds, writing grants, creating proposals, or engaging youth at the United Nations, Surya is studying economics, calculus, and international policy at COA. Surya Karki '16, in green, is surrounded by students at Maya Universe Academy. Co-founder Manjil Rana ('12), in a hood, is above him. Photo by Joseph Leyden '11. 7 Nadia Rosenthal Re-Imagining the Body and the Campus By Donna Gold For most of her life, COA trustee Nadia Rosenthal, PhD, has spent her summers on the shores of Sutton Island, watching the tides ebb and flow, wandering moss-covered trails through its woods, noticing the small miracles of nature — among them the regenerative powers of starfish. Those summers nourished a powerful place within her. Now an esteemed international scientist, Nadia led the European Molecular Biology Laboratory Outstation near Rome, Italy, for a dozen years, leaving it only recently to launch an Australian branch outside of Melbourne. She's a busy woman, her journey to the recent COA board meeting included stops in London, Beijing, Shanghai, Singapore, and Perth. But Nadia travels most joyfully to Maine because Mount Desert Island remains her touchstone. And those starfish that cling to the rocks surrounding the island? They are her inspiration. 8 A starfish missing one of its rays can regenerate it. But a human being certainly cannot regrow a finger. Like a true philosopher pushing the boundaries of the possible, for Nadia the mystery isn't that starfish can do so, but that humans can't. "Why did we drop that particular attribute?" she wonders. Why can't a human regenerate an arm — or even a heart? Nadia has devoted much of her life to investigating this question. Her work — as a biomedical researcher at Harvard Medical School (where she received her PhD), later in Italy, and now also as founding scientific director of the Australian Regenerative Medicine Institute at Monash University — focuses on the developmental genetics of heart and skeletal muscle, the molecular biology of aging, and the role of growth factors, stem cells, and the immune system in tissue regeneration. Passionate and practical, a mélange of science and philosophy, Nadia recently told Australian journalist Michael Short, "My early and abiding question has been, 'What is life? What is the reason for having animation in the universe, as opposed to merely inanimate matter such as rocks or water? What was that initial impetus that brought us to the point where we are now, in which some chance collection of molecules found it more convenient, more pleasurable, or had an appetite for getting together and forming a cell, which is our basic building block?'" Clearly, this is a woman who sees beyond what is, asking the creative questions that swiftly move from why to why not as she works with other scientists to expand healthy lives far beyond what we expect of ourselves today. College of the Atlantic Magazine What fascinates Nadia about COA are similar questions. Built into COA's genetic structure is the practice of going beyond the limitations of individual disciplines, combining the arts, humanities, and sciences to create a truly integrated education for students and continual challenges for faculty. JOIN THE BLACK FLY SOCIETY This resonates with Nadia, who is an artist as well as a world-class scientist. In Italy, she collaborated with a pottery studio, painting her interpretations of the heart on ceramic plates. Now, as editor-in-chief of the scientific journal Differentiation, she illustrates the cover of each month's issue. "I've spent my whole life trying to figure out how to merge these two somewhat competing interests," she says, bringing art even into her graduate classes. "A visual approach helps people grasp concepts." There's science behind that, she adds. "If you post an image with something that clearly has been drawn by hand, the eye responds to that differently than to a computerized version." The mark of the hand changes the impact, makes it feel more real; and so it carries greater meaning. "My incentive to pull art and science together derives from an urge to give people a sense of science that feels real to them." As an educator, scientist, and writer, Nadia works to make components come together. Which brings us to the why not question Nadia asks about COA. She'd like COA to regenerate itself. "How can we export the COA model?" she asks, seeing the possibility of even more students enjoying a vibrant, transdisicplinary education in more small, dynamic, hands-on, integrated COA-like campuses around the world. Honoring COA's mascot, The Black Fly Society was established to make donating to COA's annual fund easier and greener. We hope you'll join this swarm of sustaining donors by setting up a monthly online gift! It's the paperless way to give to COA. Go to coa.edu/donatenow and under "gift frequency" select "monthly." If you want to give to the annual fund by mail: COA Annual Fund 105 Eden Street Bar Harbor, ME 04609 Please make your check payable to COA. COA trustee Nadia Rosenthal's inside view of Michelangelo's Adam appeared on the cover of the December 2012 journal Differentiation, published on behalf of the International Society of Differentiation. Questions? Call 207-801-5622. Photograph by Dru Colbert, arts faculty member. WELLNESS It is nearly peony season at COA, a time when the flowers' lush layers begin to open — slowly, petal after petal, one layer a day — until suddenly the gardens are gleaming with dozens of huge, radiant blooms. When I think of the creation of this magazine's current theme of wellness, it is the gradual unfolding of the thick peony petal that comes to mind. For those featured in this issue, each revelation seems to open into a new understanding, another path. Peonies, by the way, are an ancient herbal healer in the East and West, China and the Mediterranean, used to enhance mental function, ease nervous conditions, improve liver function, relieve muscle cramps, lower cholesterol, and much more. The unfolding of this issue began with wondering who our alumni MDs are, discovering that for a school without an official pre-med track, College of the Atlantic has educated quite a few medical doctors. Not surprisingly, many alumni combine the best elements of several areas, bridging practice and research in diverse traditions. Peter Wayne '83 begins as a botanical researcher, then finds himself at the cutting edge of medical science, analyzing the health values of tai chi. Steven King '80 stays the course in botanical research for twenty years, shepherding latex from the Amazon rainforest into the medicine chests of those living with HIV/AIDS. Public health efforts on HIV/AIDS in Africa lead Rachel Snow '81 to the streets of Detroit. Meanwhile, Carmen BedardGautrais '07 and Todd Kitchens '06 are forging separate paths bringing integrative practices into institutional settings. From botany to cancer research, from painting to counseling, our students and alumni are continually exploring, questioning, probing — unfolding the petals of the peony to discover more petals, more ideas; sifting and learning and giving back to the world their magnificent presence. – Donna Gold College of the Atlantic Magazine 11 The Yin and Yang of Peter Wayne '83 Harvard Professor, Medical Researcher, Tai Chi Instructor By Michael Griffith '09 By day, Peter Wayne, PhD, is a clinical researcher, assessing the effect of tai chi, acupuncture, and other therapies on such problematic conditions as chronic heart failure, chronic obstructive pulmonary disease, balance instability, thinning bones, lower back pain, depression, aging, and more. Peter is the overall research director of the Osher Center for Integrative Medicine at Harvard Medical School and Boston's Brigham and Women's Hospital. This work places him at the cutting edge of integrative medical science, combining Western and alternative practices. But when the sun sets, Peter transforms into a tai chi instructor who doesn't always know — or care — how the Eastern art works: it just does. Peter has walked the S-shaped line between yin and yang since he was fifteen. That's when he discovered tai chi, which he calls "a mind-body exercise rooted in multiple Asian traditions ... that aims to strengthen, relax, and integrate the physical body and mind, enhance the natural flow of bodily energy, or qi, and improve health, personal development, and self-defense." An avid Frisbee player as a teenager, Peter turned to tai chi in search, he says, of "something that gave me a little bit more flow and grace," an advantage on the field. But his new practice gave him much more than that. It spoke to his interest in nature (he was reading Thoreau) and sparked a fascination with Eastern healing arts that would shape the course of his life. This March, Peter published the Harvard Medical School Guide 12 to Tai Chi, the result of years-long research, rigorous clinical trials, and a human ecological vision that sees science and spirituality as not only compatible, but complementary. Acrobatic human ecology The child may be father to the man, as William Wordsworth wrote, but what about the young adult? His first year at COA, Peter fell in love with plants, thanks, he says, to "gurus and mentors" Bill Drury and Craig Greene, late faculty members in biology. During an independent study with Bill spent identifying trees on Dorr Mountain, Peter managed to hike Acadia National Park every day of a winter term. It was a turning point. from multiple perspectives, to see the parts as integral components of a whole, and to see the whole as sometimes being more than the sum of the parts. The philosophy of education at COA not only impacted me as a plant ecologist; the core ideas were transferable." They were also in tune with the philosophy and practice of the Eastern arts. Peter never stopped doing tai chi, and began teaching it during his final years at COA. When he moved to "I decided to make a significant career shift, "COA was such a great environment for me," Peter says. "I grew up in Brooklyn, New York, which is as far from Bar Harbor as you can get, energetically and socially; as a scientist studying nature, it was an amazing place for me to be in closer proximity to what I was intuitively drawn to — both in terms of seeing my place in nature and having a fantastic laboratory." bringing my two worlds Courses in ecology with Bill Drury and former President Steve Katona, and environmental philosophy with the late Dan Kane, founding faculty member in law, "shaped a very deep, implicit way of looking at the world — a deep philosophy," which Peter carried through to a Watson fellowship (the first for a COA student) in plant population biology, and then to Harvard, where he earned a PhD in evolutionary biology. "What I really grew to appreciate at COA, and it continues to grow on me," he says, "is this idea of looking at problems medicine, including together and employing my research skills and ecological framework to study the clinical and basic aspects of Chinese tai chi." From Peter Wayne's The Harvard Medical School Guide to Tai Chi Boston in 1985, he founded a school of tai chi. Since then, Peter's "personal balancing act" between science and tai chi, or "acrobatic human ecology," as he calls it with a chuckle, has only become more interesting — College of the Atlantic Magazine and integrated. As he focused on researching climate change and forest biology, Peter's engagement with the Eastern healing arts only grew. Then in 2000, a trip to China for additional training in tai chi and qi gong threw the yin and yang into a new balance. Bridging cultures In his book, Peter writes that following the trip, "I decided to make a significant career shift, bringing my two worlds together and employing my research skills and ecological framework to study the clinical and basic aspects of Chinese medicine, including tai chi." The birch trees and ragweed of his formal education had given the man what he needed to incorporate the interests of the child — science and tai chi, yin and yang — moderated by a powerful vision of interconnectivity. Peter began a research program at the New England School of Acupuncture, established and led a formal collaboration with Harvard Medical School centered on Asian medicine, and in 2006 became a faculty member at Harvard Medical School. But it was at the Osher Center for Integrative Medicine that Peter found his dream job. "Both as a scientist and a tai chi thinker, I love looking for connections and building bridges," he says. And that is what he gets to do now, every single day. Not that it's always easy. By its very nature, Peter's work is about tensions — within the body, yes, but also between the healing traditions. "Medicine today is very bifurcated," he says. "It's very reductionist: divide and conquer. You go to your doctor with a foot problem but he or she COA students Will Fuller '16, Sasha Dunbar '13, and Rachel Drattler '14. College of the Atlantic Magazine Photo by Becca Haydu '16. 