Janine Shepherd: A broken body isn’t a broken person
Life is about opportunities, creating them and embracing them, and for me, that was the Olympic dream.That’s what defined me. That was my bliss.
0:22As a cross-country skier and member of the Australian ski team, headed towards the Winter Olympics, I was on a training bike ride with my fellow teammates. As we made our way up towards the spectacular Blue Mountains west of Sydney, it was the perfect autumn day: sunshine, the smell of eucalypt and a dream. Life was good. We’d been on our bikes for around five and half hours when we got to the part of the ride that I loved, and that was the hills, because I loved the hills. And I got up off the seat of my bike, and I started pumping my legs, and as I sucked in the cold mountain air, I could feel it burning my lungs, and I looked up to see the sun shining in my face.
1:06And then everything went black. Where was I? What was happening? My body was consumed by pain.I’d been hit by a speeding utility truck with only 10 minutes to go on the bike ride. I was airlifted from the scene of the accident by a rescue helicopter to a large spinal unit in Sydney. I had extensive and life-threatening injuries. I’d broken my neck and my back in six places. I broke five ribs on my left side. I broke my right arm. I broke my collarbone. I broke some bones in my feet. My whole right side was ripped open, filled with gravel. My head was cut open across the front, lifted back, exposing the skull underneath. I had head injures. I had internal injuries. I had massive blood loss. In fact, I lost about five liters of blood, which is all someone my size would actually hold. By the time the helicopter arrived at Prince Henry Hospital in Sydney, my blood pressure was 40 over nothing. I was having a really bad day. (Laughter)
2:13For over 10 days, I drifted between two dimensions. I had an awareness of being in my body, but alsobeing out of my body, somewhere else, watching from above as if it was happening to someone else.Why would I want to go back to a body that was so broken?
2:29But this voice kept calling me: “Come on, stay with me.”
2:35“No. It’s too hard.”
2:38“Come on. This is our opportunity.”
2:41“No. That body is broken. It can no longer serve me.”
2:45“Come on. Stay with me. We can do it. We can do it together.”
2:50I was at a crossroads. I knew if I didn’t return to my body, I’d have to leave this world forever. It was the fight of my life. After 10 days, I made the decision to return to my body, and the internal bleeding stopped.
3:10The next concern was whether I would walk again, because I was paralyzed from the waist down. They said to my parents, the neck break was a stable fracture, but the back was completely crushed. The vertebra at L1 was like you’d dropped a peanut, stepped on it, smashed it into thousands of pieces.They’d have to operate. They went in. They put me on a beanbag. They cut me, literally cut me in half, I have a scar that wraps around my entire body. They picked as much broken bone as they could that had lodged in my spinal cord. They took out two of my broken ribs, and they rebuilt my back, L1, they rebuilt it, they took out another broken rib, they fused T12, L1 and L2 together. Then they stitched me up. They took an entire hour to stitch me up. I woke up in intensive care, and the doctors were really excited that the operation had been a success because at that stage I had a little bit of movement in one of my big toes, and I thought, “Great, because I’m going to the Olympics!” (Laughter) I had no idea. That’s the sort of thing that happens to someone else, not me, surely.
4:15But then the doctor came over to me, and she said, “Janine, the operation was a success, and we’ve picked as much bone out of your spinal cord as we could, but the damage is permanent. The central nervous system nerves, there is no cure. You’re what we call a partial paraplegic, and you’ll have all of the injuries that go along with that. You have no feeling from the waist down, and at most, you might get 10- or 20-percent return. You’ll have internal injuries for the rest of your life. You’ll have to use a catheter for the rest of your life. And if you walk again, it will be with calipers and a walking frame.” And then she said, “Janine, you’ll have to rethink everything you do in your life, because you’re never going to be able to do the things you did before.”
5:00I tried to grasp what she was saying. I was an athlete. That’s all I knew. That’s all I’d done. If I couldn’t do that, then what could I do? And the question I asked myself is, if I couldn’t do that, then who was I?
