Christine Ritchie, MD, MSPH: Improving Care for Older Adults Through Geriatric Research

Q:  In her years as a geriatrician and palliative care specialist, Dr. Christine Ritchie has worked to strengthen quality of care for patients with serious illnesses and expand the breadth of research on aging and chronic illness. Raised in South Korean, Christine’s interest in geriatrics and palliative care is greatly tied with Korea’s culture and philosophical underpinnings, which foster respect for elders.  

As an adult, her passion was further established when she stepped into the role of caretaker for both her parents and her grandmother, at the end of their lives. As the medical chair in geriatrics, and director of research for the Division of Palliative Care and Geriatric Medicine at Mass General, Christine is focused on reducing the significant gaps in geriatrics and palliative care research, in order to improve care for people with serious illness, particularly for those with dementia and multiple chronic conditions.  

Since her arrival to Mass General, Christine has been pioneering the establishment of the Center for Aging and Serious Illness Research within the Mongan Institute. It’s a pleasure to have you here today, Christine. Welcome. 

A:   Thank you. It’s really terrific to be here. 

Q:   So to start off, can you tell me a little bit about how you developed an interest in geriatrics and palliative care?  

A:   I think that interest began as a young person, when I was living in South Korea. I was able to see the innate respect that was demonstrated to older adults across society, an expectation that, as we age, we would be cared for, that we would receive the support that we deserved, and needed, because of all the care we had provided to others in our previous lives.  

So it was a natural thing to think about the importance of older adults, and then to start recognizing, when I came to the United States, that that same perspective was not ubiquitous. And that, when we looked at our healthcare system, there were lots of opportunities for us to improve the way we provided care to older adults.  

As I got older, I also got to see the value of caring for people as they became seriously ill. And that piqued an interest in palliative care.   

Q:   Yeah. So your upbringing in South Korea sounds really fascinating. I'm wondering if you can tell me more, just about your experience growing up there. 

A:   So I grew up in a relatively rural part of South Korea. My father was a surgeon. My mother was a medical technologist. They went over to Korea after the Korean War, to support relief efforts.  

So I was exposed to healthcare, throughout my childhood. I also was able to see how it was expectation on the part of families to care for their loved ones as they got older. And that became something that I sort of saw as the norm.  

In addition, I was able to see, as a result of the Confucion philosophy that is part and parcel of much of the underpinnings of Korean society, that respect for elders was also respect for the wisdom that their life brought to bear. And that we could all benefit greatly from that, if we listened and were present to them, and tried to understand what their life stories had told them and could tell us.  

Q:  As you watched your parents, were there any moments that stood out to you as being really stark in your memory of how people in that culture regarded older adults and older populations? 

A:   Yes. Korea has become much more westernized, and has adapted many of the more westernized perspectives around aging, I would say. But back then, what I saw was a general sort of family effort around the care of especially older adults, and of the parents, the matriarchs, the patriarchs of any particular family. 

They would all come in, and frankly, camp out in the hospital when one of their loved ones was ill. They made sure that they were well taken care of. They brought food from home. They had all that familiarity around them. And, needless to say, they weren’t isolated in the same way that we now see so commonly in the United States, with older adults.  

That left a mark on me, that sense of community, that sense of connection, that sense of filial obligation in sort of the positives of the word, that we all have this sort of connectivity to each other, and that that connectivity translates across generations in a way that can be profoundly gratifying. 

Q:   And how did those experiences influence your career decisions moving forward? 

A:   Well, like many people in medicine, I was attracted to pretty much all aspects of medicine. I found it all very interesting and intellectually stimulating. And even though I had this spark in my mind about wanting to go into work related to aging, I was very much interested in and drawn to many different specialties. 

I was fortunate to be a chief resident after I finished my residency. And that gave me some time to reflect on what was really important to me. And at that time, I was able to see that there were a lot of gaps in our care for older adults, and also gaps in our understanding of what was high quality care, so gaps in our evidence-base. And, because of those two things, and having that year to reflect as a chief resident, it became clear to me that I really wanted to spend more of my time focused on that population and on learning what I could learn on how we might better care for older adults as we age. 

Q:   That’s interesting. Can you talk a little bit more about the gaps that you were seeing during your residency in age-related care? 

A:   Well, many of those gaps I still see. Many of the gaps that I saw then, and I continue to see now, related to a lack of a recognition or an understanding of some of the changes that occur with aging, a lack of appreciation for what those changes can mean for someone’s ability to be connected and benefit from care. So, let’s just say, for example, issues around hearing impairment, visual impairment, challenges around symptoms like chronic pain.  

