MARCIA DAY CHILDRESS: Good afternoon, I'd
like to welcome you to today's program.
This is a joint Medical Grand Rounds and Medical Center Hour.
I'm Marcia Day Childress from the Center for Biomedical
Ethics and Humanities.
And it's our center that produces the Medical Center
Hour.
We're delighted to be joining for the first of three times
this semester with the Department of Internal
Medicine whose Medical Grand Rounds this is.
Our program is entitled "After the Fall:
a Tapestry of Disturbance, Recovery, and Resilience."
Please come in.
There are some more chairs down the front and over here.
What connects the work of a tree biologist
with that of a doctor?
And what is a tree biologist doing
speaking at Medical Grand Rounds, a conference
specifically for internists and internists in the making?
Or for that matter, in a Medical Center Hour,
a conference addressing health related concerns
shared by the medicine and society.
What about trees?
And what can be learned from trees in far away rainforests?
What about that should matter to us in medicine?
Today's program pushes those questions.
As you'll see in this hour, there
are connections, surprising, perhaps, significant,
yes, meaningful, certainly.
And again, there are seats in the front row, down here,
a few other seats.
Please join us.
Nalini Nadkarni, a tree biologist,
is a pioneer in the field of canopy research
and in public engagements about the plants and animals that
live in the treetops.
Her interest in rainforest dynamics,
and in such forests' response to major disturbances
such as harvesting, fire, and climate change.
It prompted her over the years to enquire more widely
into the phenomena of disruption and recovery
as these occur not just in trees and forests,
but in people who fall ill or are displaced
or become refugees.
In communities ravaged by the natural disaster.
In complex systems that go suddenly and catastrophically
awry.
Professor Nadkarni, accustomed to quite freely traversing
treetops, several years back began traversing disciplines,
asking experts in other fields as far
flung as economics, neuroscience, and traffic
engineering what they know about disruption and recovery,
and importantly, what they know about the generation
of resilience, the ability not just to go on
but to flourish again anew.
Unexpectedly in 2015 her work grew personally useful.
While doing forest canopy field work
Professor Nadkarni fell 50 feet from the top of the tree.
She sustained extensive traumatic injuries.
It was during her recovery that she began to mine further
what she had gleaned from diverse fields
about disturbance and the stresses
and the opportunities it frames, about recovery
and healing and all that they mean, and about resilience
and what it enables us to do, be we trees and forests, plants
or people, arborists or internists, doctors, patients,
communities.
Nalini Nadkarni is Professor of Biology at the University
of Utah in Salt Lake City.
She's also president of the International Canopy Network.
This doesn't quite appear on her CV, but for her pioneering work
she's known around the forests as the queen
of the rainforest canopy.
I think this is the first time we've ever had arboreal royalty
here to talk with us.
But please join me in welcoming Nalini Nadkarni.
NALINI NADKARNI: Thank you so much Dr. Childress.
And as you said, I feel sort of weird being here,
actually, as a forest ecologist speaking
in this wonderful medical school.
I really want to say first that I feel humble and grateful
for the work that all of you do in terms of caring for, being
dedicated to, and learning about how to bring health to people.
As a recipient of amazing medical care
just this last year when I did fall out of a tree,
I have to say I now really understand the importance
of what all of you do.
And I want to extend my thanks not
to you, to you brothers and sisters in the profession
as well.
I also want to recognize my brother Mohan Nadkarni,
I think all of you probably know, I know him very well
and my little brother and it's wonderful to see him
in the context of his professional work here.
We do, however, me as a forest ecologist, you as people
who understand and deliver medical care,
I believe have topics in common.
And the topic of disturbance and recovery
is one that we do hold in common.
I who see the interweaving of primary rainforests
as a complex and important system that
sustains life and ecosystem services in tropical temperate
and boreal forests around the world,
but is subject to disturbances, as Marcia
said, in terms of fire and insect attack,
as well as human activities.
And all of you who are involved with the understanding
of the tapestry of systems, of organs,
of nerves, of bones, of blood movement
that make intact systems important to preserve
and to restore when disturbance, such as trauma, or stroke,
or injury, or assault takes place.
Today what I'd like to do to apply what I call for myself
sort of the art and science of tapestry thinking.
I take my inspiration from this tiny little poem
by Rabindranath Tagore "the tapestry of life's story
is woven with the threads of life's ties,
ever breaking and joining."
What I like to do with tapestry thinking
is to pull together seemingly disparate ways
of knowing from different disciplines,
using different tools, different theories in order
to understand difficult, sometimes wicked problems
such as disturbance and recovery.
I believe that I combine this honestly.
These are my parents.
My dad is from India.
He was a Hindu, he was a pharmacologist, a scientist,
a quiet, dignified gentleman.
My mother in the sari there is from Brooklyn, New York.
She was raised as an Orthodox Jew.
She studied communications and languages.
And so my four siblings and I really learned from birth
that it's very easy, it's very important,
and it's very productive to try to weave together
different cultures, different languages.
Our favorite dinner was curried bagels, for example.
And so that was really [INAUDIBLE] growing up,
and that's really what I've done through my professional life,
in terms of trying to understand problems in forest ecosystems.