5:18They moved me from intensive care to acute spinal. I was lying on a thin, hard spinal bed. I had no movement in my legs. I had tight stockings on to protect from blood clots. I had one arm in plaster, one arm tied down by drips. I had a neck brace and sandbags on either side of my head and I saw my world through a mirror that was suspended above my head. I shared the ward with five other people, and the amazing thing is that because we were all lying paralyzed in a spinal ward, we didn’t know what each other looked like. How amazing is that? How often in life do you get to make friendships, judgment-free,purely based on spirit? And there were no superficial conversations as we shared our innermost thoughts, our fears, and our hopes for life after the spinal ward.
6:11I remember one night, one of the nurses came in, Jonathan, with a whole lot of plastic straws. He put a pile on top of each of us, and he said, “Start threading them together.” Well, there wasn’t much else to do in the spinal ward, so we did. And when we’d finished, he went around silently and he joined all of the straws up till it looped around the whole ward, and then he said, “Okay, everybody, hold on to your straws.” And we did. And he said, “Right. Now we’re all connected.” And as we held on, and we breathed as one, we knew we weren’t on this journey alone. And even lying paralyzed in the spinal ward, there were moments of incredible depth and richness, of authenticity and connection that I had never experienced before. And each of us knew that when we left the spinal ward we would never be the same.
7:22After six months, it was time to go home. I remember Dad pushing me outside in my wheelchair,wrapped in a plaster body cast, and feeling the sun on my face for the first time. I soaked it up and I thought, how could I ever have taken this for granted? I felt so incredibly grateful for my life. But before I left the hospital, the head nurse had said to me, “Janine, I want you to be ready, because when you get home, something’s going to happen.” And I said, “What?” And she said, “You’re going to get depressed.” And I said, “Not me, not Janine the Machine,” which was my nickname. She said, “You are, because, see, it happens to everyone. In the spinal ward, that’s normal. You’re in a wheelchair. That’s normal. But you’re going to get home and realize how different life is.”
8:13And I got home and something happened. I realized Sister Sam was right. I did get depressed. I was in my wheelchair. I had no feeling from the waist down, attached to a catheter bottle. I couldn’t walk. I’d lost so much weight in the hospital I now weighed about 80 pounds. And I wanted to give up. All I wanted to do was put my running shoes on and run out the door. I wanted my old life back. I wanted my body back.
8:47And I can remember Mom sitting on the end of my bed, and saying, “I wonder if life will ever be good again.”
8:54And I thought, “How could it? Because I’ve lost everything that I valued, everything that I’d worked towards. Gone.” And the question I asked was, “Why me? Why me?”
9:10And then I remembered my friends that were still in the spinal ward, particularly Maria. Maria was in a car accident, and she woke up on her 16th birthday to the news that she was a complete quadriplegic, had no movement from the neck down, had damage to her vocal chords, and she couldn’t talk. They told me, “We’re going to move you next to her because we think it will be good for her.” I was worried. I didn’t know how I’d react to being next to her. I knew it would be challenging, but it was actually a blessing,because Maria always smiled. She was always happy, and even when she began to talk again, albeit difficult to understand, she never complained, not once. And I wondered how had she ever found that level of acceptance.
10:06And I realized that this wasn’t just my life. It was life itself. I realized that this wasn’t just my pain. It was everybody’s pain. And then I knew, just like before, that I had a choice. I could keep fighting this or I could let go and accept not only my body but the circumstances of my life. And then I stopped asking, “Why me?” And I started to ask, “Why not me?” And then I thought to myself, maybe being at rock bottom is actually the perfect place to start.
10:51I had never before thought of myself as a creative person. I was an athlete. My body was a machine. But now I was about to embark on the most creative project that any of us could ever do: that of rebuilding a life. And even though I had absolutely no idea what I was going to do, in that uncertainty came a sense of freedom. I was no longer tied to a set path. I was free to explore life’s infinite possibilities. And that realization was about to change my life.
