The Me in Medicine: Reviving the Lost Art of Healing by Patrick Roth, MD

For more information about the book, go to The Me in Medicine: Reviving the Lost Art of Healing.

What follows is a typical visit to the physician for back pain in the United States: A person hurts his or her back and sees a doctor for a complete workup. The clinician, careful not to miss anything, orders an MRI that is subsequently read by a distant radiologist. The report is sent back to the physician who, depending on the results, calls for a follow-up appointment to discuss outcomes. It is likely that the patient is sent to a physical therapist, who provides a therapy regimen based on the radiology imaging and his or her own experience without need for the physician’s specific prescription. While much can and has been written about this typical medical experience, from its inefficiency to its reliance on medicalization and overdiagnosis, it is the fragmentation and lack of contextualization that Dr. Patrick Roth has highlighted in his latest work, The Me in Medicine: Reviving the Lost Art of Healing.

With an increasing reliance on technology and the expansion of artificial intelligence in medicine, Dr. Roth paradoxically calls on physicians to embrace their philosophical faculties. He proposes that narratives, developed through introspection, as well as teaching, mentoring, and writing, are the missing components in our medical system today. The onus is on both patients and physicians to develop individual and, when they come together for a clinical encounter, shared narratives on health, disease, and treatment for better overall care.

For the patient, narratives mean coming to understand how he or she views health and disease. As Jerome Groopman explains in his book, Your Medical Mind, and Dr. Roth highlights in his, people have a spectrum of temperaments with regards to intervention: Some believe strongly in the human body’s regenerative capacity (naturalist) and others believe strongly in science, technology, and medicine (technologist). These proclivities are important for the patient to consider when making medical decisions, but only represent one piece of the puzzle.

Patients must also consider unconscious cognitive biases they have when making their decision for treatment. Common cognitive biases include the availability heuristic, a mental shortcut in which a person makes decisions based on readily available examples, and hyperbolic discounting, in which a person discounts future reward because of the time delay between the decision and the reward. For instance, using the availability heuristic, a patient may be hesitant to undergo a procedure because a friend had a similar procedure that did not end well, whereas using hyperbolic discounting, a patient may prefer a procedure because they perceive the reward as immediate as compared with the longer treatment course of physical therapy. While highlighting the patient’s decision-making heuristic is certainly not easy, it serves to both increase patient autonomy and satisfaction with outcomes.

The complexities of these medical decisions is the space where physicians, equipped with their own medical narratives, help the patient decide what is best. The physician has the ability to provide the context necessary for the patient’s choice. For this reason, it is incumbent on the physician to become a good storyteller. It is not enough to lay out all the options with statistics or paternalistically make the decision. Rather, believes Dr. Roth, the physician most effectively communicates through anecdotes and analogies for understanding disease ontology and treatment decisions.

There are a number of tools at the disposal of physicians and patients to accomplish these lofty, yet achievable goals. With honed doctoring skills, the physician can extract the patient’s motivations and contextualize them to reach a sustainable and satisfactory outcome. Further, the physician can foster self-efficacy and promote a deep education about disease. The patient, on the other hand, possesses knowledge that the physician is not privy to, i.e., the phenomenology of the disease. By joining support groups and forming online communities, patients empower themselves and shape the narrative of their needs for the medical community. Engaging in these exercises shapes not only the character of the patient and physician, but the disease process too, as it reforms a patient’s reality through changes in their thoughts and perceptions.

Medical science and technology naturally lend themselves to a reductive materialism with an approach that parses apart reality into molecular cascades and biotargets on which intervention is possible. Analogously, medicine, as a distinctly human endeavor, naturally lends itself to storytelling—the currency of effective communication and change. As such, Dr. Roth makes a formidable case for narratives as a staple of holistic medical practice. Narratives reform environmental context, which in turn shapes us and our health. With technology and specialization playing an ever-expanding role in our healthcare system, it will remain paramount to scrutinize our narratives and ensure they are always in service of our patients. — John Paul Mikhaiel

---

JP Mikhaiel is a medical student at Georgetown University School of Medicine. After earning his BS in neurobiology and philosophy at Georgetown University, he spent two years at the NIH researching brain-related disorders. He is currently a member of the Literature and Medicine track at Georgetown University, and serves on the management board for the coaching program, A Whole New Doctor. His work has been published in Scope, Georgetown’s literary journal. Mikhaiel plans to pursue a career in neurology.