[LAUGHTER]
Our family story, which is the five
siblings, my little brother, the baby, in the middle there.
Just so charming and sweet, whom we all just dearly
loved so much, and still do.
And who is now this important mentor, teacher, educator,
and healer here at the University of Virginia.
So he's part of this tapestry as well.
In any case, what I'd like to do during my talk is to use
this theme, this metaphor of tapestry.
I'd like to do basically three things.
First to describe my own inspiration
which is trying to understand the complex tapestry
of rainforest ecology, of rainforest systems which
are subject to disturbance and hopefully recovery.
That is, my own intellectual threads.
And help you understand why these
are important to me and to my own community of forest
ecology.
Secondly, I'd like to describe the thread of disturbance
and recovery that happened to me this last year when I fell out
of a tree, and the kinds of experiences
that I sustained, that I experienced in terms of healers
that came to me, that I experienced in the hospitals,
in the ICU.
And later on during the later stages of recovery which
I am still experiencing as well.
And m I'd like to use this idea of tapestry thinking
in ways that I've enlisted the threads of understanding that
come from other widely different disciplines who
also try to struggle to understand disturbance
and recovery.
And so I'll be sharing those with you as well.
And finally, come to sort of conclusions about where
we collectively, forest ecologists medical people,
might go to understand the processes of recovery
after a disturbance.
Well first rainforests.
As a kid I grew up climbing trees.
As a graduate student I chose to find out
about the forest canopy.
It was called the last biotic frontier.
Because of our loss of prehensile tails
we really haven't been able to get up into the forest treetops
very well, and yet this is a very important part of forest
ecosystems in terms of sustaining biodiversity,
that is many, many plants and animals
live in the forest canopy that you never
encounter on the forest floor.
Many, many interactions between plants and animals
occur in the forest canopy that you never
see on the forest floor.
And for that reason it seemed to me important
that we get up into the forest canopy to study it.
And over the last three years, we've developed,
we forest canopy researchers have developed a number of ways
to get into the forest canopy safely,
or what I used to think as safely,
and non-destructively to the trees.
And I thought, because I can't bring
all of you up into the forest canopy here
in Charlottesville, Virginia, I thought I would show you
a very short clip of a forest canopy access moment in Costa
Rica, where I do most of my research, to share with you,
not just the environment of what I see, what I find,
what my questions are in the forest canopy,
but also to demonstrate to you very
vividly that my work depends upon my physical capacity
to get up into the forest canopy.
And so a disturbance that strikes my inability
to get up there is a very significant thing.
So here we go with a bit of a film
by the National Geographic Society called
Heroes of the High Frontier.
All right, how many of you medical students and residents
would now like to start a life of understanding the forest
canopy rather than [INAUDIBLE].
I would like to see many hands.
Anyway, during the 35 years that I've spent climbing trees
with my students and my colleagues,
we have come to understand that the forest canopy is not just
the sort of remote part of the forest ecosystem,
but rather it plays a tremendous role
in terms of maintaining biodiversity of many plants
and animals species.
It also performs ecosystem-level roles
in terms of intercepting and retaining nutrients and water
that come in atmospheric forms.
Plants that live in the canopy are
very adept at holding onto these nutrients.
As they grow, they live, they die, they then
return these nutritious to the forest floor.
So they're actually augmenting the nutrient cycles
of the forest as a whole.
This was sort of the general idea
that I have sort of pieced together over these last 35
years of forest research.
But one of the concerns that has grown in me over the last five
to 10 years has been understanding the fact
that there is disturbance going on in these primary ecosystems
that are negatively effecting the plants and animals
that the forest canopy.
Human activities such as mining, conversion
of forest to pasture, forest fragmentation, global climate
change are all having a negative effect
on the functions that these primary forests had provided.
And in addition there's been this general shift
as our population has moved from being
primarily rural to primarily urban in the last two years.
Actually more than 50% of our population now live in cities.
So there's a growing distance between our connections
between ourselves as humans and natural systems
such as forests.
And this is of great concern to me.
And I decided that one of the topics that I would like
to spend a lot of my time studying now
is one aspect of disturbance, and that
is the isolation of previous primary forest trees
as we create pasture systems.
So this is a tree, for example, that was
growing in a primary forest.
A farmer has turned that into a pastor
and has left several single trees living
in those pastures for shade, for fruit, for medicinal plants,
or for aesthetics.
My question is, do those trees that are living in disturbance,
these what we call relic trees, do they serve any purpose
in terms of maintaining ecosystem function
and biodiversity?
Or are they in fact the living dead
that don't really serve any purpose at all in terms
of primary forest function.
Well it was during the research process of these relic tress
on July 3, 2015, this was just last year,
that I fell out of a tree.
My rope failed suddenly, unexpectedly.
I was with my students, I fell to the forest floor, 50 feet.
I didn't hit any intervening branches
but I just fell like a silent sack of sand to the forest
below.
I was down on the forest floor, clearly
there was something wrong, you know, definite things
that happened to my body as I looked up at the canopy.
I waited for three hours.