Our lack of attention to those things mean that, when people come in, we are often unaware of some of those limitations. And, as a result, we often go through our work in a way that does not lend itself to really understanding what the needs are of people who are experiencing chronic serious illness, or multiple chronic serious illnesses.   

And, in addition to that, we often don’t equip them to be able to live their best lives as a result. So I saw sort of a lack of person centeredness. I saw fragmentation in the way we provided care. We tend to provide care sort of one organ system at a time, as opposed to thinking about someone’s care as more holistic.  

Q:   And coming from a culture where older adults and family was just at the center  of it all, and so rich in the culture, what was that experience like, coming here, where maybe that wasn’t quite as apparent?  

A:   So our culture has, at its core, a great appreciation for our individual freedoms, and for our individuality. And there's a lot to be said about that. There's a lot of goodness that comes from our sense of individuality. The challenge, though, is that it does not give us a sense of sort of community. And we can often find ourselves, as we get older, those folks who had been important to us, and becoming increasingly socially isolated.  

And, because we don’t have this larger sense of community or desire for collective connection, then what we often see is that people become increasingly isolated as they get older. 

Q:   I love the idea of collective connection. Is there any reason why maybe that’s not a bigger part of our culture?  

A:   I think we’re all coming to an awakening that the approaches that we have taken in the past may not be adaptive for our future. And then, after a time, we find that we are not as enriched from those experiences when we don’t get to share them with others, we don’t get to learn from others, we don’t get to experience the vast breadth of diverse thinking that we can glean from others. 

What I'm hoping for is that, as we think about being more inclusive, as we think about learning from diverse perspectives, and we think about what that means for us generationally as well, how might we generationally become less segmented or segregated? How might we become less ageist in our general perspectives. 

How might we think about age as being something to celebrate and intergenerationality, something that we can support? All of that relates, to me, to collective connection. And the other thing I would say, that is important with respect to collective connection, is an ongoing embracing of new perspectives, new knowledge, and new learning. And that work really has to occur across generations for it, I think, to be effective.

Q:   And you mentioned ageism. So I’d love to hear how ageism intersects with your work. 

A:   Oh my goodness. I see ageism everywhere in our society. We see it in our often childlike treatment of people who appear older, frail, or functionally limited in some way.  

It influences my work by suggesting that those who are older, or caring for those who are older, or safeguarding the wellbeing or dignity of those who are older, is not worth investing in. 

 And I'm afraid that we've seen some of that during our experience with this COVID-19 pandemic, where our efforts are sometimes less focused on those who are particularly frail or vulnerable. 

When we think about the pandemic at its beginning, we saw that institutions that provided care for older adults, whether they were assisted living facilities, senior care facilities, nursing homes, they often didn’t have easy access to PPE. They often didn’t have appropriate staffing.    

Even now, we have not engaged the kind of creativity and designed thinking approaches that I think will be necessary for us to make sure that older adults really are able to flourish in the context of the pandemic. So I would say that ageism is somewhat ubiquitous in our society. And we have a great opportunity to think about what it means to combat it. 

Q:   Right. And with COVID-19, of course, the older population was always said to be more vulnerable and at the greatest risk for severe illness. Can you talk more about how the pandemic brought healthcare as a discussion for older adults to the forefront?   

A:   We certainly saw that there was an increased risk for much more serious illness for older adults with respect to COVID. And that played in a number of different ways. So one way it played out was, they didn’t want to seek care outside of their homes. 

Many of them waiting until the very last minute to seek care for non-COVID related concerns. 

In addition to that, we saw that institutions that provided communal care were more likely to experience fairly adverse outcomes as well, right. We saw, in our nursing homes and in our assisted living facilities, a disproportionate number of older adults becoming very sick, and many people dying in those settings. And we saw the same thing with the staff who cared for them, who were real heroes in their care for them.   

And then the other thing that we saw is that we saw a disproportionality with respect to care occur because of our use of telemedicine.  

There are many people, either because of their advanced age, their lack of comfort with technology, or their socioeconomic situation, where video care really was not an option for them.  And that has become our default form of care for many people. That also contributes to some disconnect in our healthcare with respect to older adults. 

So we certainly have seen a lot more interest and awareness, that because COVID disproportionately affects older adults, that we have to be attentive to the needs of older adults. Unfortunately, we have also seen a lot of very sad and tragic outcomes because we haven't been prepared as a society to support older adults in a pandemic like this. 