13 won't be the same person you see for a back problem, and of course that isn't related to your jaw." Holistic elements have been implicit in the history of conventional medicine, according to Peter, but they've been overshadowed by modern approaches to defining health, treating disease, and training doctors. "Reductionism in modern medicine has led to tremendous successes," Peter writes in his book. But the habit of breaking up the body into "smaller, simpler parts, or into more tractable units," has its disadvantages — especially when one's aim is wellbeing, not just the absence of disease. "Eastern holistic and ecological views of the body, mind, and health now are becoming increasingly appreciated and adopted within the Western medical community," continues Peter, but it is still rare to find an MD who can help you make well-informed decisions about alternative therapies. "Part of why I think doing research is useful is because it's a bridge between different cultures," he adds. "The medical culture, the policy culture — they want to see evidence from sound, rigorous trials" that shows whether alternative therapies work. The sacredness of minimizing bias So Peter walks the S-shaped line, seeking objective ways to describe the center's findings, using randomized trials and objective physiological measurements, "but still capturing this bigger picture, that we think that there's some value added in mindbody types of interventions." Peter stresses that he is not an "advocate researcher," looking for particular outcomes. He is committed to "figuring out what's really happening" within the framework of clinical research. "Maybe there is no impact in a particular population doing a particular type of tai chi," he says. "That's OK. There's sacredness to minimizing bias, and to being objective. Science has a whole set of rituals for achieving that: the way you design your trial, the way you have checks and balances between your colleagues." The emerging field of systems biology, familiar to Peter from his work on the environment, provides useful models for making tai chi's holistic approach to the body intelligible to scientific methodology. "In systems biology we developed quantitative and conceptual tools for characterizing the dynamics of ecosystems; when I came to study tai chi scientifically it was really obvious: 'Wow, here's "What I really grew to appreciate at COA — and it continues to grow on me — is this idea of looking at problems from multiple perspectives, to see the parts as integral components of a whole, and to see the whole as sometimes being more than the sum of the parts." a really unique set of ecosystems in this classroom, or this clinical trial, and we're approaching them with a very complex intervention.' … And so I started designing conceptual frameworks on how to study tai chi from a systems perspective, looking at mechanistic processes and physiological processes, and that's the heart of my work now: working within a systems framework, doing very rigorous clinical trials here at the medical school." At the end of the day, Peter rebalances himself, shedding his scientific objectivity. "When I leave my office, I go home, have a short meal, and go teach for about two and a half hours; I change my clothes, and I change my rules." He says there is a "dynamic balance" between his daytime and evening "rules of order." They influence each other, and both represent parts of the "larger whole" of his persona, but just as Peter is not an advocate for tai chi in the lab, he is not an advocate for medical science at the tai chi center. The human ecology of tai chi Sometimes things that happen in a typical class can't be explained in a lab — at least not yet. "I may go a little bit beyond the edges of science — to things that we just have no idea if they happen, or why they happen," says Peter. In his Guide to Tai Chi, Peter adapted a mandala-like diagram created by the late plant ecologist William Dwight Billings to tai chi. Billings portrays a plant surrounded by "spokes" of sunshine, water, wind, thermal energy, root bacteria, and fungi, enclosed by a circle representing time. The "spokes" move in time, each influencing the other: wind speed affects temperature, temperature affects humidity, and so on. "It's a beautiful picture: the survival, growth, physiology, and evolution of a plant is due to this complex environment," says Peter. Adapting Billings' diagram to tai chi, he continues, "is a literal example of how my training in human ecology translates to many different areas as a conceptual framework." In his approach, the "eight active ingredients" of tai chi — including factors such as awareness, flexibility, breath, and community — directly affect the practitioner, as well as contribute to a complex system in which everything is interdependent. It's the human ecology of tai chi — and increasingly, thanks to researchers like Peter, the human ecology of Western medicine. ***** Michael Griffith '09 lives in London, where he is completing an MA in English at King's College. More of his writing can be found at theantefix.com. 14 College of the Atlantic Magazine Human Ecology on Steroids Three Alumni Doctors of Emergency Care By Donna Gold The way Dr. Douglas Sward '96 describes it, being an emergency room physician is like human ecology on steroids. "You're in this interface between the hospital inpatient system and the rest of the community." Maybe there's a rash of synthetic marijuana use by teenagers, maybe there's been a multiple-car collision, a serious apartment fire. An emergency room doctor has to be able to communicate with everyone involved — parents, fire rescue, patients, families, law enforcement. "You're dynamically interacting with a broad spectrum of humanity, with totally different perspectives and needs, from the most affluent to the homeless — and they are right next to each other. You're dealing with older demented people who can't remember what happened to them, and young people who talk so much, you can't make anything of what they're saying, you're going from someone cursing at you because you're not giving them narcotics to doing CPR on a thirty-year-old — and having to tell his family that he has died. All of this is happening at once. It's human ecology in your face. And it's fascinating, difficult, frustrating — terrible." Nearly half the COA alumni who have become doctors of medicine have chosen to work in emergency care. Curious about whether this interest was an extension of the wilderness medicine training so many students receive, I contacted three alumni MDs to probe the connection. But though the outdoors plays a role in the choice, it's also about the schedule — an ER doctor is seldom on call, allowing the doctor time for family, for hikes, for maple sugaring — for life. But the common fascination for all three doctors actually lies elsewhere. It's the problem solving. Above, Dr. Matthew Daul '98 pauses for a moment at the end of a shift at St. Joseph Hospital in Bangor, Maine, where he serves on the staff of the emergency department. College of the Atlantic Magazine 15 Biology 101: What is a cell? Matthew Daul '98, MD 1 2 7 8 3 4 5 6 9 10 ANIMAL CELL 1. The cell membrane is a thin semi-permeable membrane that surrounds the cell fluid (cytoplasm), thus enclosing its contents. 2. The nucleus stores genetic material in the form of DNA (see page 39), and is surrounded by the nuclear membrane. Inside the nucleus is a nucleolus. Here ribosomes are made. 3. Ribosomes are responsible for assembling the proteins of the cell. They consist of RNA and proteins. 4. Mitochondria are the cell's power plants; they convert energy into forms that are usable by the cell. 5. Lysosomes hold enzymes used to digest food or break down the cell when it dies. 6. The centrosome is the production center for microtubules — fibrous, hollow rods that help to support and shape a cell, and are also involved in movement within a cell, especially during cell division. Endoplasmic reticulum, or ER, is a series of interconnected membranebounded sacs within the cell fluid. There are two kinds: 7. Smooth endoplasmic reticulum (SER) contains enzymes important for synthesizing and metabolizing fats. 8. Rough endoplasmic reticulum (RER) is covered in ribosomes that synthesize proteins; the RER can transport these proteins throughout the body. 9. The Golgi apparatus is the shipping department for the cell's chemical products. It modifies proteins and lipids, or fats, that have been built in the ER and prepares them for export outside of the cell or for transport to other locations within the cell. 10. Vacuoles are storage bubbles found in cells that might store food or any variety of nutrients a cell might need to survive. In addition, they store waste products so the rest of the cell is protected from contamination. Dr. Matthew Daul emerges from the Emergency Department of St. Joseph Hospital in Bangor, Maine, wearing navy scrubs, a serious expression, and a manner that is just what you want from a doctor. He's fully present, almost intense, and yet quite soft spoken. Medicine, for Matt, is career number three. The son of a carpenter, at COA he interned as an apprentice to a San Francisco furniture maker, and continued to focus on furniture and design for his senior project. After he graduated, he realized that being a self-employed craftsman was not the life he wanted. So he and his soonto-be wife Kara Fanning '96 climbed into his red Cabriolet convertible and headed to Brooklyn, New York. They arrived in August; by September they both had teaching jobs. At the time, you didn't need a teaching certificate to start teaching in a New York City public school, he says. After a summer backpacking through Italy, they discovered they had enough experience to get a job in an