The Moon Prince and the Sea by Daniela Rose Anderson

The world of pediatric oncology is one of extremes. The diseases strike unexpectedly, cruelly, and without discernible cause in the midst of childhood, a time of remarkable growth and innocence. While these diseases were once a death sentence, the improvements in survival rates (in places where the latest treatments are available) have been dramatic: five-year survival rates of near 90% compared to 10% just forty years ago. Even so, the burdens of disease and treatments are high, and of course, death still comes too often. Among the tribulations of the pediatric cancers, beauty can be found in the lives and loves of the children and families. One aspect of beauty is the compassionate connections that can develop between the children affected. In The Moon Prince and the Sea, Dr. Daniela Anderson captures this beauty in both words and pictures as she tells a fantasy story based on actual patients. 

Sumit is a boy in rural India who travels for days to get to the hospital for treatments for an undefined serious illness. As he physically recovers, he connects with other children in the hospital. He also learns of a girl named Marina in a distant country (the US) who has cancer as evidenced by her bald head and connection to an IV pole. He is touched by her story and dreams of her. He paints her a picture with two moons—one on earth and one in the sky—and sends the picture and a brief letter of encouragement to Marina. Far away, she receives his gifts and feels both connection and comfort.

After he returns to his country home from the city hospital, Sumit is not able to return for more treatments because of the family’s lack of resources. A caring nurse travels to Sumit’s home to find him with hopes of continuing his treatment. The neighbor children, however, inform her that Sumit is now “in God’s home.” But in Anderson’s imagining, the story has not ended and Sumit’s connection to Marina continues. 

Back in her hospital, Marina waits until family and friends are ready, and then she closes her eyes and takes her last breath. In the next place, she and Sumit are united, healed, unafraid, and bound together. 

Anderson’s watercolor illustrations are rich and vibrant, and they evoke feelings of comfort and compassion. Sumit has a yellow silk cape that both connects him to the moon and presents him with a certain regal dignity and resilience. His cape and bearing mark him as “the moon prince,” while Marina’s name means “the sea,” and thus the book’s title. While Marina is surrounded by family and the best of medical care and resources, there is a sense of vulnerability as her disease puts her beyond all efforts of cure. Understandably frightened, she has a quiet strength as she waits to take her last breath until her family is ready. Hand in hand, Sumit and Marina then travel on together, connected to the mystery of the unknown while rooted in the known, which is love. 

Children with cancer and other serious diseases are, of course, like the rest of us—not always saints, not always wise and inspirational. Yet there is something striking about the experience of a life-threatening illness at a time of life wired for dramatically persistent growth. Such children often have and show stubborn resilience and focus their time and attentions more on the prospects of living rather than dying. And if death comes, it is not uncommon that they demonstrate deep compassion for their family and their fellow patients—others who suffer. Anderson captures these aspects of children and illness in the story, which treats death as both ending and beginning. There is real sadness, of course, in the story because it is faithful to the truths of terminal childhood illness. Nevertheless, the strongest feelings and impressions are connection, compassion, and transcendence, and these are other real truths at the intersection of the worlds of childhood and illness. — Greg Adams

---

Greg Adams, LCSW, ACSW, FT is Program Coordinator for the Center for Good Mourning and Staff Bereavement Support at Arkansas Children’s Hospital in Little Rock, Arkansas. His work of 27 years at Arkansas Children’s Hospital includes time in pediatric oncology, pediatric palliative care, and grief support for staff and community adults, adolescents and children. He also writes and edits a grief/loss electronic newsletter, The Mourning News. Other current related experiences include teaching an annual grief/loss elective class in the University of Arkansas-Little Rock Graduate School of Social Work and chairing the Credentialing Council for the Association of Death Education and Counseling.