I was rescued by the medivac services
of the Harbor View Medical Center, a trauma center,
fantastic trauma center in Seattle, Washington.
And it was after that, really, immediately
after that that I began realizing
that my world had changed.
That I myself had been subject to disturbance from which I
could only hope to recover.
And what I'd like to do now is to share with you some
of the fears that I experience, especially
in that early part of my recovery, that might reflect
for you some information, or provide for you
some information about what a patient who has suffered
severe trauma, a patient who has formally been very active,
formally been very functional, suffers a severe disturbance,
such as falling out of a tree.
And I've organized this in three pieces.
With fears of losses in terms of my life and sanity
and mobility, those basic fears that I think everybody
would fear.
I also feared that my connections
that might be severed to my fellow human beings,
my family, my friends.
But also to the nature, something
which is fundamentally important to me
not only in terms of work, but in terms of my spiritual life.
And third, I feared the loss of my own functions,
my own identity.
Who am I?
How do I operate in this world?
How do I function as a parent, as a wife, as a person,
as a colleague?
What's going to happen to me now that I've
suffered this disturbance?
So first I'll tell you about what
went on in terms of this first primary set of fears of life,
sanity, and mobility.
And my first reaction was, oh my gosh
this is a terrible catastrophe.
This is the equivalent of a forest fire in my life.
Where life has been extinguished.
That life could potentially be extinguished.
That life as I know it has been ended.
I was in the ICU for a week.
My brother Mohan came out.
He was an incredible help in terms of communication.
But essentially I felt that, and the people around me
felt that Nalini was very close to death.
In fact, some of my relatives and friends who came
were really-- they told me later that they were expecting
to be there to kind of be attendant at my exit
from this world.
I suffered actually nine broken ribs, a fractured pelvis
in three parts, a burst T3 to T7 vertebrae,
so I have a spinal fusion now, a lacerated spleen,
which has since been removed, a punctured lung,
a broken fibula, and mild traumatic brain injury.
So those are the sort of physical things
that happened to me that were fixed, to some extent,
physically, in the ICU.
The ICU for me was terrifying.
It was terrifying not only because I
was feeling about facing death but it was also
terrifying because I felt that I had lost my mind.
And in fact I had lost my mind.
I suffered these hallucinations.
There were some very real hallucinations.
I imagined or pictured an African-American soldier
with a rifle behind that green curtain who was pointing
that rifle at me and my son.
And in fact, my son was sitting between the soldier and me.
And instead of trying to protect my son, to my horror,
I just let him sit there.
I mean, what possible horrible, more horrible thing
could a mother imagine about herself that she
didn't protect her own son.
I also imagined or felt or hallucinated
that this nurse, this very competent nurse,
was doling out poison pills to me.
That the pills that I was receiving
were poison, rather than something that might help me.
And so this made me question everything
I knew about what I knew about myself, which is that I'm
a same and logical person.
At one point I overheard nurses in the ICU
talking about my potassium levels, that they were low.
And I was intubated so I couldn't speak,
I couldn't communicate, my voice could not be heard
but I wanted to find out what was going on
with my potassium levels.
And I had read the biography of Helen Keller
when I was eight years old and in the back of the book
there was a page that taught me the deaf/mute alphabet.
So I kept signaling K, K, K, K, tell me about my potassium
levels, but they didn't understand what I was doing
and so again I felt completely silenced
in my intellectual efforts to try
to help myself through this very difficult time.
So that time in the ICU was a time of fear, of loss of life,
of loss of mobility, and loss of my sanity.
I also very afraid of the loss of connections to other humans.
I felt very isolated, even though I
had the benefit of many family visits, the visits
of many friends, there were times in the dark of night
when I felt completely alone in that hospital.
And not knowing, not just what would happen in the hospital,
but what would happen after that.
I'm a very social person.
I have interactions with colleagues, with students,
with families, with friends.
What would happen after I got out of the hospital
if I couldn't keep up with my former kinds of connections?
Another great worry was my last connection
to nature, something that's deeply important to me,
not only because I work in nature,
but also because that is where I get my sense of renewal
and my sense of continuity, my sense of beauty in life.
I felt that if I could not go hiking into the mountains
that I love, the forest that I love,
I would suffer a very deep loss and I
had no idea whether or not I would
be able to return to that.
And finally, the loss of function and identity, again,
as a person who was a full professor at the University
of Utah, an R1 institution, I have multiple graduate
students, I have grants from the National Science Foundation,
I attend conferences, I have friends, I have family.
Who would be fulfilling the functions
that I fill if I was incapacitated
by this disturbance.
Here's a simple example, when I had returned from the hospital
but before I went back to work and I was still
suffering from minor traumatic brain
injury I got a call from a reporter at the Boston Globe
and he wanted me to write up a statement about a paper that
was being published in science about forests
around the world, their global significance.
And I knew to write this paper I would really
have to focus on getting those numbers right
and I knew that I simply wasn't up to it,
mentally, at that time.
And so I had to compose an email to this reporter and say,
you know, I just can't do this.
And here are three names of other colleagues
that might be able to help you.
But I felt a deep sense of loss, a deep sense of cutting myself
off from what was a professional obligation,
a professional privilege, in terms
of contributing to the scientific record about trees.