11:31Sitting at home in my wheelchair and my plaster body cast, an airplane flew overhead, and I looked up,and I thought to myself, “That’s it! If I can’t walk, then I might as well fly.” I said, “Mom, I’m going to learn how to fly.” She said, “That’s nice, dear.” (Laughter) I said, “Pass me the yellow pages.” She passed me the phone book, I rang up the flying school, I made a booking, said I’d like to make a booking to come out for a flight. They said, “You know, when do you want to come out?” I said, “Well, I have to get a friend to drive me out because I can’t drive. Sort of can’t walk either. Is that a problem?” I made a booking, and weeks later my friend Chris and my mom drove me out to the airport, all 80 pounds of me covered in a plaster body cast in a baggy pair of overalls. (Laughter) I can tell you, I did not look like the ideal candidate to get a pilot’s license. (Laughter) I’m holding on to the counter because I can’t stand. I said, “Hi, I’m here for a flying lesson.” And they took one look and ran out the back to draw short straws.“You get her.””No, no, you take her.” Finally this guy comes out. He goes, “Hi, I’m Andrew, and I’m going to take you flying.” I go, “Great.” And so they drive me down, they get me out on the tarmac, and there was this red, white and blue airplane. It was beautiful. They lifted me into the cockpit. They had to slide me up on the wing, put me in the cockpit. They sat me down. There are buttons and dials everywhere.I’m going, “Wow, how do you ever know what all these buttons and dials do?” Andrew the instructor got in the front, started the airplane up. He said, “Would you like to have a go at taxiing?” That’s when you use your feet to control the rudder pedals to control the airplane on the ground. I said, “No, I can’t use my legs.” He went, “Oh.” I said, “But I can use my hands,” and he said, “Okay.”
13:11So he got over to the runway, and he applied the power. And as we took off down the runway, and the wheels lifted up off the tarmac, and we became airborne, I had the most incredible sense of freedom.And Andrew said to me, as we got over the training area, “You see that mountain over there?” And I said, “Yeah.” And he said, “Well, you take the controls, and you fly towards that mountain.” And as I looked up, I realized that he was pointing towards the Blue Mountains where the journey had begun. And I took the controls, and I was flying. And I was a long, long way from that spinal ward, and I knew right then that I was going to be a pilot. Didn’t know how on Earth I’d ever pass a medical. But I’d worry about that later, because right now I had a dream. So I went home, I got a training diary out, and I had a plan. And I practiced my walking as much as I could, and I went from the point of two people holding me up to one person holding me up to the point where I could walk around the furniture as long as it wasn’t too far apart. And then I made great progression to the point where I could walk around the house, holding onto the walls, like this, and Mom said she was forever following me, wiping off my fingerprints. (Laughter) But at least she always knew where I was.
14:41So while the doctors continued to operate and put my body back together again, I went on with my theory study, and then eventually, and amazingly, I passed my pilot’s medical, and that was my green light to fly. And I spent every moment I could out at that flying school, way out of my comfort zone, all these young guys that wanted to be Qantas pilots, you know, and little old hop-along me in first my plaster cast, and then my steel brace, my baggy overalls, my bag of medication and catheters and my limp, and they used to look at me and think, “Oh, who is she kidding? She’s never going to be able to do this.” And sometimes I thought that too. But that didn’t matter, because now there was something inside that burned that far outweighed my injuries.
15:27And little goals kept me going along the way, and eventually I got my private pilot’s license, and then I learned to navigate, and I flew my friends around Australia. And then I learned to fly an airplane with two engines and I got my twin engine rating. And then I learned to fly in bad weather as well as fine weatherand got my instrument rating. And then I got my commercial pilot’s license. And then I got my instructor rating. And then I found myself back at that same school where I’d gone for that very first flight, teaching other people how to fly, just under 18 months after I’d left the spinal ward. (Applause)
16:19And then I thought, “Why stop there? Why not learn to fly upside down?” And I did, and I learned to fly upside down and became an aerobatics flying instructor. And Mom and Dad? Never been up. But then I knew for certain that although my body might be limited, it was my spirit that was unstoppable.