Blessings and Sudden Intimacies by Greg Stidham, MD

Blessings and Sudden Intimacies: Musings of a Pediatric Intensivist, a 2016 memoir by Greg Stidham, MD, begins with a “sudden intimacy,” an encounter with a parent whose son has just died.  The boy’s mother, after asking Dr. Stidham's permission, takes hold of and strokes his beard, an emblem of his sense of self.   

It's that kind of startling detail, one remembered and deeply felt, that stands out in this medical memoir. In many ways, the author followed the normal trajectory of a clinician's path: After growing  up in Cleveland, and excelling in school, Dr. Stidham attended Notre Dame and the Medical College of Ohio.  In the 1970s, he was a fellow at Johns Hopkins, which had one of five Pediatric Critical Care training programs in the country.  What starts to emerge in the narrative is Dr. Stidham's heightened sense of purpose: He went on to establish a pediatric palliative care program, the first in the region, at LeBonheur Children’s Medical Center hospital in Memphis, where he spent twenty-eight years of his career.

Encounters with critically ill and dying children and their parents present the poignant “sudden intimacies” of the book.  The “blessings” of the title refer to the young patients, families and healthcare personnel who touch him.  But they are also more broadly defined, as when Dr. Stidham writes about his early career, that “without that training and the opportunity to gain [pediatric critical care] expertise I would not have had the adventures that blessed the rest of my life.”  The book is just as much about his personal as his professional life, and he says the two are “inextricably intertwined.”  This is reflected in the structure of the book, which moves around in time and ranges wide geographically.  We are taken on hiking trips to Colorado, camping trips in Arkansas, to Nicaragua where he helped set up a pediatric cardiac surgery program, and to Kingston, Ontario where he moved late in his career.

Dr. Stidham frankly relates his own marital and health problems, numerous enough to raise the question of how much his personal life suffered from the professional toll of long hours, nights on-call, and the emotional strain of dealing with dying children and their families, a potential conflict he doesn’t address directly.  Instead he conveys his belief that life is extraordinary, and that he has done unusual and extraordinary things with his.  He maintains an optimistic world view, a mindset that gives him the empathy and strength needed to sustain a long medical career.

Dr. Greg Stidham

Blessings and Sudden Intimacies makes you think about what you’ve done with your life, yet somehow Dr. Stidham leaves you feeling that whatever you’ve done, it’s enough.  He writes with disarming charm:  “Every life is rich in its own unique way, and deserves commemoration.  Perhaps it is, in part, for those others that I write, for their rich, but otherwise uncommemorated lives.”  He certainly conveys the richness of his own.—Priscilla Mainardi

---

PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently The Examined Life Journal and Prick of the Spindle.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.  She joined the editorial board of the Intima in 2015.

Anatomies: A Cultural History of the Human Body by Hugh Aldersey-Williams

In Hugh Aldersey-Williams' Anatomies:  A Cultural History of the Human Body (W. W. Norton & Company, 2013), he poses a quasi-cultural, and intentionally un-anatomical, rationale for his constant middle of the night urination troubles: he’s getting old. The book does not offer a detailed glimpse into any specific disease, nor does it follow any individual navigating through a disease process. However, Anatomies allows the reader, regardless of training or background, to enjoy humorous anecdotes that explain how our cultural interpretations of our bodies, and what disease can do to them, have been shaped for centuries.  

Aldersey-Williams makes known his disdain for doctors’ predilection to use overly obtuse medical definitions for body parts, like saying coxa for hip.  He flexes his wit and knowledge on some of the most complex of organs while seamlessly jumping from micro to macro levels of anatomical and cultural understanding.

While tackling the larger questions that researchers continue to disagree upon, such as what constitutes an organ, the author also poses questions mystifying and ridiculous in equal parts, asking how we join many other species in the act of grooming yet we are unique in our development of hairstyles. He allows you to draw from the experiences he has accumulated as a field researcher as he reports drawing limbs and organs from the formaldehyde confines of an anatomy lab, to sketches of live subjects, and onto the assessment of dancers’, and our own, physical limits. 