On more personal basis in terms of my function
as a mother, my daughter Erica, right here,
she and I had planned a bicycle trip that summer.
We were going to commune as mother and daughter.
We were going to function together as mother and daughter
at this stage of her life, she's 23 years old,
I felt it was an incredible opportunity
that she had invited me to do this
and, of course, lying on my back in the hospital
I wasn't able to do this.
And she reassured me that, mom I'll
be thinking of you on the bike trip,
and I reassured her that I would be with her in spirit.
But again, I felt this loss.
That I was not functioning as a mother, in this case,
because of this disturbance.
And finally, in terms of the connection to my profession,
I really felt, in terms of my function as a researcher--
I had since climbed trees.
This last year, two months ago actually I
was climbing in the Pacific Northwest,
climbing up some of my old Douglas fir tree friends.
But it felt very different.
I realize that at any moment my rope could fail.
At any moment I could have a catastrophic fall.
At any moment there was danger.
Something I had never experienced before.
I had always trusted trees and trusted my ropes
and trusted the techniques that we've
developed over the last thirty years implicitly.
And so this was a loss too.
Not that I can't climb trees, I can do that.
But it's with a different sense, a different feel,
a different understanding.
And that in a way is a loss I feel too
because of that lack of confidence
that I once held for myself before the fall.
I'll mention one last thing and that
is that concerns something really important
in terms of identity.
That is, the decisions that we make about life
there are so many decisions that we
who are privileged to had choices in our lives can do.
We work through the different kinds
of opportunities, the different kinds of choices
that are made available to us.
And if we have some sort of sense of passion,
some sense of central movement, as I
do, to understand forest canopies
and understand disturbance of forests, rainforests
and why that's important.
Well that's what I had before I fell.
I had this really strong sense of my own destiny,
my own importance, my own ability
to do something in this world that's important to me.
But after the fall I have found the arrow has sort of
faded away to be honest.
That there are many choices.
And in many cases, in all cases, those choices
might disappear today if there's another disturbance,
or tomorrow, or next year.
So what's the point of developing a big research
program with graduate students that
take five years to go through to get answers to questions that I
was previously really thrilled about.
What does that mean in terms of my decisions?
Does that mean I let it all go?
Does that mean I grab randomly?
Does that mean I fake it and pretend that I'm
as interested as I was?
These are questions I just don't have
an answer to give to myself or to give you,
in terms of where I am now in terms of recovery,
sort of a psychological and professional recovery
from that disturbance that I experienced.
And it was at that point, just several months ago,
that I began thinking about the unansweredness
of those kinds of questions.
The unansweredness of my function and my identity.
That I began to think back to my research about relic tress
in pastures where I've been trying
to find answers to questions about disturbance and recovery.
And one of the ways that I've tried to do this
is through the idea of tapestry thinking.
If we don't have all the answers in forest ecology,
answering what is the role of these relic trees
in maintaining biodiversity and ecosystem function,
maybe we can go to other disciplines
to look at their theories, their tools, their approaches,
and their ways of knowing that we might be able to apply
to forest ecology.
And my case, to the disturbance and recovery of my own life.
For example, when we think about the scar
that we have of a forest clear cut,
we might think about burns trauma.
The fact that when you burn a patch of skin
that that is perhaps, in some ways,
similar to what we see in a clear cut.
And perhaps those who are expert, experienced,
have theory and tools and an understanding
of the recovery of burns, they might have some insights
into how we could attach those theories and ideas to forests
that have been disturbed as well.
And so last year, before my fall,
I pulled together what I call an interdisciplinary colloquium
around the topic of disturbance and recovery.
I used the find a researcher site on the University of Utah
website to look for faculty who are doing research
in disturbance and recovery.
And I was able to get 10 colleagues, 10 faculty
members who studied disturbance and recovery but in wildly
different fields, burn trauma, refugee
studies, neurosciences human development, economics,
urban planning, traffic engineering, criminal justice,
and modern dance.
And we decided to come together for two hours
each month to talk about our respective fields,
to talk about our investigations of disturbance recovery,
and to see whether there might be
some commonalities, some emerging themes that
come up that might benefit each of us in our separate fields.
What I'd want to do today today is to talk about just five
of these disciplines, take a sub sample of them that have some,
I think, relationship to disturbance and recovery
in human health.
So forest ecology, my field, those relic tress,
refugee studies, human development, neuroscience,
and urban planning.
So just to give you just a super brief idea of what we learned
from each other, the faculty member in refugee studies
really focuses on the fact that there
are populations of people who in their undisturbed state,
in South Somalia, in Chad, in Iraq, when they move,
when they experience a disturbance
and become refugees, political refugees, in the United States
for example, they experience a disturbance
and then they go through some process of recovery.
And she's been studying those populations.
In neuroscience we know that that field
has advanced tremendously in the last 30 years.
When we have an intact brain that's
damaged by trauma, by a stroke, that the neurons are
capable of neuroplasticity.
That some of those relic neurons,
those surviving neurons can actually change in function
and take new functions that promote human health.
The field of human development is
very interested in disturbance.