16:48The philosopher Lao Tzu once said, “When you let go of what you are, you become what you might be.” I now know that it wasn’t until I let go of who I thought I was that I was able to create a completely new life. It wasn’t until I let go of the life I thought I should have that I was able to embrace the life that was waiting for me. I now know that my real strength never came from my body, and although my physical capabilities have changed dramatically, who I am is unchanged. The pilot light inside of me was still a light, just as it is in each and every one of us.
17:40I know that I’m not my body, and I also know that you’re not yours. And then it no longer matters what you look like, where you come from, or what you do for a living. All that matters is that we continue to fan the flame of humanity by living our lives as the ultimate creative expression of who we really are, because we are all connected by millions and millions of straws, and it’s time to join those up and to hang on. And if we are to move towards our collective bliss, it’s time we shed our focus on the physical and instead embrace the virtues of the heart.
18:32So raise your straws if you’ll join me.
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Peter Attia: Is the obesity crisis hiding a bigger problem?
I’ll never forget that day back in the spring of 2006. I was a surgical resident at The Johns Hopkins Hospital, taking emergency call. I got paged by the E.R. around 2 in the morning to come and see a woman with a diabetic ulcer on her foot. I can still remember sort of that smell of rotting flesh as I pulled the curtain back to see her. And everybody there agreed this woman was very sick and she needed to be in the hospital. That wasn’t being asked. The question that was being asked of me was a different one,which was, did she also need an amputation?
0:48Now, looking back on that night, I’d love so desperately to believe that I treated that woman on that night with the same empathy and compassion I’d shown the 27-year-old newlywed who came to the E.R. three nights earlier with lower back pain that turned out to be advanced pancreatic cancer. In her case, I knew there was nothing I could do that was actually going to save her life. The cancer was too advanced. But I was committed to making sure that I could do anything possible to make her stay more comfortable. I brought her a warm blanket and a cup of a coffee. I brought some for her parents. But more importantly, see, I passed no judgment on her, because obviously she had done nothing to bring this on herself. So why was it that, just a few nights later, as I stood in that same E.R. and determined that my diabetic patient did indeed need an amputation, why did I hold her in such bitter contempt?
1:50You see, unlike the woman the night before, this woman had type 2 diabetes. She was fat. And we all know that’s from eating too much and not exercising enough, right? I mean, how hard can it be? As I looked down at her in the bed, I thought to myself, if you just tried caring even a little bit, you wouldn’t be in this situation at this moment with some doctor you’ve never met about to amputate your foot.
2:17Why did I feel justified in judging her? I’d like to say I don’t know. But I actually do. You see, in the hubris of my youth, I thought I had her all figured out. She ate too much. She got unlucky. She got diabetes. Case closed.
2:36Ironically, at that time in my life, I was also doing cancer research, immune-based therapies for melanoma, to be specific, and in that world I was actually taught to question everything, to challenge all assumptions and hold them to the highest possible scientific standards. Yet when it came to a disease like diabetes that kills Americans eight times more frequently than melanoma, I never once questioned the conventional wisdom. I actually just assmed the pathologic sequence of events was settled science.
3:08Three years later, I found out how wrong I was. But this time, I was the patient. Despite exercising three or four hours every single day, and following the food pyramid to the letter, I’d gained a lot of weight and developed something called metabolic syndrome. Some of you may have heard of this. I had become insulin-resistant.
3:30You can think of insulin as this master hormone that controls what our body does with the foods we eat,whether we burn it or store it. This is called fuel partitioning in the lingo. Now failure to produce enough insulin is incompatible with life. And insulin resistance, as its name suggests, is when your cells get increasingly resistant to the effect of insulin trying to do its job. Once you’re insulin-resistant, you’re on your way to getting diabetes, which is what happens when your pancreas can’t keep up with the resistance and make enough insulin. Now your blood sugar levels start to rise, and an entire cascade of pathologic events sort of spirals out of control that can lead to heart disease, cancer, even Alzheimer’s disease, and amputations, just like that woman a few years earlier.