The book, much like a textbook sitting on the edge of a cadaver tank in the anatomy lab, is broken up by region and body part. When read through continuously, this layout can prove to be a little disjointed, but the separation of topics allows for a seamless re-entry into the text after prolonged periods of interruption. Anatomies will hardly provide direct insight into any one area, but opens avenues of thought into how we perceive ourselves, each other, and the most famous around us.— Salvatore Aiello 

---

Salvatore Aiello M.S. is a medical student at Chicago Medical School at Rosalind Franklin University. After graduating from University of Michigan, he found that his minor in writing had the most lasting utility in both his academic and creative pursuits. Salvatore has several scientific articles published in peer-reviewed journals and has contributed to the blog, In-Training. Beyond his coursework and writing, he is described as the Benevolent-Overlord of the Medical Humanities Club where he works with his colleagues to promotes resiliency in physicians and all healthcare professionals.

Barriers and Belongings: Personal Narratives of Disabilities, Edited by Michelle Jarman, Leila Monaghan, and Alison Quaggin Harkin

An Iraq veteran fighting the “quiet conflict” of PTSD, a woman with memory loss who hides her disability as well as her misery, a man whose traumatic brain injury helps him make sense ofhis brother’s disability.  These are a few of the many voices we learn from in Barriers and Belongings.

At first glance, the book is a disabilities studies textbook with an introduction and chapter openings that provide background on social and cultural approaches to disability, as well as useful definitions.  But Barriers and Belongings is much more than a textbook:  it’s an eye-opening collection of lives, told with honesty and moving candor.  The narratives, which are organized into sections around themes such as communication, family and relationships, are engaging and short, allowing room for many different points of view.  Most are written from the perspective of early adulthood, reflecting back on growing up, which gives them an appealing coming-of-age quality.  The writers lead us up to the moment their conception of their disability changes in some way.  The ways are as varied as the disabilities themselves, which range from acquired conditions such as PTSD and chronic pain, to congenital conditions such as cerebral palsy and Down Syndrome, to mental health and cognitive conditions.  Because of these many viewpoints, one writer identifies the need for “people with diverse disabilities [to] recognize our common struggle” in order for the disability movement to reach its “full potential to change society.”

For the book is as much about the larger society as it is about the individual stories.  Most of the writers see disability not as a problem to be solved but as an integral part of themselves, and want to reframe disability from a nonsocial and nonmedical perspective.  As one writer puts it, “I wonder how the world would be if everyone realized that normal didn’t exist, and that trying to achieve normalcy was futile.  What if disability didn’t always need a cure?  What if everyone equated disability with difference, not deficiency?”  Or as another writes:  “Sometimes, abnormal is normal.”

---

PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently The Examined Life Journal and Prick of the Spindle.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.

Catching Homelessness

When I read Josephine Ensign’s piece in this spring’s Intima and saw she had a novel coming out soon, I immediately wanted to read it.  The book, Catching Homelessness: A Nurse's Story of Falling Through the Safety Net, published this year by She Writes Press, doesn’t disappoint.  Ms. Ensign brings her masterful crisp prose and extensive experience as a family nurse practitioner, writer and teacher to the issue of homelessness, and offers an engaging, informative and moving memoir.

Catching Homelessness begins with Ms. Ensign’s childhood growing up at a camp near a Civil War battlefield, “a landscape of ghosts and half-buried violence, covered in violets, punctuated by deep, abandoned wells.”  But the memoir’s main focus is Richmond, Virginia in the 1980’s, when Ms. Ensign was a newly minted nurse practitioner running a health clinic out of a homeless shelter.  Her perspective of the homeless changes from her initial view of them as “exotic, impoverished, foreign-to-us people,” to real people with real problems:  Lee, “dressed in several layers of hospital gowns, with the vulnerable air that clings to them,” who when dying of AIDS names Ms. Ensign as his next of kin; schizophrenic Louie, covered in head lice; pregnant Sallie with an IQ of 45.  Ms. Ensign changes our view too, reaching us on an emotional level with these and other precisely drawn characters.  We pick up a lot of knowledge along the way, not just about homelessness but also about the origin of the nurse practitioner role, the geography of Richmond and the lingering effects of its history.  We learn to empathize with the people drawn to serving the homeless.  

