THE WASHINGTON POST – At whatever grade level teachers find themselves, from kindergarten to the final class at medical or law school, few moments stir the emotions as deeply as when former students reappear years and often decades later with an update on where their journey has taken them and what resiliencies have been the pavement on which they’ve travelled.
So it was when a recent letter came from Kelli Harding, a student 21 years ago in my Peace Studies summer course in Washington. The weekly tuition-free class, in a roomy space that Ralph Nader and his Public Citizen non-profit group provided, was discussion-based and required no useless drudgeries like homework or exams. Just come in and figure out how to increase peace and decrease violence. And do it today, tomorrow is too late. The course attracted mostly congressional interns, with a few exceptions like Kelli who was in Washington as an AmeriCorps volunteer.
Her year-long service included comforting HIV/AIDs patients at a free health clinic and following up with the solace of delivering meals to the homebound. It was a world apart from her undergraduate days at the University of California at Berkeley and majoring in political science. The Washington experience, which Kelli would later call “transformative”, was the fuel that carried her into medicine to earn a master’s degree in public health from Columbia University and a medical degree from the University of Rochester, and almost two decades of practice as an emergency room psychiatrist at NewYork-Presbyterian Hospital and a clinical professor of psychiatry at Columbia University Irving Medical Center.
Kelli’s letter, a literate update on both her personal and professional life, touched my heart, and especially so when saying that two decades later she still has the course text, ‘Solutions to Violence’, and that “it remains one of my favourite possessions”. She lives in Lower Manhattan with her husband, Padraic, whom she met on a flight to London, and their three boys.
If Kelli stands out, it’s because like physicians William Carlos Williams, Robert Coles, Walker Percy and Atul Gawande, she is also a writer – a gifted one. Last month, Atria Books, an imprint of Simon & Schuster, published her book The Rabbit Effect: Live Longer, Happier, and Healthier With the Groundbreaking Science of Kindness.
With a blending of free-flowing confessional prose and scholarly research found in 461 notes, Kelli met my expectations that her ideas and ideals would be sound and singular. “Despite our scientific progress,” she writes, “Americans are remarkably unhealthy. In 2016, the United States ranked 43rd in the world for life expectancy. It is also by far the world’s most expensive place to get sick.”
Enter the rabbits – not those bunnies scampering in our woodlands but ones serving in two month-long medical experiments to test the effects of eating a high-fat diet and the connections between cholesterol and heart disease. With similar diets, the expectations were that all the rabbits would have similar cloggings of their arteries. Yet one group had 60 per cent fewer of them.
The reason? Instead of receiving the standard care given to lab animals, the 60 per cent group was watched over by a newcomer to the lab who, Kelli writes, “handled the animals differently. When she fed her rabbits she talked to them, cuddled and petted them. She didn’t just pass out kibble, she gave them love. The studies indicate something is missing in the traditional biomedical model. It wasn’t diet or genetics that made a difference in which rabbits got sick and which stayed healthy. It was kindness.”
Amid the clanging political noise about Obamacare, Medicare, Medicaid, health insurance and thieving pharmaceutical companies, Kelli Harding stands apart from the horde calling for quick fixes, the simpler the better. She has walked too many miles in the halls of hospitals visiting too many far-gone patients and seeing too many medical mistakes to go along with conventional thinking.
“The rabbit effect,” she explains, means that “when it comes to our health, we’ve been missing some crucial pieces: hidden factors behind what really makes us healthy. Factors like love, friendship, and dignity. The designs of our neighbourhoods, schools, and workplaces. There’s a social dimension to health that we’ve completely overlooked in our scramble to find the best and most cutting-edge medical care. Ultimately, what affects our health in the most meaningful ways has as much to do with how we treat one another, how we live, and how we think about what it means to be human than with anything that happens in the doctor’s office.”
In more than a few passages, she relates the stories of men and women who came up against assembly-line medicine where patients were treated mostly as pieces of flesh.
“Clinically,” she writes, “it’s common to see two patients with the same condition, such as recovering from a heart attack, have two very different courses based on seemingly irrelevant factors, such as their family relationships or their educational level. In my practice, the sickest people I see often share similar backgrounds: loneliness, abuse, poverty, or discrimination. For them, the medical model isn’t enough. It’s like fixing up an airplane engine and ignoring that the pilot is on his third drink and a massive storm is overhead. To properly care for patients, we also need to care about the lives of the people getting the care.”
Kelli wastes no time taking cheap shots or potshots at the medical establishment and its body-centred biomedicine methods.
Instead, she remains positive, holding up for praise one of her medical school professors, George Engel, an internist “who always noticed not just a patient’s physical findings but little details about her life, such as if she had family pictures up in her hospital room or flowers delivered.
He was the kind of trusted doctor you’d feel relieved to see and welcome into the room with a sick family member. He’d sit down to talk with the person not just about medical problems, but about her life and priorities. He built a large consultation service to address the holistic needs of hospitalised patients, including psychological and social factors.”
It’s a guess how many George Engels in their white jackets and stethoscopes are at work these days and another speculation on the number of Kelli Hardings the nation is blessed with. Please, may the totals be large and getting larger.