international school, so they remained in Europe, teaching in Milan for several years. The work returned Matt to his high school fascination with science and math — and to a craving for a different challenge. That's when medicine came up. With no savings, two children and one soon to come, they decided to risk it all. If Matt could get into a good postbaccalaureate program for the necessary pre-med courses, they'd move back to the States and take the plunge of additional schooling and some debt-ridden years. Matt first went to Bryn Mawr, then the University of Rochester Medical School in upstate New York. With the position at St. Joe's, they've come full circle, returning to live at what has become a family compound on Mandala Farm in Gouldsboro, Maine, along with Matt's father, his stepbrother Genio Bertin '97, and Genio's wife, Sara Faull '98. For Matt, emergency medicine is about discovery, problem solving, decision making. "I get to be Johnnyon-the-Spot and that is satisfying. I like making decisions when there's a crisis. It's action-oriented." Each day is new. Even though Matt did not seek out pre-med courses at COA, he finds human ecology to be a fitting gateway to the hospital's many personalities and complicated structures — with the microcosm of each individual human body at the center of the scene. "Having an education from COA, and coming at this from a career change, makes me better suited to empathize with some of those who come in," he says. Ann Clemens '96, MD "Every patient that comes in here has a story and a background and a connectedness that reaches far beyond the exam room," says Dr. Ann Clemens '96. "Their story plays a key role in their health, their social situation, their ability to maintain health, follow our recommendations, and their ability to get better — it's the human ecology of medicine; there's always a connectedness to consider in treating a patient." Ann is an urgent care physician working in a clinic in Bend, Oregon, and sometimes also on the ski slopes of nearby Mt. Bachelor. Her clinic handles the less acute issues for which people often go to the emergency room — flus, rashes, broken limbs, even chest pains. There are no appointments; there's no continuity of care. It's a model that many believe will expand as the new health care reform laws encourage more medical visits because while more patients will have insurance, there aren't enough primary care providers to handle them — at least not currently. College of the Atlantic Magazine The daughter and granddaughter of doctors, Ann originally shunned medicine, then became intrigued by international health. For her internship, she served as a medical assistant at Shirati Hospital in Shirati, Tanzania, basing her senior project on the experience. But after receiving a medical degree from Philadelphia's Jefferson Medical College, and completing her residency in family medicine, "life happened," she says. With two daughters, urgent care allows her a stable schedule and the intellectual challenge she loves. As for international medicine, that's for the future, when her daughters are older. Medicine in Bel Air, and the other half as a clinical assistant professor in the Department of Hyperbaric Medicine at the University of Maryland Medical Center Shock's Trauma Center. Shifts on Mt. Bachelor connect Ann to wilderness care — and the wilderness. She takes her Nordic skis to work and heads into the snow before donning scrubs to work onsite with the ski patrol, swiftly triaging patients, airlifting those with serious trauma by Life Flight for more intensive care. Though she misses having relationships with her patients, she says, "I really like the medical part of what I do. We are the first person that a lot of people will go to, so there is a good deal of problem solving. Urgent care work is a good pace, and an intellectual challenge, figuring out what the problem is." There's also an element of outdoor experience in Doug's interest in hyperbaric medicine, as SCUBA divers experience this form of pressure. But the specialty, which handles what happens to gasses, especially oxygen, under pressure, is most involved in carbon monoxide poisonings — whether from faulty appliances, attempted suicides, or other issues. The flip side of the field is that pressurizing gasses within the body can be useful in complications from radiation and diabetes. And it can be a mechanism for handling the rash of MRSA, or methicillin-resistant staphylococcus aureus infections, that recently have invaded hospitals. The kind of questioning encouraged at COA has helped Ann throughout her medical career, she says. Asking questions "is a critical piece in medicine. The obvious could be just the obvious, but frequently it's more than that and we have to keep looking for answers." Douglas Sward '96, MD Training in wilderness medicine and work in Acadia National Park as a wilderness first responder convinced Dr. Doug Sward '96 to pursue medicine. Now he spends half his time as an attending physician at the Upper Chesapeake Medical Center Department of Emergency Having recently completed a fellowship in wilderness medicine, Doug is also medical advisor for Maryland Search and Rescue and faculty advisor for the University of Maryland Wilderness Medicine Student Interest Group. His training, following his 2004 graduation from the Medical College of Virginia, was a residency in emergency medicine at the UM Medical Center. Doug was the last of the three COA doctors I interviewed, allowing me the courage to ask one final question: Can you just leave everything at the hospital, or do you worry? In other words, What's your drive home like? Doug laughs, a bit ruefully. You can't just leave it all at work. "I worry about what I did, or didn't do, what I missed or did wrong. A lot of issues you can leave behind, but there's usually one case each shift that torments you on your drive home." 17 Bloodlines and Bodywork Carmen Bedard-Gautrais '07, Traditional Chinese Medical Practitioner By Sarah Haughn '08 "She came to me for relief from sciatic pain," explains Carmen BedardGautrais, practitioner of traditional Chinese medicine. The pain, which worsened after menopause, was now so severe the woman was struggling to walk properly, to sleep. But Carmen — whose work relies profoundly on narratives of pain as well pain's physiological presentation — wanted to dig deeper. From where was the pain coming? Why? Exploring the history of the woman's sciatic pain, Carmen learned she had been diagnosed with hemochromatosis — an excess of iron in the blood — and, per one of the last surviving examples of bleeding in allopathic 18 medicine, was having a liter of blood removed every month. So Carmen began thinking inversely — of blood deficiency and how it manifested. Blood. What else in the woman's life was connected to blood, to traumas of blood? Menopause, the point after which the woman's sciatic pain had manifested. Menses. Childbirth. The woman had experienced multiple serious miscarriages during which she lost tremendous amounts of blood. Now her daughter was pregnant. As her daughter's pregnancy progressed, the woman's own pain worsened. Carmen wondered whether her anxiety for her daughter caused her to relive the stress of her own loss — both blood and baby — expressing itself in sciatic pain. Carmen began treatment — helping the woman dig through the emotions of her miscarriages as well as treating her blood — balancing long-term healing with short-term relief. She used methods such as acupuncture and cupping (a traditional therapy involving localized suction), and also administered internal formulas. According to Carmen, the woman's spleen system was not nourishing her muscles, leading to stagnation. In traditional Chinese medicine College of the Atlantic Magazine the spleen system also includes the pancreas, with the capacity to digest, then transform the food into transportable nutrients which are delivered to organs and muscles. Imagine a river, she explains, with little water left in it: things don't move through it very well. But as they worked together to process her emotions and nourish her blood, the woman no longer had to have blood removed — her iron levels evened out. After several months she was able to mourn the loss of her miscarriages and celebrate her daughter's impending birth of a healthy baby. The neurologist she had been seeing for herniations in her lumbar spine was shocked to see that her condition had not degenerated as he had expected. "She was one of my first long-term patients," says Carmen, "Everything is theoretical until we see it in practice. … It was a really big learning experience for me to see a very physical pain that we could describe in Western medicine as disc herniation and sciatic pain, where the nerve is being irritated and it's radiating down the leg and that's what it is, period; versus yes, that's presenting, but there are a huge amount of emotional factors under it: life experiences, nutrition experiences, many other factors triggering this pain to worsen at that particular time. You learn to see the body as a constant communicator. It's very exciting." Diagnosis via color, texture, sound, smell, feel Carmen came to TCM, or traditional Chinese medicine, circuitously and somewhat serendipitously. While at College of the Atlantic, she worked with Gray Cox, faculty member in political economics, to compare various approaches to healing. Her senior project was based on work she had done on traditions of healing in Kenya. After COA, Carmen intended to study naturopathic medicine, but upon matriculating into a program felt a disappointing lack of connection. While struggling to understand where she belonged in the world of healing, she visited College of the Atlantic Magazine Above from top: Ju hua, a flower used as an eye bath, or as a decoction for cold/flu symptoms, hypertension, and eye pathologies such as conjunctivitis. Huang qin, a root used as a broad spectrum antibacterial anti-inflammatory herb, especially for upper respiratory tract infections. Shi chang pu, a root used as a sedative, also against seizures and epilepsy. Shan zha, a fruit, used as an antibacterial, antihyperlipidemic, cardiotonic, and immunostimulant, as well as in cooking. 