4:20With that scare, I got busy changing my diet radically, adding and subtracting things most of you would find almost assuredly shocking. I did this and lost 40 pounds, weirdly while exercising less. I, as you can see, I guess I’m not overweight anymore. More importantly, I don’t have insulin resistance.
4:38But most important, I was left with these three burning questions that wouldn’t go away: How did this happen to me if I was supposedly doing everything right? If the conventional wisdom about nutrition had failed me, was it possible it was failing someone else? And underlying these questions, I became almost maniacally obsessed in trying to understand the real relationship between obesity and insulin resistance.
5:07Now, most researchers believe obesity is the cause of insulin resistance. Logically, then, if you want to treat insulin resistance, you get people to lose weight, right? You treat the obesity. But what if we have it backwards? What if obesity isn’t the cause of insulin resistance at all? In fact, what if it’s a symptom of a much deeper problem, the tip of a proverbial iceberg? I know it sounds crazy because we’re obviously in the midst of an obesity epidemic, but hear me out. What if obesity is a coping mechanism for a far more sinister problem going on underneath the cell? I’m not suggesting that obesity is benign, but what I am suggesting is it may be the lesser of two metabolic evils.
5:54You can think of insulin resistance as the reduced capacity of ourselves to partition fuel, as I alluded to a moment ago, taking those calories that we take in and burning some appropriately and storing some appropriately. When we become insulin-resistant, the homeostasis in that balance deviates from this state. So now, when insulin says to a cell, I want you to burn more energy than the cell considers safe, the cell, in effect, says, “No thanks, I’d actually rather store this energy.” And because fat cells are actually missing most of the complex cellular machinery found in other cells, it’s probably the safest place to store it. So for many of us, about 75 million Americans, the appropriate response to insulin resistance may actually be to store it as fat, not the reverse, getting insulin resistance in response to getting fat.
6:49This is a really subtle distinction, but the implication could be profound. Consider the following analogy:Think of the bruise you get on your shin when you inadvertently bang your leg into the coffee table. Sure, the bruise hurts like hell, and you almost certainly don’t like the discolored look, but we all know the bruise per se is not the problem. In fact, it’s the opposite. It’s a healthy response to the trauma, all of those immune cells rushing to the site of the injury to salvage cellular debris and prevent the spread of infection to elsewhere in the body. Now, imagine we thought bruises were the problem, and we evolved a giant medical establishment and a culture around treating bruises: masking creams, painkillers, you name it, all the while ignoring the fact that people are still banging their shins into coffee tables. How much better would we be if we treated the cause – telling people to pay attention when they walk through the living room – rather than the effect? Getting the cause and the effect right makes all the difference in the world. Getting it wrong, and the pharmaceutical industry can still do very well for its shareholders but nothing improves for the people with bruised shins. Cause and effect.
8:11So what I’m suggesting is maybe we have the cause and effect wrong on obesity and insulin resistance.Maybe we should be asking ourselves, is it possible that insulin resistance causes weight gain and the diseases associated with obesity, at least in most people? What if being obese is just a metabolic response to something much more threatening, an underlying epidemic, the one we ought to be worried about?
8:37Let’s look at some suggestive facts. We know that 30 million obese Americans in the United States don’t have insulin resistance. And by the way, they don’t appear to be at any greater risk of disease than lean people. Conversely, we know that six million lean people in the United States are insulin-resistant, and by the way, they appear to be at even greater risk for those metabolic disease I mentioned a moment agothan their obese counterparts. Now I don’t know why, but it might be because, in their case, their cells haven’t actually figured out the right thing to do with that excess energy. So if you can be obese and not have insulin resistance, and you can be lean and have it, this suggests that obesity may just be a proxyfor what’s going on.
9:23So what if we’re fighting the wrong war, fighting obesity rather than insulin resistance? Even worse, what if blaming the obese means we’re blaming the victims? What if some of our fundamental ideas about obesity are just wrong?