Josephine Ensign

    As a young new nurse at the Richmond clinic, Ms. Ensign recalls, “I still wasn’t sure how far I’d go, what I’d risk catching in the name of compassion or health care duty.”  Run-ins with Richmond’s male-dominated medical establishment, disillusionment with her Evangelical Christian upbringing, and a failing marriage lead to Ms. Ensign’s own homeless crisis, an experience which enables her to bring a unique perspective to the issue.  By the end of the book, you feel you’ve read a good story and learned a lot too.  And you’re sure to take the advice she offers in the book’s comprehensive appendix, and respond to the next homeless person you meet with a smile and a kind word. -- Priscilla Mainardi

---

PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently Blue Moon Literary and Art Review and The Examined Life Journal.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.

Sleepwalker: The Mysterious Makings and Recovery of a Somnambulist

UPDATE, May, 2017. Kathleen Frazier, a Columbia University Narrative Medicine Masters student, has won the 2017 Independent Book Publisher Award for Best First Book – Nonfiction, for her memoir, “Sleepwalker: The Mysterious Makings and Recovery of a Somnambulist.” Book Award Listings (see #83):  2017 Independent Publisher Book Award. We'd like to congratulate Kathleen and urge you to read this enlightening book.

A picture of a very young Kathleen Frazier stayed with me throughout Sleepwalker, her fascinating memoir of the effect of her sleep disorder on her life.  Ms. Frazier’s sleep problems begin in earnest at age twelve and range from insomnia to sleepwalking and night terrors, from which she awakens screaming in fright and occasionally in perilous situations.  She blames herself for these problems and hides them, afraid that if anyone learns about them they will lock her up.  Though living in a constant state of exhaustion and fear, she attends college, moves to Manhattan, marries and divorces, and pursues an acting career while holding down numerous waitressing jobs.  Her sleep problems continue through her twenties as she self-medicates with alcohol and, unable to sustain intimacy, becomes promiscuous. 

Ms. Frazier is the youngest of five children whose parents are not without their own problems:  her father is a recovering alcoholic and insomniac and her mother experiences night terrors.  The stories they tell about her grandparents also hint at sleep problems, and the book raises the question of whether sleep disorders have a genetic component.            

Sleep science is in its infancy, and Sleepwalker illustrates the lack of understanding of sleep disorders among medical professionals as well as the public.  Ms. Frazier eventually finds help from a doctor who specializes in sleep disorders.  She starts to sleep better, first aided by medication, then through a combination of diet, therapy, lifestyle modification, and the support of friends and her newly established family.  She comes to recognize the role of her own denial and of traumatizing events of her childhood in her sleep disorder.  She begins to write Sleepwalker, and telling her story becomes an essential and integral part of her recovery.--Priscilla Mainardi

---

PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently Blue Moon Literary and Art Review and The Examined Life Journal.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.

Interview with Kathleen Frazier, Author of Sleepwalker

I talked to Kathleen Frazier, author of Sleepwalker: The Mysterious Makings and Recovery of a Somnambulist, recently on her lunch hour from her administrative job at Columbia University, where she has been accepted into the Masters of Science Program in Narrative Medicine.

Congratulations on the publication of Sleepwalker and its continuing success.  I read that your agent signed you after reading your piece about sleep disorders in Psychology Today.  Very nice story.

Thank you.  I originally wrote that piece for Modern Love [the New York Times column] but they turned it down.  It really belonged in Psychology Today.  My proposal was based on that essay.  Years before, in the late 1990s, I’d begun writing down my memories from sense memory exercises at The Actors Studio.  But I felt too much shame to share the sleepwalking publicly so I turned the memories into young adult fiction.  The teen protagonist was a sleepwalker but the material was too dark for the young adult market, though it wouldn't be now.  The turning point for me, in regard to my decision to write the memoir, was the tragic death of Tobias Wong, who hung himself in 2010, most probably while sleepwalking.  Soon after, I took an essay writing class and my teacher pointed out that my memoir was really a love story.  (I'd met my husband just days after a severe accident I had in the middle of a sleepwalking/sleep terror episode.)  My agent helped me focus the story on my sleep disorders as they related to my relationships and my fear of intimacy.  I was especially terrified of being seen as a freak, even as a child.