19 Pacific Rim College in Victoria, Canada, where complementary and integrative medicine is taught, and felt immediately at home. She committed to five years of rigorous study and travel to China to obtain a doctorate in TCM, completing her degree in April, 2012. "We use many tools for diagnosis: subjective intake with a specific series of sixteen classical questions as well as observation — from color to texture to body position, similar to Western medicine," she explains. Also "sound, smell, palpation; we look at the tongue. This in-depth intake allows us to diagnose a pattern. Headaches for one person can be due to a very different physiological pattern than someone else with a headache, and appropriately we would treat it quite differently. This is where human ecology comes in. We observe not only the patterns within the individual but also how this fits with the environment in which the individual lives, emotions, lifestyle, seasons, life cycles, spiritual state, diet, etc. Then our treatment modalities can vary accordingly, from nutrition to massage, from acupuncture to complex herbal remedies and formulas. It's lots of fun, very in-depth. I think a lifetime isn't enough to master the subtleties." What resonates with Carmen about traditional Chinese medicine lies in the foundational differences between it and conventional Western medicine: how we define health. "When we're looking at the definition of health and well-being, often in Western medicine it's an absence of disease, perhaps an absence of symptoms at least — most of those being physical. And if they are emotional it gets tricky because then even in depression it's looking at depression as a disease in and of itself, so each aspect is very isolated. Health as harmony "In traditional Chinese medicine the definition of health is broad; it comes down to the purpose of life, almost. You're looking at aspects of being in harmony with your environment, your relationship not only with yourself but with those around you, and following the patterns. It's looking You learn to see the body as a constant communicator. I think a lifetime isn't enough to master the subtleties. at the patterns that exist in nature, that exist within ourselves." Western culture's individualistic focus, she continues, "pervades our definition and approach to health. However, as we learn in human ecology, we are only a piece of a vast puzzle. Not only are we individually affected by many aspects of our surroundings, we in turn influence our environment." And this intricate exchange is fundamental to TCM practice. "So when we see disease we see a presentation of symptoms that are demonstrating a larger pattern at work. If someone comes in with pain, it may be that they have experienced a physical trauma. But with chronic pain you often see a greater pattern connected to past events, emotional factors, nutritional factors, cultural factors, and activities of daily living. Equally as important as their internal environment is their external environment — is the pain worse in a particular season, climate, or temperature? What we consider reaches far beyond merely focusing on the presenting symptom. We appreciate the interconnection of all aspects, similar to a human ecology approach." During Carmen's doctoral training at Pacific Rim College, she studied at a teaching hospital in Shenyang, Liaoning Province, China. "It was my version of Disneyland," she says, describing a pharmacy so massive it occupies an entire floor of the building with drawers reaching the ceiling. The seven-story hospital houses both outpatient and inpatient services, and blends traditional Chinese treatments with approaches from Western medicine — taking the best from both, depending on each patient's unique history and symptoms. Carmen is currently pursuing a master's degree in physical therapy at the University of British Columbia in Vancouver, where she lives with Ian Illuminato '06. Inspired by her study in Shenyang, she hopes to carry her TCM expertise into hospitals, working within Canada's public health system. Her desire is to offer a form of healing informed as much by life stories as by symptoms to those who otherwise couldn't access it. Ultimately, she seeks to redefine what health is and how we speak about our bodies even within the mainstream medical community. ***** Sarah lives in and writes from Davis, California, where she is enjoying the arrival of baby Malcolm Afaayo Nambale. She looks forward to beginning a master's in creative writing (poetry) at UC Davis in September. 20 College of the Atlantic Magazine An Integrative Life: One Doctor's Journey Christopher Todd Kitchens '06, DO By Marni Berger '09 It is 2001 and Christopher Todd Kitchens is hiking the Beehive Mountain in Acadia National Park with friends when, with an odd specificity, one friend tells him he would make an excellent osteopath. Todd's professional career up until now has consisted of art and animation, and so the suggestion seems offhand, but he considers the new occupation for the first time along the steep trail. By the time the friends make it back down, the idea has solidified with uncanny speed into a decision. He will become a doctor. The dozen-year journey It is February 2013. Over the phone, Todd and I discuss this decision of twelve years ago. I have asked a slew of questions that shed light on those years, questions about osteopathy, about integrative medicine, about being an artist, about his professional journey. (I do my best to avoid soliciting free medical advice after a two-week bout with the flu.) In particular: What made you want to be a doctor? Todd tells me about the mountain, about his friend's suggestion, and adds, without hesitation, that after deciding to pursue his passion to help people by studying medicine, "I have not for a second looked back." Now an osteopath with three young daughters and a degree from the University of New England, Todd is months away from finishing his residency in family medicine at Lewiston's Central Maine Medical Center. He focuses on primary care, College of the Atlantic Magazine using alternative methods, such as yoga treatment. He also employs therapeutic lifestyle interventions and osteopathic manipulative medicine. The credo behind osteopathy not only asserts that the structure and function of the body are reciprocally intertwined, but also that the body is capable of selfregulation, self-healing, and health maintenance. Todd emphasizes the link between osteopathy and human ecology — both defined by how humans connect to each other, themselves, and the environment. He says at College of the Atlantic he was able to customize a pre-med track, making his undergraduate studies something of a human ecological approach to medicine. Osteopathy Osteopathy is a branch of medicine once considered alternative. In the late nineteenth century, Andrew Taylor Still, MD, followed his impulse that there must be something more to medicine when his three children died of meningitis. He dedicated some thirty years of his life to better understanding the human body. But despite his medical degree, he was met with dissent from the mainstream medical community that, with its strict sense of tradition, considered his new perspective a threat. Todd points out that it is different today. Now osteopathic doctors undergo training identical to that of allopathic doctors with the exception that osteopaths are required to complete additional hours of osteopathic manipulative training. Although modern DOs often drop the hands-on approach pioneered by Dr. Still, Todd embraces it with his focus on integrative medicine, which he describes as "a combination of the best evidenced-based medicine, 21 both complementary and alternative to traditional Western medicine." Putting theory to practice, Todd advocates treating the individual and the body as a whole, rather than symptom by symptom. The idea is to get to the root of the problem. He says, "When somebody comes to see me and tells me, 'I have reflux and I have this back pain,' I don't separate the two. I ask myself: Are these related? Is it mapping in the way I would expect it to map on their body?" Everything is connected Todd's treatment process can be likened to long- and short-term conflict resolution. "I've had several patients who came to me with a visceral complaint — gall bladder pain or back pain," he says. "So of course I rule out the big bad things: are they having a heart attack? Then we talk about their diet." For shortterm needs, he is not afraid to use medication or other mainstream approaches; he emphasizes that by seeing every patient as an individual, he is modeling the expansion he'd like to see throughout health-care networks: that everyone would have access to customized care, short-term as well as preventative. "Everything is connected," Todd tells me. I wonder what he means, specifically, and before I ask, he elaborates: "Medicine is really just an extension of how I approach life." Todd grew up in Florida and lived in Atlanta for twelve years, where he met his wife, Honnie Goode — who earned her MPhil at COA in 2006 and is now finishing her second master's degree, in mental health counseling (see page 23). After a stint in New York, the two moved to Maine in 2001. Until then, Todd's professional training was primarily in multimedia design, web animation, music, and video. He played and produced electronica sounds in the studio and for his bands — most notably the band Fascia that he formed with Honnie in 1997 — while he and Honnie also created site-specific installation work. 22 "I am probably the last person my family thought would do anything like this … become a doctor," he admits. "I'm the first person to graduate from college in my family." In reflecting on his path through an integrative lens, he understands that all aspects of life and self are connected. Find it, fix it, leave it alone Todd recalls always wanting to help people. In 1998, three years before his hike up Beehive, he created an installation that involved a pair of metal beds ten inches off the floor and a projection screen lowered to wheelchair height for an exhibition held at the Dalton Art Gallery of Georgia's Agnes Scott College. "People would approach the screen," Todd says, "but the space would force them to lie down on these beds, and the projection was from above. [On the screen] there was a swimmer swimming in these rhythmic movements, with music we had produced that was very atmospheric." After the show, a viewer who had lain on the bed for a half an hour approached Todd and said, "I just want to let you know, this is the most relaxed I've felt in years." It turned out she had lupus. on it. Todd began his work, as he would on any patient. Three days later, the woman returned, elated. Not only was she not in pain, but she could arch backwards. The pain that Todd believed was acute turned out to have been chronic — the woman revealed that this was the first time she had not felt back pain in over a year. "She seemed like a different person," Todd says, "a happier person. It's in those moments I know I'm doing the right thing." As part of the pilot program at Central Maine Medical Center offering integrative medicine, Todd works with practitioners in the community. In regard to osteopathy and integrative medicine in general, he says, "I personally feel it's where medicine is headed." Todd remains hopeful that integrative medicine — and by extension greater access to customized healthcare — could become a focus in the United States medical system, rather than the current symptom-based care. "I feel," he says, "like I am in the perfect situation to assist in that transition." ***** "I don't see what I am doing now as that much different than what I was doing then," says Todd. "In fact, I see it more as a direct extension of what I was doing, even though medicine was the furthest thing from my mind at that point." Today, Todd finds himself emphasizing this popular adage of osteopathy: "Find it, fix it, leave it alone." Let the body heal itself. "Finding health should be the object of the doctor," he paraphrases the words of Dr. Still. "Anyone can find disease." "I try to approach every treatment with these concepts in mind," Todd says. He describes an encounter with a recent patient, a medical assistant who asked Todd to work on her upper back. She said she had "slept wrong" After graduating from COA, Marni Berger '09 received an MFA in writing from Columbia University. Her essays, short stories, and author interviews can