Q:   And you mentioned, at the very beginning, that a lot of older adults were disinclined to seek care for themselves. How did you open up that discussion?   

A:   Well here, at Mass General/Brigham, we worked very hard across the system to outreach to older adults, in particular, and older adults who we knew were experiencing chronic serious illness.  

Then we worked very hard to engage in outreach, by telephone for the most part, to older adults, because of a recognition that they were more likely to be disadvantaged in the pandemic and during COVID. 

Q:   And I know that a large portion of your work is centered on improving care for homebound adults. So during the COVID-19 pandemic, with older adults being way more isolated than the average person, how did quarantine measures affect those patients?  

A:   We were very worried about folks who were homebound. We were worried about, again, their food security. We were worried about, whether or not they would be willing to have caregivers come into their home. We were worried about caregivers coming into their home and potentially bringing in COVID. 

That being said, I will say that I have seen, across the country, and here in Massachusetts, so many homecare providers, skilled home healthcare nurses, physicians, nurse practitioners, social workers, EMT providers, all playing a key role in assuring the wellbeing of homebound older adults, and seeing it as part of their responsibility.    

Part of what we did at MGB was we worked hard to make sure that our infection control measures that we were initiating within our healthcare system were adapted to be relevant in the homecare setting.   

So we worked really hard with our homecare colleagues to make sure that they had the information that they needed, and as information became available to us from our infectious disease colleagues, that we were translating that to high quality provision of care for those who were homebound. 

Q:  Throughout the pandemic, I did hear of age-related stigma. And I know you mentioned that earlier. So I'm curious, how that was amplified during this time.

A:  The challenge we saw, and how it relates to age stigma issue, is that creative solutions were not forthcoming quickly. In some respects, that’s completely understandable. Everybody was learning as they were going.   

But, if you look at sort of how we navigated our care of older adults, it took us quite some time, and I would say we’re still in a high learning mode, to sort of wake up to some of the very important issues that relate to the wellbeing of older adults. And I’ll use one example, and that is social isolation. 

So we focused a whole lot on safety from COVID-19. We focused less on the profoundly negative effect of social isolation, in terms of people’s wellbeing. And now you're beginning to hear stories in the news about how social isolation itself, people not having access to their loved ones, not getting the kind of care and feeding that they had been getting before, also contributed to their decline, and sometimes to their death. 

So I think we’re seeing sort of the waves of this ageism and age-related stigma as it bears out in our community. As this becomes more apparent, my hope is that it will give us more energy to do something about it, and to counter that ageism and that age-related stigma going forward. 

Q:   Was this surprising to you being in the field, seeing colleagues and other people in the field sort of become more aware of this during these past few months? 

A:   I was heartened by the desire on my colleagues’ parts to assure the highest quality of life and quality of care for older adults.  

That there was all kinds of creative efforts to try to connect people, even though there were all these impediments and barriers to it. So I would say I was heartened by the increasing recognition of the challenge and the desire to do something about it, both now, and as we move forward, that we think about how this is the beginning of a lesson learned. And we need to really think about what additional lessons we can learn to keep something like this from happening again. 

Q:   Can you talk a little bit more about that, what changes really need to happen, to foster support of older adults, moving forward? 

A:   I think we need to be providing care for older adults in a context where they are heard on their terms, and in the context of their needs in that moment. Recognizing that those needs will evolve, and those concerns will evolve as well.   

So what that means for us going forward, is thinking more about all the various components, both psychological, social, spiritual, physical, biological, that contribute to somebody’s overall wellbeing, and addressing those holistically through interprofessional care, through much more systematic approaches towards assessment, towards care that’s focused more on the home as opposed to in the hospital. 

That provides people the care they need, when they need it, no sooner or no later, and at the right dose that they need it.  

Q:   And what are the sorts of needs that this population have that are unique to other patient populations? And, you know, like we had talked about sort of feeling disinclined to even ask for help in the beginning, how do you sort of break down those barriers? And then, what are the needs that you're finding with these patients? 

A:   There are many older adults who are fortunate to be quite healthy, quite robust, living full lives. And contributing significantly to our society. There are also those of us who have accumulated conditions as we've aged.   

And for that population, those are the folks I think we really need to sort of hone in on how we can support them. And it is true that we accumulate these sort of hits to our body as we get older. And those accumulation of various hits to our body are more likely than to translate into a whole array of medical conditions. Whether it’s heart failure, advanced lung disease, dementia, sensory impairment.  