9:41Personally, I can’t afford the luxury of arrogance anymore, let alone the luxury of certainty. I have my own ideas about what could be at the heart of this, but I’m wide open to others. Now, my hypothesis, because everybody always asks me, is this. If you ask yourself, what’s a cell trying to protect itself from when it becomes insulin resistant, the answer probably isn’t too much food. It’s more likely too much glucose: blood sugar. Now, we know that refined grains and starches elevate your blood sugar in the short run,and there’s even reason to believe that sugar may lead to insulin resistance directly. So if you put these physiological processes to work, I’d hypothesize that it might be our increased intake of refined grains, sugars and starches that’s driving this epidemic of obesity and diabetes, but through insulin resistance,you see, and not necessarily through just overeating and under-exercising.
10:38When I lost my 40 pounds a few years ago, I did it simply by restricting those things, which admittedly suggests I have a bias based on my personal experience. But that doesn’t mean my bias is wrong, and most important, all of this can be tested scientifically. But step one is accepting the possibility that our current beliefs about obesity, diabetes and insulin resistance could be wrong and therefore must be tested. I’m betting my career on this. Today, I devote all of my time to working on this problem, and I’ll go wherever the science takes me. I’ve decided that what I can’t and won’t do anymore is pretend I have the answers when I don’t. I’ve been humbled enough by all I don’t know.
11:27For the past year, I’ve been fortunate enough to work on this problem with the most amazing team of diabetes and obesity researchers in the country, and the best part is, just like Abraham Lincoln surrounded himself with a team of rivals, we’ve done the same thing. We’ve recruited a team of scientific rivals, the best and brightest who all have different hypotheses for what’s at the heart of this epidemic.Some think it’s too many calories consumed. Others think it’s too much dietary fat. Others think it’s too many refined grains and starches. But this team of multi-disciplinary, highly skeptical and exceedingly talented researchers do agree on two things. First, this problem is just simply too important to continue ignoring because we think we know the answer. And two, if we’re willing to be wrong, if we’re willing to challenge the conventional wisdom with the best experiments science can offer, we can solve this problem.
12:25I know it’s tempting to want an answer right now, some form of action or policy, some dietary prescription – eat this, not that — but if we want to get it right, we’re going to have to do much more rigorous science before we can write that prescription.
12:41Briefly, to address this, our research program is focused around three meta-themes, or questions. First, how do the various foods we consume impact our metabolism, hormones and enzymes, and through what nuanced molecular mechanisms? Second, based on these insights, can people make the necessary changes in their diets in a way that’s safe and practical to implement? And finally, once we identify what safe and practical changes people can make to their diet, how can we move their behavior in that direction so that it becomes more the default rather than the exception? Just because you know what to do doesn’t mean you’re always going to do it. Sometimes we have to put cues around people to make it easier, and believe it or not, that can be studied scientifically.
13:30I don’t know how this journey is going to end, but this much seems clear to me, at least: We can’t keep blaming our overweight and diabetic patients like I did. Most of them actually want to do the right thing,but they have to know what that is, and it’s got to work. I dream of a day when our patients can shed their excess pounds and cure themselves of insulin resistance, because as medical professionals, we’ve shed our excess mental baggage and cured ourselves of new idea resistance sufficiently to go back to our original ideals: open minds, the courage to throw out yesterday’s ideas when they don’t appear to be working, and the understanding that scientific truth isn’t final, but constantly evolving. Staying true to that path will be better for our patients and better for science. If obesity is nothing more than a proxy for metabolic illness, what good does it do us to punish those with the proxy?
14:44Sometimes I think back to that night in the E.R. seven years ago. I wish I could speak with that woman again. I’d like to tell her how sorry I am. I’d say, as a doctor, I delivered the best clinical care I could, but as a human being, I let you down. You didn’t need my judgment and my contempt. You needed my empathy and compassion, and above all else, you needed a doctor who was willing to consider maybe you didn’t let the system down. Maybe the system, of which I was a part, was letting you down. If you’re watching this now, I hope you can forgive me.
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