be found online at The Millions, Fringe Magazine, Litro, and The Days of Yore. Her short stories have been finalists in three Glimmer Train fiction competitions, as well as a New Millennium Writings short story contest. Her poetry is forthcoming this year at Crescendo City. Currently, Marni teaches writing at Manhattanville College and lives with her fiancé in New York City by Central Park; most days you will see them in the park failing heavily at keeping their two adolescent dogs from swarms of self-assured squirrels. College of the Atlantic Magazine Kara, combined process on wood, 66" x 84", 2003. Photo by Mike Jensen. Honnie Goode, MPhil '06 A tactile, intuitive, spiraling, and yes, rational journey College of the Atlantic Magazine 23 Horizon, combined process on wood, 48" x 36", 2005. Photo by Mike Jensen. Life's journeys are often not linear, but circular, or even spiraling; we change and grow, acquiring new skills, but retaining our essential core. By the time this magazine is published, Honnie Goode, artist, COA MPhil, and mother of three young daughters, will be well on her way to becoming a licensed clinical professional counselor, or LCPC, another passage on a journey that remains integral to her creative center. "Creativity is the core of me; it informs everything else," says Honnie. She came to COA in 2004 as a graduate student, seeking to find deeper connections between the painting that had been her livelihood and the world around her. "COA helped me to learn to see the world in a bigger way," she says. Now, working with clients, she mingles a creative approach with an ecological perspective honed at COA. In therapy, she says, "I take a strength-based approach." Frequently, practitioners see the disease, not the person. This one's the cancer patient. That one is the bulimic. The relationship begins on a negative. Honnie looks for her clients' health, drawing upon environmental, feminist, creative, cultural theories. A woman comes in. She's not "a depressed homemaker," for instance, but a Catholic woman of sixty whose husband has just left her for a man. 24 College of the Atlantic Magazine Circles Series #9, combined process on wood, 40" x 30", 2009. Photo by Honnie Goode. When making art, Honnie focuses on the creative kernel. Her artist's statement offers this declaration: "By combining the emotional with the rational, I aspire to achieve a balance within myself." She begins by pouring paint onto wood, then embedding objects — glass beads, bits of metal, paper, fabric. Eventually she returns to the piece with oils and varnishes. "I rarely use brushes," she says. "I like to literally push paint." She'll pick up an electric sander, heated metal, even a blowtorch to make her marks, moving constantly. "I'm interested in representing layers: the body, the land, space, and time." Human ecology enters Honnie's thoughts frequently. "COA put words to the way I was thinking. It helped to shape my world view in such a way that I can be a really good problem solver. It primed my brain to think quickly in very different ways — you can't put a price on that." Ultimately, Honnie's journey will include collaborating with her husband, Todd Kitchens '06, DO (see page 21). And she'll continue her art-making, applying her intuition to the techniques she has acquired over the years. – Donna Gold College of the Atlantic Magazine 25 Re(de)fining Global Health Rachel Snow '81 on HIV/AIDS and the Ironies of Social Equity By Sarah Haughn '08 Among crises in public health, HIV/ AIDS is as serious as it is persistent. As such, it has garnered much attention and funding. But what if the solution to this crisis is not, in fact, public health? So suggests Rachel Snow, PhD, associate professor in the Department of Health Behavior and Health Education at the School of Public Health, and a research associate at the Population Studies Center of the University of Michigan. Following her doctorate in population studies from Harvard School of Public Health, Rachel conducted clinical trials of contraceptives with the World Health Organization. Then HIV/AIDS emerged and resources immediately shifted. Rachel was called to Nepal, then South Africa. It was there that she realized that public health was just a part of the crisis. Three-quarters of those suffering from HIV/AIDS live in Africa, where women remain among the most severely affected. In Uganda and South Africa, where Rachel works, the greatest urgency has been to provide life-saving therapy, and to prevent mothers from transferring the disease to their newborns. But HIV/AIDS constitutes only part of the crisis for infected women. They tend to be poorly educated, have limited access to household wealth, reside in female-headed households, have at least one HIV-infected infant, and experience higher rates of divorce, separation, and widowhood. While pharmaceutical treatments are available, says Rachel, "we are left with what has been neglected — the problems of human behavior, poverty, and inequality: women and children still trading sex for food." And so, she 26 says, "we are up against an absolute failure in preventing new infections, despite public health interventions." "I believe in public health; it's my life's work," Rachel continues. "But the reality is that what probably matters more are livelihoods and education. Healthcare is an important third, the other two its antecedents." Rachel sees the crucial need for a shift in the focus of public health — not only incorporating a more holistic understanding of the epidemic, but also addressing its third-world designation in academia. "Students tell me they want to do global health in Ethiopia. That's not global health; that's Ethiopian health. Global health should be something thematic, something that is a problem in multiple places. Its study should illuminate truths toward solutions that can be broadly applied." Rachel's current work brings her knowledge of the epidemic in Africa to bear on the HIV/AIDS crisis in Detroit. Awarded funding from the Ford Foundation, Rachel and a team of anthropologists, public health experts, and community development workers have established Detroit Youth Passages. This project researches the impacts of deindustrialization, addressing the HIV/AIDS epidemic among residentially unstable, ethnic minority youth involved in sexual commerce — a population with one of the highest infection rates in Michigan. In Africa, Rachel works at the administrative level with hospitals and clinics; in Detroit she also spends time on the streets. It is incredible, she notes, how similar to one another poor urban crises look, regardless of the continent. "Detroit. Uganda. South Africa. The HIV risks are similar because they reflect inequality, under-employment, and sex as currency. In poor cities of America, the parallel economy of drugs and sexual commerce can be devastating, and the human vulnerability in neighborhoods of New York, DC, and Detroit are as bad as the barrios of Latin America, as bad as the worst slums in Africa. "I wanted a degree in human ecology because it was a statement about values, and in the human and social environment those values are social equity, fairness, and vulnerability," Rachel adds. She hopes COA students and faculty take as much interest in the health of Maine communities as those in Africa and Latin America. "Maine is not untouched. Kids grow up in these small, rural communities and get side-tracked into drugs and alcohol. They have ambition, but they're attending weak public schools. A parent may be addicted to meth or pills, and life's choices get awfully narrow. Those with access to wealth and privilege can surely do more to broaden opportunity," she says. "In these neighborhoods and towns where there are problems with drugs and incarceration there's also all kinds of creative potential." It is this richness, this potential that Rachel wants to see the college community recognize, embrace, and nurture. The whales, yes. The climate, certainly! But the people, too — not only those requiring a plane ticket and a visa to visit, but also the communities nearby whose struggles surround us daily. To read about Rachel's work, visit detroityouthpassages.org. College of the Atlantic Magazine "Detroit. Uganda. South Africa." " The HIV risks are similar because they reflect inequality, under-employment, and sex as currency," Rachel Snow '81 said to COA writer Sarah Haughn '08. But what does that mean? What does Rachel find on the streets of Detroit? In reply, she sent some of her raw notes interviewing sex workers in Detroit. Here is the briefest of reports, one encounter out of many over several weeks of interviews. Monday, August 20, 2012 "We pull into a dark shaded area beside a park. AR, receiving anal sex three to four times a night, as he who is organizing the session, leans into my window needs the money. It's never planned, it's not a job, his and speaks softly. 'Just wait here, it's best that you stay time horizon is very short, it's about food and bills. He in your car.' Then he steps under the trees, and young describes stress levels through the roof, constant fear. men gather around him quickly. He brings a young man He's homeless, just staying with friends. He cries at one to me, letting him into the passenger side, introducing point, and rests for a while. When we finish the interview us. The man is cautious, shy, in his early twenties. I realize the men have started lining up under the trees, Desperately poor. The encounter is heartbreaking; as hoping for a chance to earn the $20 for an interview." he settles in and starts to feel safe, he tells me he's Above: Maternity ward, Mbarara National Referral Hospital, Uganda. Photo courtesy of Rachel Snow. May 6, 2011 A neurosurgeon is marking my skull with a Sharpie to make a little window to my brain, to my brain tumor. My wife, Ava Moskin '95, sits beside me on my bed at Maine Medical Center. Our son's at school. Just a couple of days ago we appeared to be a normal family, but I knew I was ill. My right foot was numb. I lost peripheral vision in my right eye; I walked into walls. My head was in a fog. Then, early yesterday morning, I woke to a surge of nausea and promptly threw up. My head was pounding. I dismissed it, but Ava, who is also a doctor, sent me away in a taxi and stayed at home with our sleeping boy. The ER didn't know what to do, except dull the pain. Ava lobbied the department chief, by phone, for a CT scan. While I rested inside the machine I couldn't help thinking that I wanted an answer to this mystery, that I wanted them to find something. And they did find something. And I was relieved. And I hated myself for it. When the neurosurgeon saw the scans, he judged the tumor inoperable. A cheery social worker entered my room. An MRI produced a clearer and more fortunate picture. The surgeon changed his mind: he would operate. The social worker disappeared. ≈ I'm alive. I'm in a noisy room, but the curtains are drawn around my bed. I'm alive. But what's left of me? I've got an arc of metal staples in my scalp and an 28 IV in each wrist. My throat is sore from intubation. I search myself desperately for a sign of enduring intelligence. It seems a man in a nearby bed is having his bladder drained, because "urinary retention" is the phrase I clutch like a life preserver. I lose it. I find it again. May 7, 2011 I'm discharged, going home. But home is not