For example, attachment theory is
all about when a parent disappears
due to death or divorce that child can sustain severe damage
or disturbance.
And in fact, that can have implications
later on in it's life, that it's not
as able to point trusting relationships because
of the disturbance that happened during that early time.
And in urban studies, you know, in cities like New Orleans,
for example, that suffered the Hurricane Katrina coming
through, that the process of recovery
have been very well studied in terms of the kinds of changes,
the kind of shifts, in terms of population, architecture,
and culture that have been promoted
by this disturbance that causes it.
So there were a number of emerging themes that came out
of these discussions.
and I'll talk about five of these
as they relate to my recovery.
A first team that all of us agreed with
is that pretty much people think disturbance
is a negative thing.
When you talk about a forest fire or infestation of bark
beetles in an inter-mountain west forest, for example.
We even use negative language, of catastrophic burns,
of devastating insect outbreaks.
So there's a general belief, in fact, that disturbance
is a bad thing.
But one thing that I learned from the faculty member who
studied refugees, she said sometimes
there can be positive outcomes from disturbance.
For example, in many of the refugee populations coming
from Muslim countries when they come to the United States
the young women are able to get education.
They are able to promote themselves in ways
that they would never have been able to do if they had stayed
in their home country.
So actually disturbance can have some positive aspects as well.
And for me, as I was lying in the hospital bed there,
surrounded by the family and friends that had come around
and rallied behind me, I realize and I
hoped, as I thought about this example of the refugee studies,
that maybe there was some hope that there would be
some positive outcomes as well.
Another emerging theme is that knowledge enhances
the trajectory of recovery.
And when we think about neuroplasticity,
when we think about the amazing research that's
gone on in the neuro sciences to understand that once
you have a head injury it doesn't mean
that that's it for your brain.
There's actually ways, there are mechanisms
in which neural function can be restored.
And so that was very wonderful for me
as I was sitting there in the ICU,
as I was recovering in the hospital,
that trajectory of recovery was helped greatly by the knowledge
that I was presented with by my doctors, by my nurses,
and by my therapists.
That was enormously hopeful for me
because it meant I wasn't crazy.
There's actually such a thing called ICU delirium,
there's ICU psychosis.
Even though I saw that guy with the rifle pointing a gun
at myself and my son I learned from my doctors
that in fact that was not something
that was in my brain that was permanent,
it was something that would come and go.
It was a completely normal thing.
So that knowledge was really important.
So you as doctors interact with patients,
with patients like me, please give them knowledge
because that can really help to enhance the sense of recovery.
Another emerging theme was that the web of relationships
is very important in terms of recovery in many systems.
For example, on this relic tree forest system
there are some bird species that will never
cross that ocean of pasture.
If they're pollinators those plans that are pollinated
by them will not be pollinated.
But there are other birds and other insects that
will cross that ocean of pasture to go out
to that single isolated tree, and therefore the flowers
will be pollinated, the fruits, will be produced,
the fruits will be dispersed, and there
will be this continuation of the reproductive function
of that landscape.
And so for me this web of relationships
was very important.
For me to know that my brothers and sisters, my husband,
my kids, my friends were concerned about my recovery
was very important.
And I'll just give you a few examples
of how important this was and how it was
manifested in my own recovery.
My daughter Erica, just two days after my fall,
she was in Seattle, Washington, she
had a bunch of pictures on her MacBook Pro.
She went to a Kinko's, she printed out
a bunch of pictures of family, of friends,
she put them on a poster board and that poster board
accompanied me to all the different rooms in which I
was moved within the hospital.
So even if there were no human beings with me,
my family was absent or friends weren't there,
I still had these images of my family and friends
that kept me connected to this web of relationships.
I also subscribee-- my family also subscribed me
to Caring Bridge.
Caring Bridge is a fabulous tool for patients
to be in touch with their friends and their family.
It allows you to write blogs every week,
or anybody can write a blog.
People can subscribe to that Caring Bridge blog, can
keep in touch with how the recovery is going.
They can write their own comments of encouragement
which can be read at any time.
And so over the seven months that I
was in the hospital and sort of incapacitated
over 400 people subscribed to Caring Bridge, to my site,
and we got over 7,000 hits.
So that meant like 20 people a day were writing to me saying,
hey Nalini, how you doing?
Let me find out how you are.
What can we do?
Let me tell you a little joke, let me send you a poem.
So this was a way to keep in touch with people
not only who are close physically to me,
but people who were distant as well.
And finally, one of my really good friends, Chris Maynard,
took it in his head to make what he called a recover tree.
This was a giant branch and he elicited from all our friends
sending in leaves that little messages on them
that would encourage me.
And this hung above my hospital bed, it hung above in the ICU,
in the regular wards, and at home,
again reminding me that I was not isolated,
I was still a part of the web of relationships
of my former life.
The other thing about connecting is not
just how other humans but also connecting nature.
And as all of you know here in a hospital environment,
basically nature is kind of nowhere.
That we're separated from nature in almost every case.
Although I did see those wonderful nature photographs
as I walked through the lobby, which I thought was fabulous.
But one of the things that my graduate students did
was to make these tissue paper flowers.