And since those are more likely to occur as we get older, then we need to really be thinking about them, not one at a time, but again, thinking about them in a complementary way. Dementia, I would say, is a condition that we see predominantly in older adults, and that has a whole array of challenges associated with it, that requires the support of others for that person to live their best lives. And that also requires support of caregivers.  

When we think about dementia, we have to think about two different sort of strategies. One is doing everything we can to mitigate against the development of dementia. And then, what can we do to help them and their loved ones live their best lives? That is an opportunity that we still have a lot of work to do on, because our system has not been set up for people with cognitive impairment.  

We don’t actually recognize cognitive impairment. We don’t address people’s needs. And we don’t provide anticipatory guidance. And as people’s mobility decreases, we don’t think about how we can provide more of their care outside of a traditional bricks and mortar setting.   

Q:   And I know that you were the caretaker of both of your parents and your grandmother at the end of their lives. How did this experience impact your work?   

A:  My experience as a caregiver helped me appreciate how complex and challenging caregiving is, and how, prior to my experience as a caregiver, my proposed solutions as a physician, were probably overly simplistic.   

I didn’t really acknowledge the profound challenge that is part and parcel of caregiving. And, at the same time, I don’t think I appreciated the deep meaning and gratification that can occur in the context of caregiving.   

You know, my father had Lewy body dementia at the end of his life. And he was tall, lanky individual. And always a threat for falling. And my mother, because of her ailments, and osteoarthritis, and other things, truly could not care for him. So when he would get up in the middle of the night, we would have our monitor on. He was living with us at the time.  

My husband or I would take turns getting up with him, and making sure that he wouldn’t fall. This was still in the context of living our daily lives, going to work every day, taking care of our young children. And it truly gave me an appreciation for how to be a caregiver, it is ideally a team effort.

And how it is often for people not the only thing they do. And I think, as healthcare providers, oftentimes, when we see caregivers come in, we assume that sort of that’s their fulltime job. But, for many people, and I would say especially for many women, it is not their only job. It is one of many, many jobs. 

And being able to experience that personally gave me a deeper understanding, and compassion, for caregivers when they came in, and were often at the end of their rope, exhausted, not even aware that they weren’t getting the self-care that they needed.

Q:   I’d like to ask, too, how do you talk to your children? And maybe it depends on the age. But how do you talk to your children about aging, and about that respect for older populations? How does that play a role in your life? 

A:   Because my children had to live it daily, my parents lived with me for a total of seven and a half years, which was the large bulk of the time when my children were growing up. They got to see it in action. They got to see the challenge. They got to see the joy of it. They got to see the enrichment of it. 

We talked about aging. We talked about ageism. We talked about the importance of connection across generations. We talked about the importance of their relationship being good, when the time came for them to potentially care for us. And it was a routine part of our daily conversations.  

We talked about death and dying. We talked about being prepared for whatever the future holds. I would say those are some of the gifts that palliative care and geriatrics just offer. And I feel deeply grateful for them. They're just a natural extension of work that was easy to bring into comfortable conversations at home, that felt very natural.  

Q:   You mentioned earlier the healthcare system is not set up to take care of people with chronic illness, particularly dementia. So what challenges did you experience while working with the healthcare system as a caregiver of a family member? 

A: I was privileged, because I am a physician, and I understand healthcare systems better than most. So, with that caveat, I was surprised that I experienced as many challenges myself as a caregiver in trying to make sure that my parents received the care that they needed.    

I’ll give you another story or example. And that is that, with my father, he needed to be hospitalized. And his hospitalization was probably one of the worst experiences of my personal life, I saw his dignity being stripped from him, very little care provided to him, that actually took into account the amazing person that he was.  

He was treated more like a commodity than as a person. And after that hospitalization, I vowed that I would never allow him to be hospitalized again. That was a painful decision for me, as a healthcare provider, to see how much our hospitals are not set up for the care of people with dementia, how much they strip people of their dignity and their humanity. 

And it also helped me appreciate how much work we can do to keep that from being the case forever 

Q:   So what measures do you think need to be taken in order to restore people of their dignity? 

A:   We need to start with a recognition that we have biases against older adults. And with an appreciation for the fact that, just because someone has limitations, it doesn’t mean that they don’t have much to give us in the world.  

If we start with those two recognitions, and a perspective that we have the opportunity to learn much from others, and all of these challenges that we begin to experience more of as we age, can be both instrumental in our own growth as we age. 