the same. I strike my head on the door frame as I climb out of the car, then stagger up the walk. I want to go to bed, but I can't find the stairs. They were on my right, and I didn't see them. I dream of a snake. But it is lifeless, charred black. The day is punctuated by pills: steroids, anti-seizure, stool softeners, sleep aids. Ava tells me I'll need chemotherapy and radiation treatments. I have a grade IV malignant gliosarcoma. Am I not rid of this cancer yet? The surgeon said, of the tumor, that he removed "all of it," but some cancer cells would inevitably remain, would inevitably grow, would inevitably kill. It seemed my life expectancy was halved and doubled and halved again each day. "All of it." Those words had been my prize but they had not been earned. June 8, 2011 Tomorrow I begin radiation therapy. My head will be pinned to a padded table by a form-fitting plastic mask. A fabulously expensive machine will focus an intense beam of energy on my tumor cavity with the goal of shredding the DNA of remaining tumor cells, sterilizing them. It will also kill some normal brain cells. It could cause a genetic mutation and a new tumor. There's a 10 percent chance of "cognitive impairment." And it's not expected to cure me, only to extend my life by some weeks or months; some fabulously expensive weeks or months. June 17, 2011 "You are washed in healing light." I repeat this to myself, over and over as the Varian Clinac iX 2100 linear accelerator lights my brain with the power of a thousand X-rays. The technicians have fled and secured a radiation-shielded door behind them. I imagine myself in the shower, rinsing my hair. Think positive, right? It is uncertain how this will play out on a molecular level. The machine makes a faint whirring noise. I feel nothing. I come for radiation treatments five times a week, and take chemotherapy pills at home. I've escaped bad headaches and nausea, for now. The faucet-shaped photon blaster rotates over my head. I see its aperture set in the shape of my tumor, and I see my reflection in the glass, turning as if I'm on a skewer. August 3, 2011 Three months after brain surgery, and two weeks after completing radiation treatments, I feel strong and capable. I'm visiting my old friends at the old lake house. They're taking a day off to rest, grill some burgers, and drink some beer. But "a day off" means College of the Atlantic Magazine My Brain Cancer Diary living with gliosarcoma By Bogart Salzberg '96 nothing to me. While I sit idly by, the government deposits money into my bank account. I could say I retired early, while I still have time to enjoy it. Technically I'm "disabled" and today I'm not enjoying it. I'm sitting in the warm sun on a sandy beach, but I'm restless. I yearn to be alone in silence. I walk into the water and swim away. Miles away. I'm desperate to deplete myself. I wonder how far I can go before I can't come back. I return sore and tired, cold and hungry; changed. I want only to be in or on the water. I buy a wetsuit, fins, snorkel, and mask. Then a kayak. Then a sailboard. I want to wear myself out, to be dragged down into sleep I've earned. 2012 Winter doesn't start well. An increased dosage of chemotherapy cripples me with nausea. It feels like someone has pulled my stomach out through my mouth. I'm out of tune, hot and cold, dull and disinterested. I want to die. I fantasize about drowning. I want to drown. But I won't do it. It would hurt people I care about. ≈ Spring limps home. I ought to see summer, perhaps my last. My prognosis, a median life expectancy for my disease, expires in August. It may be my last chance to do something important. I should submit to charitable deeds, but I want an College of the Atlantic Magazine adventure. I want hardship and perseverance and triumph. I so often see the span of Casco Bay from the hill where I live: a dozen miles of open water. That's the way I want to go: far, far away, over the horizon. It is with this in mind that I conceive my adventure: a journey, by water, from Portland to Bar Harbor. I choose to sail, instead of kayak; it seems wise to harness the wind. I choose to sail my sailboard because it's the only sailboat I have. But it isn't even a boat, really. I make a paddle (my engine), collect safety gear, and stock up on sports drinks and protein bars. Through the height of summer I "train" for my trip. I have the Coast Guard looking for me a couple of times, am almost run over (twice), endure a thunderstorm, lose my sail (temporarily), and almost spend the night on an uninhabited island. Some people are worried about me. What's the worst that could happen? I'll die? August 12, 2012 If I somehow deserve terminal cancer, then this is what it bought me: seven days of exploits I'll remember in my hospice bed. I launch in the pouring rain. The wind is light, but I'm optimistic and excited. I drift with the tide, behind schedule from the very start; I never catch up. There's not enough wind and I'm caught in the currents. There's too much wind and I can't sheet the sail. There are moments of wonder: settling a tiny unnamed island; bright stars crowding the sky above a dying fire; the electric seams of sunlight on the water. After four days of struggle, my body is broken. My skin is burned, grimy, caked with salt. My fingertips are nearly worn through from gripping the boom. I text Ava: "Meet me in South Bristol." I've covered only a third of the planned route. I crawl into bed around midnight, delirious with fatigue, too tired to regret my failure, knowing I'll try again. September 6, 2012 This time I opt for kayaking. I depart from Pemaquid Harbor, mid-afternoon. Miles ahead, Pemaquid Point appears to spray gaily. But up close, six-foot swells break on the shoals with a terrible power. I keep a wide margin, then turn east to Port Clyde. September 7, 2012 The NOAA weather radio calls for winds and seas to build tomorrow and worsen after that. I'm desperate to reach Stonington. I'll paddle in the dark if need be. But Penobscot Bay is fogged in. Horns at Owl's Head and Rockland are blaring, and VHF channel 16 is chattering non-stop. It's a nervous but uneventful two-hour crossing to the Fox Islands Thorofare, navigating by compass. By the time I emerge on the eastern side, the sun's going down. But the end is dead ahead four miles, Mark Island light and the way to Stonington; the rest of Deer Isle on the left; and the 29 profile of Isle au Haut off to the right, ribbed with wild hills. I swallow a pain-killer: not ibuprofen but Vicodin. I still have a few pills left over from my surgery. I could use some relief from the pain in my arms and upper back. I see myself paddling through the night, stubbornly enduring, spurred to beat the weather. And I can see the headline: "Drugged Kayaker Drowns on Night Crossing." I know I'm setting a bad example, but I press on with my reckless shadow, into the gloom. As I paddle I notice a strange faint light on the edge of my wake as it spreads from the bow. There is no moon, nor any light nearby. Then I see, in the wake of each paddle stroke, a swirling orb of green light. Bioluminescence! Never before had I witnessed the glow of these tiny single-celled creatures. September 8, 2012 Jericho Bay is calm and I make good time to Casco Passage. I text my wife the good news and make plans to meet in Bar Harbor later. She'll be there in time if she leaves soon from Portland. We could meet at Indian Point instead, she suggests. It's closer, more protected and technically within the municipality of Bar Harbor. I see her point: declare victory and go home. I'd rather stick with the plan. "It's personal," I reply. I ask myself, "Why is it personal?" I don't answer. Do I wish to confront my fear of death? Or do I wish to die? Am I racing for the finish, or away from my fate? Might I endure this disease, this day, by sheer force of will? Or shall I die choking, cursing, kicking, drowning … on my own terms? I take a Vicodin. Am I really very sore? Will I be any faster or more successful within an opiate cloud? Perhaps it silences my better judgment, naming it weakness and worry. High winds and seas today, worse tomorrow, says the weather radio, as it did yesterday. I hear it but I'm not sure I'm listening. My mind is made up. I'm stationed on a run-down ramp on the far side of the Stonington waterfront, packing to go for my final day's journey. An old Blazer parks near a pile of wrecked bricks. A guy steps out. He's about my age. We talk about the weather. "It's supposed to blow," I say. "Be careful," he says. It might be a seed of doubt, but for the way he says it. His voice is measured and sincere, coming from experience. "The sea has no conscience." His eyes are witnessing in memory the proof, won "foolishly," of this otherwise poetic assertion. He recalls urchin diving, years ago, coming to the edge of what a man can survive, and finding there no quarter for regret. He shakes his head, struggling to bear the favor of fate, I imagine. A barge arrives, lowers its ramp, and he drives on. He's headed east. I follow a few minutes later. 30 I reach Bass Harbor Head around four, a little slow in the rising wind and waves. But the last significant crossing is complete, and with three hours of light to spare I feel relieved and optimistic. I rest for a while in the calm, warm sunlight at Ship Harbor. I try an Eskimo roll to test my skill and confidence, though I've never capsized my kayak by accident. I pop another pill and sprint out of the cove, energized and eager for the home stretch. But by the time I'm east of Sutton Island, the scale of this last leg seems misunderstood. Have I not numbered these miles? The sun has thinned. The sea is a shadow. A dim haze of humidity hangs low over Northeast Harbor, the last refuge before the steep, rocky, exposed, and utterly dark headlands of Acadia National Park. I don't want to stop. The seas build. I can't stop. Waves lift me, drop me, turn me, and crash over the deck. They are six feet tall, disordered, bouncing off the cliffs and coming back. They meet in unpredictable heaps, welling to a peak and collapsing just as fast. For hours, I slap and knife the waves, watching the starboard. The light of dusk drains so completely that I cannot tell sky from land but for shades of black. Dimly I see the waves. Suddenly I am lifted up from the port rear as I finish a portside stroke. The kayak slides sideways down the face of a wave. I'm going over, but I feel no panic. I have to roll up, and I know I can. I am upside-down in the water, in total darkness. For a moment, I feel calm. I've practiced this Eskimo roll countless times. Now I need it to work. Everything's backward now, of course. The air is "beneath" the hull. I need to swing the paddle out to one side, push it "down" to the surface and pull it "up and over" my head. I always practiced it this way, in steps, wearing a diving mask so I could see what I was doing. But suddenly I'm blind. "Where is the paddle?" It must be right in front of me. "Push the paddle." Which side? I am stuck in neutral, suspended. The pieces fall apart. My calmness evaporates. I need air. Without even trying to roll, I pull my spray skirt and push the kayak away with my feet. I bob to the surface and take a breath. How is it that I find the spray skirt release? Is it the power of instinct in desperation? "Don't panic," I say to myself. "Think. Priorities." I