They knew that they couldn't bring soil and plants
into the ICU so they made these tissue paper flowers which
were very important to me in terms
of providing color, providing a connection,
providing a thread to that web of connection to nature
that was just outside my window.
And this is something that isn't something
just that belongs to me, there's a huge and growing literature
on the importance of views of nature or nature imagery
to the recovery of human beings in especially hospital
locations.
Roger Ulrich published the first very seminal study
where he compared the health outcomes
of patients who looked out at trees vs. a concrete wall.
Found that there were fewer days in the hospital, fewer
narcotic drugs, fewer nurse complaints, fewer
complications.
And so we know that, in fact, nature views
are very useful in terms of making
patients feel less stressful, and can actually
increase their recovery.
There are a number of companies now
that create nature views, Sky Factory for example,
creates above ground views and sides of nature
so that people can see them even where there might be no windows
or access to the outside.
And one of the things I'd like to see promoted,
this is something I worked up much earlier,
is a product called Nature Wear where
we make botanically correct images on clothing,
we make them into attractive jackets
like I'm wearing right now.
And this is actually the image of a wonderful rain forest
canopy plant in Costa Rica called piper auritum.
We printed it on fabric, made this great jacket.
It comes with a little hang tag that
has information about the biology and conservation.
For instance, this is related to black pepper, which
is, you know, that you put on your scrambled eggs
in the morning.
So when I walk through or go to a coffee shop and someone says,
wow, I like your jacket, I can say,
well let me tell you about piper auritum.
It's [INAUDIBLE] to the black pepper
that you put on your scrambled eggs
and let me tell you how to contribute to the Rainforest
Action Network to promote it's conservation.
So I thought, well, if this is an idea that
could work for regular clothes, could it not work in hospitals?
Because one of the things I noticed in the hospitals
where I was saying is that the nurses and my own gowns
were like completely dull, completely colorless,
completely uninteresting.
And so I started a project after I got out of a hospital
to create a hospital Nature Wear.
And I worked with the Shriners Children's Hospital
in Salt Lake City, where I live.
We created some pilot examples of trees and outer space
symbols and birds and so forth that
were placed on patients and nurses
scrubs so that we could actually bring images of nature, not
just through windows or through these false video screens,
but also as people walk through the corridors.
So it's an idea.
I'd love to hear your response to it
to see if it has any merit.
But it's something that I think might
help bring this connection, this web of connection
between people who are in hospitals who are receiving
care after a disturbance to connect with nature,
if not outside then inside the hospital.
A fourth emergent property is functional shift.
That components of systems are actually, in some cases,
capable of shifting.
I talked to you just before about human development,
about attachment theory.
This idea that if a child loses a parent then
it's sort of doomed to not being able to
have trustful relationships.
But actually there can be a functional shifts, that
is if an uncle or a grandfather steps in in place
of father that might have disappeared or died then
the child is much less subject to the disturbance consequences
that might happen from that separation.
And so I began thinking about functional shifts
in my own recovery.
And for instance, my wonderful husband, Jack Longino,
did a tremendous amount of functional shifting which
made our lives just remarkably better,
and my reassurance that, in fact, we could
continue to live our lives.
I was always the one who used to cook breakfast, do the laundry,
make the beds and so forth.
Well Jack took that over.
And he took it over with joy.
As far as I could tell.
[LAUGHTER]
And I was so grateful for it.
And we've actually retained some of that.
Every now and then now, even though I'm
perfectly capable of making breakfast
he actually will occasionally make breakfast too.
And I don't think that would have
happened in previous times.
Not because of Jack's unwillingness to do it,
it's just that there was no void.
There was no place for him in which to move in to.
And so I think that this is a very simple kind
of silly example.
But what I learned from it is that other people in my life
were able to take on some of the things
that I thought I was irreplaceable for.
My graduate students took over some
of the capacity of some of the grant projects
that I had very easily.
They did it without effort.
They checked in with me.
They talked about it.
But they were carrying out the things
that I thought I was uniquely suited to.
And that was a tremendous lesson also.
The fifth and final emergent theme that came out of this
is what we started in our seminar, our colloquium,
calling the third state.
That is, sort of, we tend to think that after a disturbance
there is recovery and we return to our original state.
That's kind of the norm.
But what we found, as we recounted example
after example in discipline after discipline,
that, in fact, this recovery to an original state
hardly ever happened.
That what would happen is that would
recover to a second state or a third state
or a fourth state or a fifth state.
And so that is something that I really have to think about.
And we can think of that in terms of the urban planning
faculty member, for example, who was
studying the effects of Katrina on urban ecology of New
Orleans.
Had looked and analyzed the sort of original neighborhoods,
the disturbed neighborhoods of Katrina's effects
and then following that, what got rebuilt?
How did those neighborhoods change in terms of culture,
in terms of architecture, and in terms of interactions
with other neighborhoods?
And she found that it did not return to its former state,
but instead turned into a third state, a forth state,
and a fifth state.
And that's kind of what I have found too.
I mean, I have been able to recover remarkably,
especially when you sort of go back to me
in ICU, me with my walker, and my collar
and so forth, and then me on my anniversary right here,
the anniversary of my fall.