But also instrumental in our teaching others about what aging well can look like, that will give our healthcare systems, a starting point to engage in the care of older adults, not as an inconvenience, but as a true opportunity to provide high quality person-centric care. And ultimately, an opportunity to provide the kind of care that we’re going to want when we get older. 

Q:   Yeah. And this is reminding me of a phrase I've heard you use in the past, which is generational cohorting. Can you speak more about this, and what kind of impact this can have on society and subsequently healthcare? 

A:  We see this in our retirement communities, where there is the 55-up community, or there are these retirement centers, where people often go, where they can go into various levels of care. 

And while some of that makes sense, because, people appreciate each other, it doesn’t allow for the rich interconnections that can occur when we learn across generations, when we understand that people who are in their 20s can teach people in their 80s so much. And people in their 80s can teach people in their 20s.  

That generational segmenting, ultimately contributes to some sense of social disconnect and social isolation. I'm very hopeful because I see some real groundswell of interest and intergenerational connection, that this will not be something that we relegate ourselves to over the long haul. 

We can learn from many, other traditions in other countries, other traditions within our country, that have respected elders and seen an understanding of the richness of connection across age groups, as an important part of our learning and growth as humans. If we can take that on as a society, and we take that on as a healthcare system, I truly believe we will all be the better for it. 

Q:   And I’d love to hear, too, during your experience as a caretaker, were there any interactions with any of the members of your parents’ or grandmother’s care team that stood out to you as being really helpful, as you navigated that situation? 

A:   I was fortunate in this, especially in the care of my mother, to have tremendous colleagues around me providing support to me. My mother was a big devotee of palliative care. She thought it was the best thing ever. And she would routinely tell me that when all was said and done, she wanted her focus to be palliative so she could live her best life regardless of the fact that she was very sick.   

Between her perspective and the profound support of my colleagues around me, they were able to help me see what she needed when I couldn’t see it. 

In addition, that has helped me appreciate that, when you get too close to a situation, even if you're a healthcare professional, you just stop seeing certain things. And we need each other to provide different sort of insights and perspectives on what's going on, because we just are too close to it ourselves.  

My colleagues were always asking me gentle, compassionate questions about the needs of my mother that, frankly, I just couldn’t see. And I was very grateful for that.  

Q:   That’s amazing. And while taking care of your loved ones, and your family, how did you have to take care of yourself and your own wellbeing?  

A:  Any person who is a part of a sandwiched generation situation, where they have young children, and they're caring for their parents, and they're working, will attest to the fact that it is not for the faint of heart. And that it’s easy to get exhausted, and sometimes to lose perspective. And I certainly would say that that was true for me as well during that season. 

That being said, I was fortunate to have an incredibly supportive husband. My children, even though they were in elementary and middle school, were bought into an intergenerational way of life. And they were very supportive of the journey. And I had many friends and colleagues who were aware of the challenges and were there to provide support.  

Q:   And I know you said that this experience helped you find more compassion in your own work. Are there any other impacts that this had on your work? 

A:   It has given me a great passion to do research in the space of palliative care and dementia care in particular. 

And around supporting the research of up and coming investigators, to make sure that we really are providing consistently better care for older adults in general, and particularly those who are living with dementia.  

Q:   So I would love to learn a little bit more about your research pursuits. Can you talk about what gaps currently exist in geriatric and palliative care research? 

A:  In palliative care we have learned a great deal from our work in cancer care. And still, there's a lot to learn about what it means to help people live well with serious illness. Because our treatments for people with serious illness change. That means the side effect profiles change. What their needs are change.

Translating that good learning from cancer care to other chronic serious illnesses like dementia is a tremendous opportunity for us. We don’t really know how to provide high quality end of life care for people with dementia. We don’t really know how to optimally provide high quality symptom management for people with multiple chronic conditions, who don’t just have one serious illness. 

And their medications are interacting with each other. And they're experiencing high illness and symptom burden. So I'm very energized around how we can pay attention to the needs of these populations who historically have not been in our clinical trials, who have historically not been part of what we've learned about need or impact of our treatment regimens. And think about how we can provide good quality palliative care for those individuals. 

What medicines work, what medicines don’t work. How can we bring in our psychologists, our social workers, our spiritual care providers? All of our interprofessional team, to make sure that these individuals are really getting the best life that they can get in the time that they have remaining. 

Q:   And why historically has there not been inclusion in clinical trials? And how can this really positively impact the field? 