find myself holding both the paddle and the cockpit coaming. Instinct. It is not much consolation. The water is over sixty degrees, relatively warm. But it's not for swimming — not with my thin wetsuit. "Get out of the water, or you will die." I flip the kayak rightside-up and secure the paddle under an elastic deck cord. I throw a leg over the stern, straddle it, and inch my way forward toward the cockpit. But the kayak is bobbing erratically; waves break over the side and flood the cockpit. With many gallons of College of the Atlantic Magazine water sloshing around inside, the hull is unstable. I lose my balance, roll off, and the kayak capsizes again. I flip it over, again, then fail, again. I finally drop into the cockpit when it is full and low, and more stable. I'm half out of the water, sitting in a cool bath: an improvement, not a solution. Only the bulkheads and hatch covers keep the kayak from sinking. Breathing hard, I check my condition. I feel a desperate urgency, but I need to question myself, to temper instinct and favor reason. I pump furiously with my hand pump, but the waves pour in. I can seal my spray skirt and keep the waves out, but my "bathwater" will be sealed in. I try paddling the swamped kayak. With exhausting effort, I turn it around to face the shore. A flare of green sparks follows each churning stroke: bioluminescence, again. A sliver of my attention lauds its amazing beauty. Another takes note of the details of this singularly important moment. But the bulk of my attention rests on the choice of what to do: paddle on, or land. A part of me wishes to paddle on, however slowly and inefficiently, in sheer contempt of my failure. The choice is no less than life or death. "I must land," I think. "I want to live. I want to see my wife and son again." I feel it clearly: I've decided to live. The sea, of course, ignores my change of heart. In the dark I can barely discern a fleeting paleness of surging, smashing water along the rim of a shallow cove. Then I am struck by the terrifying thought that I will die. I understand it now, how a good swimmer is worn down, beaten, rolled over, and choked. And drowned. I breathe hard and deep. I hear the air rushing through clenched teeth, feel it fill my lungs; it calms me. I scan the shore slowly from left to right. About fifty yards ahead, I find a void. I paddle closer and pull a small flashlight from my PFD. Through the glaring mist I see what appears to be a ledge near shore College of the Atlantic Magazine with a pocket of water behind it leading up to a slope of rock. I turn off the flashlight and hold it in my teeth as I paddle around the ledge. Water floods the pocket and quickly falls away. I will need to land on foot. I jump out of the kayak, grab the bow handle, and kick to shore. My feet touch bottom. I lean into the rock and probe for a hold. Its face is steep but rounds over just beyond my reach. One hand and one step will do it, but it is slick and smooth. The next receding wave yanks the kayak out of my hand. I struggle to stay upright. The closer I come to safety, the more desperately I want it. "I need air!" I still have the flashlight in my mouth. I take it out. My view is so narrow that it seems at first an impediment, then a mere ten-dollar loss. I toss it away. I rest, leaning against the rock. I am out of breath, approaching the limit of my fitness. The pocket's softened waves are still pushing me around. I feel a surge of fear. Again, I think I might die here, how simple and easy it is. Then, suddenly, my foot gains a hold on a little dimple. My hand finds another. I scramble out of the surf. Even then I feel the water reaching. I stumble stiffly, frantically forward. I sit with my legs pulled up to my heaving chest. I am alive, but I don't know the meaning of it yet. I hear the ocean seething. I am shivering slightly, and very tired. I don't want to move, but I must. Taking stock, I find a pocket unzipped. My phone's gone. I pull the radio from the other pocket. It's no use calling for help now. I don't know where I am. But with the glow of the radio's backlight I can see the ground in front of me. My feet sting sharply from barnacle cuts. I've lost my shoes. I step out of my spray skirt and drape it over my shoulders. I hobble over broken rocks to the black woods. Above the bank, the ground is flat and empty. A trail! I head east. Or is it north? I find a trail marker, pointing back the way I came, to Great Head. I walk an hour. Maybe two. I can't see the shore; then I can. A side path goes down to a beach. Sand Beach. Have I gone in circles? The trail turns inland and I climb for a while. Then I see a faint paleness on my right, easy to miss. Maybe I missed it once already? It's an empty parking lot at the end of an empty road. I've lost all traces of will. I am simply an object in motion. After walking half a mile, a small truck pulls up to a stop sign. I enter the glare of the headlights and wave my arms over my head. The truck edges into the intersection, turning to the right. The driver, a grey-haired man, asks me if I am OK. "Well, I was sort of shipwrecked." It sounds strange, like idle conversation. My urgency seems self-evident, but the truck inches forward. "So, you're OK then?" The truck continues to turn away. "Well, no," I say, with audible panic. I try to explain how I crashed my kayak and stumbled through the woods. I can see myself standing there with a bizarre black garment hung over my head and chest, shins bloodied, barefoot, eyes vacant, casually pondering my "shipwreck." He seems aggrieved as he thinks of what to do. "You can ride in the back. We'll bring you back to town." In town I find the house of Suzanne Morse, who taught me biology my first semester at COA — half a life ago. She answers her door squinting, incredulous. I blurt out my story and surprise myself by concluding, with some emotion, "I almost died." The next day I recover the deeply scratched kayak and bring it home. That I bring myself home too is a bonus. I know now that I hold my life in my own hands, with no more regret for living it. For more on Bogart's journey, visit mybraincancerdiary.com. 31 THE SEARCH FOR BALANCED IMBALANCE Perspectives from Student Life Within COA, wellness goes far beyond the physical and even the emotional. When Dean of Student Life Sarah Luke, or Sluke as she is known to students, thinks of wellness, she thinks about five interlocking circles that include physical, mental, spiritual, recreational, and aesthetic wellness. On Week 9 of winter term, five current resident advisors, or RAs, took time out from their studies to talk about campus wellness. Our conversation began with a discussion of how they operate as RAs, but soon delved into how they seek to encourage self-understanding for their housemates and for themselves. Donna Gold: So, what would you say most focuses your time and attention as student leaders? Anjali Appadurai '13: I think wellness is about balance, but my personal take has always been that it's not about total balance all the time, and there's no authority involved because everyone has their own equilibrium. It's not about, "you shouldn't be stressed," because stress happens, and it's OK, but rather encouraging people to be aware of themselves, to know when they are getting to an unhealthy point — and after that finding space and opportunity for finding resources for health. … It's more of an organic approach. Joe Perullo '14: How I interpret wellness in relation to COA's message is that I think it really is important to have this balance between allowing students to go into uncomfortable spaces, and figuring out how to deal with that without letting them go off the deep end — and being very conscious of the subjective 32 experience that students go through. And yeah, it's kind of this balancing game of encouraging students to push their boundaries, but also helping them in those times. way. Through the Student Life team we're watching everyone. We have multiple people, because different personalities attract different needs. When something is amiss we know. Janoah Bailin '14: Maybe total balance actually means being imbalanced sometimes. What I really like about this school is that we recognize that all these areas of wellness play into each other and affect how we work … so it's a very roundabout way to get out the thing we want to get out — your goal or area of focus — but it's a recognition that all these areas will help to get at a more effective person. Donna: This is not typical of other colleges, is it? Amber Igasia '15: I see our role as being resources for the community; we confer with Sarah Luke when someone's struggling. We are the points in a web that pull things together. Janoah: Right. And the safety net lies in the dispersal of those points, if you have a wide enough net and connect all the points in the right Brittany Cullen '14: It's really unique to COA. I have way more responsibility than friends in my role at other colleges. At other schools, the RA might be a resource for referring students to study skills, but at COA we know our residents, we know when they're doing well, and we know when they're struggling; and even after you refer them to help, you have to be there with them as they go through it. Amber: Because we're such a small school, and we have a ratio of about one RA to eight students, we have the ability to build that relationship. It's almost preemptive, because when you have a good relationship with your residents, you are able to see when someone is struggling. We have that College of the Atlantic Magazine ability to almost be individualized, to cater our responses to each individual. Joe: I think one of the interesting qualities of how we approach wellness at COA is that it has a really reflexive element to it. We have to usually teach people about how wellness at COA works — which is intentionally organic and ambiguous. Sarah Luke isn't telling us, "This is what you do as an RA." We have to adapt. For a lot of people that's a very confusing system. It's not like, "Here are the laws of COA." Janoah: It gets into how we think about wellness in general — and how we think about human ecology. I came in thinking that all the other stuff is extracurricular. As the Student Life team, we're trying to demonstrate that it's not extracurricular, it plays an integral aspect in our lives. We need to teach that, because it's fairly unique. Joe: Right. A lot of people are coming from systems in which the things you mentally need to do to cope with academics — like sports, or whatever — were treated as separate from academics, whereas I think here we recognize it as an entire process of learning. Janoah: Often those activities were things that you ran to when you came College of the Atlantic Magazine to a wall in your academics, like you're studying, studying, studying, and you need to use these extracurriculars as things to get away from the pressure. What I hope we might do is to bring an awareness in prior to that wall, and have a whole network of wellness pushing you to tackle that wall in the first place, instead of it being something that you feel guilty about or ashamed of. Donna: Can you talk about what you have learned as RAs? Brittany: I've learned more about my boundaries. Being an RA can take so much emotional energy. I've learned what I need to do to restore myself in order to be there for my residents. I think that the way we can improve as a community in promoting wellness is to reflect that in ourselves because often we don't lead by example. We're overworked, or don't demonstrate good self-care, and I think that's crucial to what our residents pick up on and how they learn to take care of themselves. I think we can do better to recognize when we are stressed out or when we're not taking care of ourselves, how it ends up impacting our residents. Janoah: And being honest about that with our residents, and showing them how we struggle with that too, and not creating set images, or goals for people to get to — but giving tools and processes that people might work with and towards. Donna: Is there a concern that we do too much? Anjali: It comes down to what the aim is for an adult who is exiting college and moving into the working world or wherever they are going. Is the aim just to produce a piece of paper that is a degree? In that case we're way overdoing it. But the reason COA exists is for a whole other level of engagement with society, with the world around us, and we aim to be global citizens — well-rounded, engaged, thinking, feeling, responsible people who are — and I would use the word intention or consciousness here, because that is the difference. Going into the world consciously or intentionally to do things with that intent — that comes when you've been taken care of, when you know what it feels like to be part of a community. You know what it feels like to have interpersonal relationships and to have power dynamics that are healthy and mutually responsive, mutually beneficial, and that's what you're going to go out and foster in the world. 