This was July third of this year.
I went back to my field site in the Olympics.
I went back to the very tree that I had fallen out of.
I put my hand on that trunk of that tree
and I just burst into tears.
But they weren't tears of anger or rancor
or sadness or disappointment.
It's like this rich mix of emotion
that I felt as I touched that tree.
And I sat there for an hour by myself.
Then I walked back to my car and I put my backpack on
and I solo hiked 38 miles up and over the Olympic peninsula.
And did it in two days.
I was so happy.
Because that was when I had try to envision myself
as as I was lying in the ICU.
Will I ever climb those mountains?
Will I ever go into that forest again?
And I was very happy to be able to do that.
But I'm still at a third state.
Why?
Because my fibula is still broken.
It's a non-union.
My doctor, my orthopedist, says, you know,
it's never going to heal.
And I find that I cannot run more than three miles.
After three miles I just-- it hurts too much.
So I'm not sort of back to that person
who was routinely running half marathons.
I can hike over the mountains.
I'm back at work.
I can climb trees again.
But I'm not quite back to myself.
I'm in a third state.
Now when I was talking about this to my brother
Mohan yesterday night he shook his head and said, Nalini,
what is with you?
You were near death, you were like almost dead.
And now you can hike 38 miles, you
can run three miles, what are you complaining about.
And I said, I'm not complaining I'm just
recognizing that in fact this disturbance has
had an effect on me.
I've come to understand it better thanks to the tapestry
thinking that I've been able to garner, the understanding
that I've been able to get from these other institutions.
But you know, I'm still not sure who I am on the bottom line.
I'm still not sure who I am now.
So I don't have that answer to give to you.
But what I would like to do in the last few minutes
is to play you a very short video that kind of explains
maybe where I might be.
Thank you.
[APPLAUSE]
ROSS BUERLEIN: My name's Ross Buerlein,
I'm one of the chief residents of the Department of Internal
Medicine.
And on behalf of the Department of Medicine
I just wanted to say thank you so much for the excellent talk.
I thought it was striking that we often
see patients in a time of recovery
but we don't see them in a time of their disturbance.
And so perhaps if we could better
look at the patient's disturbance
and how it affected them so individually
and uniquely we could connect with them on a different level
and learn something that could help us
with our own emotional resilience
as we challenge the disturbances that
are going to happen in our own lives,
whether we see them coming or not.
So thank you so much for that.
At this time I would like to open the floor to any questions
or comments for Dr. Nadkarni.
AUDIENCE: I almost never get to ask a question.
I'm Marsha Childress from the Center for Biomedical Ethics
and Humanities.
You talked a lot about and showed
us some of those examples of bringing visuals of nature
into the more sterile hospital settings, including your tree
bow with all of the leaves from friends.
I'm curious too, are there opportunities
for us to introduce nature's soundscapes into settings
like this.
And I was moved particularly by her comments
about what it was like to be alone at night.
And what about nature at night?
NALINI NADKARNI: I think that's a splendid idea.
Sort of grown from that one study I mentioned,
Roger Ulrich's study just did this very simple metrics,
looking at seeing visual-- a real tree and not concrete.
That spawned hundreds and hundreds
of articles about the use of nature imagery of all kinds
in places where there's a nature deficit.
And it's valuable in terms of cognitive ability,
in terms of reduction of stress, in terms of speedy recovery,
and so forth.
And nature sounds are a part of that.
There are probably 50 to 100 articles
that have focused specifically on bringing in a nature sounds
to people who are deficit.
I've been working in prisons a lot
also, bringing science education and nature conservation
projects to incarcerated men and women, especially in--
and we've been doing that with nature
to the minimum and medium security folks,
but we can't do that with the men and women
in solitary confinement.
So we've been bringing these nature videos in.
And one of the comments and things
we've recorded in our case studies
work and our surveys has been that it's
the sounds that very often trigger
their sense of reduction of stress, of calming,
of soothing, of loss of the sense of aggression,
and so forth, which they can then
bring with them in sort of a self-regulatory way back
to their cells.
We've been administering these in their exercise rooms.
So I think there's something really there.
And because sound can be administered with headphones
very easily with an iPod cast, it
makes perfect sense that would be something that could be,
I think, fairly easily done.
I mean, I don't know the world of hospital administration
and what the rules and regs are, I'm more familiar with prisons.
But you guys know about what is and isn't allowed in terms
of administration to patients.
And again, speaking from my own experience, someone
who is attuned to nature sounds, if I
had had a podcast or some sort of way
to listen to nature sounds during those empty nights
when there was nobody, you know, my family wasn't there
or my friends weren't there.
It would have been enormously comforting to hear the crickets
or to hear the rainforest sounds that to me evoke
a sense of things are OK, things are all right,
you're still connected to nature even though it's not right
there.
I think that's great idea.
AUDIENCE: I'm Kristen Reynolds and we're all very glad
that you are standing been before us.
NALINI NADKARNI: I can't see who's--
AUDIENCE: I'm here.
NALINI NADKARNI: Oh sorry.
Yeah.