A:   So as you might imagine, recruiting somebody who’s very sick, and who has many different medical illnesses, might be more difficult to begin with. And for that reason alone, I think it’s more likely that people who are healthier are the ones that often get embroiled into clinical trials. In addition, when you have somebody who has many different healthcare needs, or chronic conditions, they could be easily excluded from a clinical trial, because they might make the trial muddier.  

It might be harder to interpret the findings or the results. So for many, many, many years, the predominance of clinical trials excluded the very people who would have benefited the most from being in them. That is, those individuals for whom these medications are most likely to be used on. And the National Institutes of Health has begun to recognize this as being a real issue, and is working very hard to make sure that we are including people in clinical trials across the age continuum, and across the illness continuum. 

That’s a relatively new phenomenon. So what that means is, we have a lot of work to do, to catch up, to make sure that we really understand what some of these treatments that have been tested in healthier populations mean for people who are more ill to begin with, or who have been living with chronic serious illness for a long time.  

Q:  What barriers are there, that people face right now, that are hoping to enter academic medicine?  

A:   In geriatrics and palliative care in particular, the training that geriatricians and palliative care clinicians receive is focused purely on clinical practice. That is very important. And it is not sufficient to create the next generation of clinician investigators who have expertise in geriatrics and palliative care.  

One of my great hopes is, as a community, that we will invest in what will be required to train up the next generation of clinician investigators in geriatrics and palliative care. And that will require resources that currently don’t exist as part of routine clinical training or practice. Happily, there are some mechanisms to support those investigators through the National Institutes of Health. But much more work needs to be done. 

A:  It’s my hope and vision that, as a community, we will come together to find the tools, the strategies, and the resources to build up this next generation of researchers in aging and serious illness, and particularly to find ways to train clinicians in geriatrics and in palliative care, to take that knowledge that they’ve had from their clinical practice, and apply it to high quality research, the creation of high quality evidence, and ultimately, to better care. 

Q:   Thank you so much. And before we wrap up, I just have my final five questions for you. What's the best advice you’ve ever gotten?  

A:   The best advice I've ever gotten is a very funny phrase, but I think of it often. And the advice is, comparisons are odious. The idea being that we each have our own unique precious life. And when we start comparing it to others, we lose the uniqueness, the preciousness of it. And we start actually trying to own somebody else’s life. And essentially, we lose in the process.  

Q:   That might have just turned into the best advice I've ever gotten. What rituals help you have a successful day? 

A:  My morning rituals are probably the most important rituals to me. My husband is kind enough to bring me a cup of coffee every morning. That's pretty special. I engage in daily meditation, daily reflection, daily gratitude journaling. And all of those rituals in the morning provide me with a lot of groundedness for and contentment to take on the rest of the day.   

When I can, I love to run, do yoga, engage in strength training, all those things that give me a lot of joy and energy and sort of feeling my body. That doesn’t happen every day. But, when it does happen, it’s a good day. 

Q:   And if you weren’t a doctor, what would you be? 

A:   If I weren’t a doctor, I would be one of two things. I would either be a potter, and make pottery, or I would be a social worker. I think social workers and therapists provide such important work in our world. Social workers help deal with the complexities and the messes of our daily life, and especially when things get hard.   

They often know all the little tricks to figuring out how to navigate difficult situations, especially difficult situations financially, socially, with caregiving, and, and frankly, with sort of navigating the system. Therapists often help us see the sort of narratives in our lives, or the things in our lives that are keeping us from being able to experience our greatest joy. 

Pottery, just because it’s deeply creative and meditative, social work because I think it has tremendously important impact, and therapy because I think it is underappreciated how important and beneficial it can be for people, in terms of their living their best selves.   

Q:   What advice would you give your younger self?  

A:   Don’t take yourself so seriously.  

Q:   What's the best decision you’ve ever made? 

A:   That’s a tough one. I would say probably one of the best decisions I ever made was marrying my husband. He’s been an incredible soul mate and partner throughout my entire—our entire journey together. He’s a pretty thoughtful, wise, kind, generous person. And I think I was really lucky. But it was a good decision.  

Q:   Wonderful. Do you have any guilty pleasures? 

A:   I love chocolate. On vacation, I like reading magazines that have nothing to do with medicine. And those are probably my two routine guilty pleasures.

Q:  Great. And my last question. What do you consider your super power to be? 

A:   My super power is probably listening and reflection.  

Q:  Thank you so much, Christine. It was so wonderful to speak with you.  

A:   It was very wonderful to speak with you, Kelsey. Thanks for this time together.