A Bold New Idea
Dr. Anastasia Rowland-Seymour, a clinician and assistant professor of internal medicine at Johns Hopkins, is accessing the hospital database on the black Dell computer mounted on a small corner desk in one of several generic ten-by-ten Hopkins exam rooms. She’s reviewing my blood work and specialists’ reports from the past decade. The manila patient file that sits open below with my name on it is two inches thick.
It’s unlikely to faze her. Which is why my own internist, who has recently relocated to Boston, sent me her way.
I have heard Rowland-Seymour’s name in medical circles for some time. Despite the fact that—at age thirty-nine—she is one of the youngest internists in the Hopkins group, word has spread that she’s the doctor whom you see—or try to get to see—when Western medical care has done what it can do. She came to Hopkins after doing an integrative medicine fellowship with Dr. Andrew Weil at the University of Arizona School of Medicine. Before that, she spent most of her time working in inner-city Manhattan, getting her start in medicine working with women and children suffering from human immunodeficiency virus (HIV)—in Harlem. She walks the hard path with patients, incorporating the best that traditional medicine has to offer with alternative practices many patients have never tried or even heard of before. Although she has only been at Hopkins for a year, all second-year medical residents are already required to do an outpatient rotation in integrative medicine with Rowland-Seymour. Her practice is full, and her wait list long.
“You’ve been through a great deal in a relatively short period of time,” she says. She looks up at me. Her brown eyes are penetrating and bright behind wire-rimmed glasses. Her shoulder-length hair, pulled back tight from her forehead into a ponytail, springs wildly free once past the confines of the elastic band that contains it.
After ten years of hospital stays I think I’m ready for any question but not the one she asks: “I’m just wondering . . . did anything happen in your childhood that could have contributed to all this?”
I’m speechless.
Nowhere in my medical record does it reveal that my father died from a medical error during routine surgery when I was twelve, or that my widowed mother seemed to disappear into her own grief.
“My dad died suddenly when I was twelve . . . he bled to death after an operation for an inflammatory bowel condition. He had the same bleeding disorder I do, and his own autoimmune struggles.” I pause. “My mom was shocked and understandably quite sad and . . . everything changed.” I shrug, or try to. “After that I was pretty much left to figure things out on my own.”
There is so much I am leaving out: the sharp blow of loss, coming to terms with the medical error that led to his sudden death, my mother’s plunge into a well of grief. An extended family imploding. Something old crosses a deeper recess of my brain, one level down.
I don’t take that elevator. I blink twice.
She nods, her smile soft, as if she is not surprised by what I’m saying or that I’m leaving out everything important. It strikes me that she is not wearing the requisite doctor’s white coat, but a soft, beige blouse and black slacks. “Sometimes a kind of brain-body stress—the precursor to an inflammatory response—is set in motion early on, in childhood, and we see the illness years later. What we’re starting to find in the research is that traumatic events that occur in childhood can change us not just on an emotional level but on a cellular level, too.”
I am staring at her, my eyes squinting, trying to follow. I expected her to ask about my sleep, my supplements. But . . . my childhood?
She tilts her head ever so slightly, as if sensing my surprise at hearing a Hopkins physician talk about mind-body from a psychobiological perspective.
“Sometimes a harmful brain-body stress cycle gets set in place during a childhood trauma,” she repeats. “Or it might be triggered by present stressors, or stem from both. Whatever the catalyst, in addition to treating all the physical symptoms, we have to try to rewire the brain-body connection so that we can help to quiet that stress-induced inflammatory response, calm the immune system down, and give healing a chance to happen.”
Despite being a science reporter, I find this a lot to grasp in five minutes. “Are you saying that experiencing trauma in childhood causes a stress reaction that physically changes how well our immune system functions—for life?”
“Yes,” she says. “In layperson shorthand, that’s exactly right.”
I share with her that I’ve recently been reading up on how our mental state can determine the chemical signals our brain sends to our immune system, our nervous system.
“Yes,” she says. “Psychoneuroimmunology. It’s changing the way we look at chronic illness.”
“But what you’re saying is a little more novel,” I go on. “You’re saying that the relationship between stress and illness begins in childhood, and that what happens when we are very young might affect our immune system and our health—even decades later?” I ask.
She nods, navigating on her computer screen. “We refer to those early stresses as ‘adverse childhood experiences, or ACEs,’” she explains, pivoting the monitor toward me so I can see the page she’s brought up. “Researchers have been working on ACE studies for a while now. And the research tells us that childhood trauma is a strong predictor of adult illnesses.” She pauses. “We’re a long way from figuring out exactly what this means for patient care, though we have some ideas.”
She pushes a stray, brown hair away from her face and tries to tuck it into her ponytail. It springs back. “It would be hard to imagine that your own childhood stress hasn’t played a significant role in your immune dysfunction and syndromes. Your brain became wired early on to be stress reactive. Your immune system has paid the price.” She pauses, her gaze certain. “It’s paying it still.”
“I don’t see myself as someone who experienced ‘childhood adversity,’” I practically sputter. Blame-the-childhood sounds like a cop-out. I’m proud of how tough and resilient I was during my childhood years. Besides, we’ve all had gut-it-through years as a kid. I’m not interested in blaming the problems I have now on what I couldn’t control back then.
“Professional blind spot, maybe?” Rowland-Seymour muses, kindly.
“I’m trying to imagine how something happening at the age of twelve could determine my health forty years later.”
“Let’s put it this way,” Rowland-Seymour says. She spreads her hands out in the air, giving a minuscule wave with her right fingers. “The early trauma you experienced sparked neural pathways and a pattern of hormone and inflammatory chemical cascades that have impacted you on a cellular level for decades.” She pulls her right hand in, making a light fist that sits in the air in front of me. She wiggles the fingers of her left hand. “The stress you face in your daily life now from illness and any other factors adds insult to injury—sparking the same stress reactivity and inflammation cascade that was set in place early on.” She pulls her left hand in and wraps it around her right hand, creating a thick double fist that looks a little like a hammer. “The stress-induced inflammatory response—and inflammatory disease—hits you twice as hard.”
“You mean my stress-induced inflammatory response is stuck in the ‘on’ position, like a gas pedal that’s always pressed to the floor?”
“That’s another way of putting it.” She places a palm firmly on top of the file that contains reports from every – ologist I have. “But you can intervene and begin to change that process now. You’ve tried everything modern medicine has to offer. Including a slew of alternative therapies and dietary changes. But you’re not really seeing as much improvement as you’d like, are you?”
What she says is true, I admit. I’ve not only had a plethora of IVs and drugs put into my body, I’ve swallowed homeopathics and herbal supplements, and been on a half-dozen special elimination diets drinking nothing but vegetable and protein smoothies for months. I’ve worked with complementary health experts to detox and rid my system of everything from parasite infections to candida overgrowth to mercury toxicity. Just in case it might make a difference. And it’s all helped. Here I still am. Walking. Breathing. Still alive.
But it’s a getting-by life. A long way from where I might have hoped to be as a working, married, grown-up woman raising two children in what should be my most productive decades.
She drums her fingers again, her smooth brown eyes smiling. I sense she’s excited—though I’m not sure why. “I know you know nearly everything there is to know about the immune system,” she says. She is familiar with my last book, she says. “But what you really need to translate for people—those for whom Western medicine has done all it can—is this: all the science is pointing to the fact that your brain is your last best cure.”