AUDIENCE: So we're very glad that you have
survived to share this story.
Your parents were really a model of resilience.
You father in a scientist and both of them
from very different spiritual backgrounds.
How did their life also open for you
different ways of thinking about spiritual growth
now that you're in that phase of your own learning and journey.
NALINI NADKARNI: That's a great question.
And I have thought about that quite a bit.
I think all my siblings have.
Because we have such a unique, well it wasn't unique,
I'm sure there are many oddball families out there.
But when felt ours was sort of different because we grew up
in suburban Maryland, my dad worked for the NIH,
so he'd get into a suit and go out every day.
But when he came back and they were home we'd eat Indian food,
we sat on the floor, there was hardly any furniture.
I didn't know that people used two sheets,
you know, for their beds until I went
to patrol camp in sixth grade because we were sort of living
in an Indian household.
At the same time, you know, there was the menorah
right next to Ganesha on our little family alter
and we would celebrate passover.
So we had this sort of mix.
And I think what that told me number one, what
it taught me is that all religions are essentially
the same.
All spiritual truths are the same.
They have different clothing, they have different holidays.
and they have different-- you know, in one religion
you can't make an image of God and in the other
you have 8,000 deities that represent God
that all look different.
So but what we learned was that the two religions,
and therefore all religions, can knit together seamlessly.
And that you can therefore find spirituality wherever
you would like to find it.
And I myself, did not find it in Judaism nor with Hinduism,
although I respect both religions,
but I find my spirituality in nature.
I find that as my holy place.
It is a place where I happen to work but it is also
a place where I renew myself, where I feel connected,
where I feel I am not alone, which is really,
I think, the essence of what spirituality is about.
I think the other thing is that my parents-- their life
together revealed to us, to me anyway,
that despite prejudices that outsiders might
inflect, negative judgments.
Like my parents couldn't get married in Washington
DC in 1951.
Why?
Because my dad had dark skin.
And so that was considered miscegenation.
He was considered an African-American.
They had to go to New York state to get married.
So our own nation's capitol didn't even
honor a marriage between these two.
But I never felt as a child that there
was anything different, really, or wrong or disastrous
about my four brothers and sisters and me.
And I think that was another gift that they gave us,
another way that I have come to say,
you know, traffic engineering and urban studies
and human development and economics and forest ecology
and medicine, they're all kind of the same
and there's no judgment.
I don't feel any judgement from all of you
because I'm not wearing my white coat.
So I sort of walk through life with a sense that I'm OK.
And I think a lot of that comes from my parents who said,
we're OK.
It wasn't that it was easy, necessarily,
and who knows what went behind closed doors
in terms of their own sense of their place in the world.
But as a child of theirs I feel completely
accepted in terms of who I am, what I try to do for the world.
AUDIENCE: Nal, you're not OK.
[LAUGHTER]
NALINI NADKARNI: This is what I lived with.
[LAUGHTER]
AUDIENCE: My name is [INAUDIBLE],
and I was touched by your speech.
I think this is one of the powerful speech
that I ever heard in my life.
I am a person, I'm here as a result of disturbances.
I am a refugee from Ethiopia.
NALINI NADKARNI: I see.
AUDIENCE: I came ten years back here,
now I am a BNP student, just ready to finish,
you know, wrap up my-- so disturbances, technically,
if we [INAUDIBLE] them properly can open another
chance and opportunity.
And thank you for giving us this powerful speech.
I think it was amazing.
NALINI NADKARNI: Thank you very much.
I think, you know, you were saying
how-- when I was interacting with my colleague who
works with the refugees she talks
about how difficult it is to assess
the effect of refugee movement.
On the one hand, you're forced to flee, you give up your home,
you give up your friends, you give up the land,
you give up so many things when you have
to come to another country.
On the other hand as she said, as I talked about,
there are some opportunities here
that you couldn't get in your own country,
so that's a positive.
And there are what she called anchor families, those families
who hold on to their culture, their costumes, their food,
and they become very important members of the refugee
communities where they live because they
are holding on to that.
But then there's a negative part of that which is, well,
if you hold on to that then you're not being sort of free
and part of the society where you are here.
And so this is constant plus, minus, plus, minus.
And I think all of us as perhaps western human beings
are very uncomfortable with that plus, minus, plus, minus.
We want to hear is it plus or is it minus.
And that's how I feel about my own disturbance,
and perhaps you and maybe other refugees
feel about their disturbance, that in fact there
are pluses and minuses, can I hold them together in my head
and accept that there are both.
Or do I have to somehow push the negative so that it's all
positive, or push the positive so that it's all negative.
And again, I don't have the answer to that.
But I think it's really interesting
to know that in all of the disciplines that I pulled
together the representatives spoke about this bifurcation,
this is plurality of emotions or assessment
that we have to deal with if we're thinking
about disturbance and recovery.
And that is a challenge, I think,
for all of you who are always dealing with disturbance
and recovery I would think that there is this positive,
negative always going on.
ROSS BUERLEIN: OK.
Anybody else want-- any questions or comments
or anything?
Well help me in thanking Dr. Nadkarni one last time.
Thank you.
[APPLAUSE]