33 Research Successes Two Alumni Receive FDA Approval for Innovative Pharmaceuticals By Marni Berger '09 Blood-red latex exuding from Croton lechleri. The Significance of Dragon's Blood: Steven King '80 Between 1978 and 1979, Steven King, PhD, spent nine months living with the Angotere Secoya indigenous people in the Peruvian Amazon. A Peruvian non-governmental organization had contracted him to study the diet and medicinal plants of the group for his College of the Atlantic internship. In December of 2012, thirty-four years after Steven's first visit to the region, the healing properties of a purified drug extracted from latex so viscous and red that it is known as sangre de drago, or dragon's blood, have been approved by the US Food and Drug Administration as a medication 34 that can halt the fluid loss caused by diarrhea. It took two dozen years of careful research and experimentation by Steven, senior vice president of sustainable supply, ethnobotanical research, and intellectual property at Napo Pharmaceuticals, but the drug — known as crofelemer and sold as Fulyzaq — now offers relief to those living with HIV/AIDS, many of whom also have to live with severe diarrhea from multiple causes. It is also the first botanical, orally administered, anti-diarrhea medication — and only the second botanical prescription drug — approved by the FDA. Because it is hardly absorbed into the bloodstream, there are little-to-no side effects, and so it can be taken, if needed, on a regular basis. That's only part of the story. Crofelemer, unlike most FDA-approved drugs, cannot be manufactured by chemical synthesis. It must be extracted and purified from the latex of the Croton lechleri tree growing in the western Amazon basin. Its success requires careful attention to the environment. The extraction is College of the Atlantic Magazine done sustainably, by local community members. For years, Steven has assisted these communities on reforestation projects. So the FDA's stamp of approval has provided another long-term sustainable source of income from the rainforest to local communities. Steven was the first graduate student at the Institute of Economic Botany of the New York Botanical Garden, earning his PhD in biology from the City University of New York. He learned of the tree's special properties from healers. He speaks of having had "the great privilege to work with, learn from, and conduct research with healers and experts in ethnomedicine in Peru, Ecuador, Colombia, Tanzania, Papua New Guinea, and Nigeria; and to work with communities in Peru and scientists on the long-term sustainable harvest of Croton lechleri." He also has had more than sixty scientific articles published and has organized numerous workshops and lectures around the globe. This work showcases just how business, the environment, human health, and one's own passion can intersect. "The cultivation and sustainable production of the Croton lechleri tree and its latex provides income to local communities," Steven says. Culture groups and governments in the countries where the team works will receive a portion of profits from crofelemer and any other drugs sold. Steve and Napo are now focusing on the use and approval of crofelemer to treat cholera-induced diarrhea, and are working with their partners to gain approval for a pediatric form of crofelemer that can be used around the world to treat children who needlessly die of fluid loss from childhood diarrhea. Above left: Young Croton lechleri trees growing as a result of natural germination in Chimbana, Peru. Top right: Cesar Lozano and Steven King '80 hold a Croton tree at an agroforestry production site in the Huallaga River basin. Cesar, one of Napo's Peruvian partners, develops and manages reforestation projects. Bottom right: Sunset on the Maranon River, returning from an agroforestry production site. Photos courtesy of Steven King. Building a Better Flu Vaccine: Clifton E. McPherson '84 Clifton "Trey" McPherson, PhD, is responsible for helping to keep the wheels of a large machine oiled. At Protein Sciences, where he is vice president of product development, Trey works with a dedicated team that has spent the past years developing and producing the first fully eggfree and recombinant flu vaccine, Flublok. Trey currently oversees the work of some fifteen specialized scientists who are developing new vaccines and other products. College of the Atlantic Magazine To anyone who has ever received a flu shot that didn't "work," Flublok may be an alternative. The Flublok vaccine is not only more sustainably manufactured than egg-based vaccines, it can provide a much more precise match to the seasonal flu. It is created using moth cells, which is preferable in that it reduces potential risks from the vaccine production, since so few viruses affect both insects and humans. Quite recently, research and theory — years of work aimed at necessary authorization — have hit a bulls-eye. On January 16, 2013, the US FDA approved Flublok. Despite, or perhaps related to, his influence in the health industry, Trey has his feet on the ground. "Many of the scientists I oversee," Trey says laughing, "are much more expert in their fields than I am." 35 Trey recalls he did not find his professional place right away. While at COA, he slowly began to find his niche in the sciences. After graduation, and a year's position mapping the genes of anemia and other blood disorders at The Jackson Laboratory, Trey's interest in biology solidified. He decided to continue, earning a PhD from Vanderbilt University, then receiving a postdoctorate fellowship in molecular genetics from Brown University. There, Trey published a groundbreaking article in the journal Cell on how DNA is packaged differently around genes that are actively expressed. Trey has since published nineteen more scientific articles. He continues to actively pursue his calling, currently seeking FDA approval on Panblok, a vaccine for pandemic flu made with the same technology as Flublok. The significant difference between the two lies in Panblok's considerably wider reach. Biology 101: What is a cell? PLANT CELL Items 1, 11, & 12 are unique to plant cells. 1. The cell wall is made from dense fibers and forms an extra layer of protection which maintains the cell's shape and prevents it from bursting when it takes on more water. 2. The cell membrane is a thin semi-permeable membrane that surrounds the cell fluid (cytoplasm), thus enclosing its contents. 3. The nucleus stores genetic material in the form of DNA (see page 39), and is surrounded by the nuclear membrane. Inside the nucleus is a nucleolus. Here ribosomes are made. 4. Ribosomes are responsible for assembling the proteins of the cell. They consist of RNA and proteins. 5. Mitochondria are the cell's power plants; they convert energy into forms that are usable by the cell. 6. The centrosome is the production center for microtubules — fibrous, hollow rods that help to support and shape a cell, and are also involved in movement within a cell, especially during cell division. 7. Smooth endoplasmic reticulum (SER) contains enzymes important for synthesizing and metabolizing fats. 36 3 1 4 2 5 6 7 8 9 10 11 12 8. Rough endoplasmic reticulum (RER) is covered in ribosomes that synthesize proteins; the RER can transport these proteins throughout the plant. 10. Peroxisomes contain more than fifty enzymes and play many important roles in cell metabolism, including breakdown of fats and alcohol. 9. The Golgi apparatus is the shipping department for the cell's chemical products. It modifies proteins and lipids, or fats, that have been built in the ER and prepares them for export outside of the cell or for transport to other locations within the cell. 11. The large vacuole stores sap and is especially important in osmosis since it stores water in the cell. 12. Chloroplasts, found in the cells of the green parts of the plant, are where photosynthesis takes place. College of the Atlantic Magazine Aoife O'Brien '05 Babycatcher By Marni Berger '09 Aoife O'Brien, CNM, sits with five babies she "caughtâ€? while working at the Midwife Center for Birth and Women's Health in Pittsburgh, PA. The babies are all under four months old. Aoife O'Brien will never forget her first "catch" of a baby. "I was twenty-two years old, living with fourteen Mayan midwives at a clinic in Guatemala. They told me I was no longer going to watch. I was going to use my hands." She describes the photograph taken just after the catch: "My smile is so big, it looks like my face might split." The work in Guatemala was Aoife's senior project; midwifery, she knew, was her calling. In 2009, Aoife enrolled in Columbia University School of Nursing, earning her bachelor of science in nursing through an accelerated one-year program and graduating with her master's of science in nurse-midwifery in 2011. For a year she saw clients in a freestanding nonprofit birth center in Pittsburgh. She has since returned to Maine to work at Blue Hill Memorial Hospital. Midwives, says Aoife, "strive for health maintenance first, followed by treatment of illness when necessary." Midwifery assumes a holistic approach, with midwives trained as experts in normal labor, birth, and the postpartum period, as well as well-woman care across the lifespan. "When the time comes to have a baby," she continues, the midwifery team "encourages women to listen College of the Atlantic Magazine to their bodies, and we guide their efforts as needed." Using their medical training and expertise, they focus on reassuring the mother, facilitating position changes when helpful, and managing labor only when necessary. "Decreasing fear greatly decreases the experience of pain and suffer