How common are sleep disorders?

More common than people realize.  Dr. Mahowald, who wrote the foreword to my book, was a Principal Investigator in the first national study ever conducted on nocturnal wandering in the United States, in 2012.  The research showed that almost thirty percent of Americans have experienced at least one episode. Sleep disorders, especially insomnia and sleep terrors, can often be related to trauma.  You see them in PTSD and chronic trauma, for example in victims of child abuse, domestic violence, rape, and other crimes.  And, very much in the news, we see debilitating sleep issues associated with our soldiers returning from war.  Sleep is inextricably linked to our mental health.

 The book raises the question of whether there’s also a genetic component to sleep disorders.  You write that your father was an alcoholic and your mother also suffered from night terrors. 

Yes, it does raise the question of genetics.  My father got sober, which was unusual for that time.  Later he relapsed on sleeping pills, though at the time no one recognized this as a relapse.  He suffered terribly from insomnia, from the trauma of WWII.  Both my parents survived alcoholic homes and both had unpredictable fits of rage. 

Acting seems like an odd choice for someone who wanted to be invisible as a child, as you write. 

I used to sing as a child, at a neighbor’s house. Some part of my spirit wanted to express itself that way.  Doing work on stage made me feel so happy and connected to that part of my spirit. I was “bit,” as they say, the first time I was on the stage as a senior in high school. 

You were afraid to share your sleep problems with anyone, afraid of being diagnosed as mentally ill.  Did you really think you were mentally ill, since you functioned pretty well during the day?

I did the best I could, but I was functionally affected.  There was a lot of denial.  I had read about my sleep disorders in Psychology Today when I was sixteen and the message was to tolerate them.  By the time I finished theater school in New York, I was constantly exhausted, unable to go for auditions, even though they were important to me.  My insomnia worsened for fear of having episodes.  Sleep deprivation is a form of torture.  I began self-medicating with alcohol and became promiscuous in a city that was burgeoning with Aids.  This was self-abusive and a hidden cry for help.

And now?  Are you fully recovered?

I still have an occasional night terror when I’m under stress or get triggered, for example by violence in a movie.  I haven't left my bed in over 20 years.  Still, I remember how unsettling it was to be told that I did something while sound asleep without any recollection.  Just as frightening was to wake up during a night terror, like waking up in the middle of a horror movie. 

What are you working on now?  

An historical novel called Selkie Girl inspired by my Irish grandmother, about a girl at the turn of the last century whose unwed mother commits suicide on the night she’s born.  She’s ostracized by her village and forlorn that her mother abandoned her. A kindly grandma figure consoles her, and tells her that her mother was a selkie, a seal which, according to Celtic legend, sheds its skin to become human on land.  I won't say anymore—don’t want to spoil it—but the book incorporates a lot of the intergenerational trauma that I explored in Sleepwalker.  

What about acting?

I participate some at the Actors Studio, but lately my creative attention has been towards my writing.  I've had the challenge recently of using voice-activated software because of wrist injuries.  I also narrated my book for Audible and am creating a podcast about sleep which will focus on people's narratives.

Has Sleepwalker helped a lot of people?

My dentist recommended it to a patient.  Another dentist I know had a patient whose teeth were ruined because she would get up during the night and chew on ice chips.  Some people make and eat whole meals while asleep.  Readers seem to identify with my story, with the connection between trauma and sleep problems, and they pass it along to others who might benefit.

Shortly after this interview a family reached out to Ms. Frazier to tell her how much her book comforted them after the tragic death of a family member while sleepwalking.  Ms. Frazier wrote in an email:  “The fact that my book came out only two months before this death is for me a sign that it has the potential to educate, comfort, and I hope maybe prevent injury and even death by sleepwalking. I am very, very grateful that sharing my story could bring this family any bit of comfort.”

The Editors at The Intima are in turn grateful to Ms. Frazier for sharing her thoughts and ideas with our readers.—Priscilla Mainardi