The Ecology of Care. Introduction: Kitchen Medicine

I've decided to post chapters here from my book -The Ecology of Care: Medicine, Agriculture, Money, and the Quiet Power of Human and Microbial Communities- & to host gatherings on the topic as well.

I spent 9 years of weekends writing The Ecology of Care: Medicine, Agriculture, Money, and the Power of Human and Microbial Communities (between 2006 and 2015). Readers tell me it is more relevant than ever, and I agree. Although I’d focus even more on water and a bit less on carbon if I were to rewrite it today.

The health of humans and ecosystems are declining even more rapidly than when I wrote it—a decline driven primarily by the extractive quest for profits. Most frightening to me are the complex neurological issues that are increasingly affecting our ability to think clearly about the issues we face. Yet it doesn’t have to be this way. It really doesn’t. There are places in the world that are addressing many of these issues together, with great success. It’s time to bring the promise and perspective of the Ecology of Care back into focus, worldwide.

Because of this, I’ve decided to offer chapters of the book here on Substack, and to start teaching a series of international online gatherings related to the book’s topics—so we can use living-systems approaches to finding effective intervention points where each of us lives and works.

The story starts in my former clinic. (Though within a year of the book being published, I had already shifted away from my clinical work with individual patients, and was working full time as a speaker and educator on the topics of soil health, water, and climate. ) Enjoy…

The Ecology of Care: Medicine, Agriculture, Money, and the Quiet Power of Human and Microbial Communities

Introduction

I live in my clinic these days. I moved in to save money when oil prices spiked and the economy started to collapse, but this cross-pollination of life and work has become a fertile, still-unfolding experiment—with implications I never could have imagined. In 2008, I was living in a sweet little house on ten acres up in the quiet wooded hills of Thetford Center, Vermont.

In the summer chickens roamed around our yard, scratching around the flower beds and eating blueberries. In the winter my two young sons and I painted pictures and played cards in front of the woodstove. The boys could jump off the deck into the snow when the plow pushed it up into six-foot-high piles. Next to the deck was a tremendous old apple tree, where a barred owl often sat keeping me company while I ate breakfast outside.

I had bought the house a few years earlier, when anyone could get a mortgage. I had another mortgage and utilities to pay at my clinic, located a few miles down the hill in the village, where I worked as an acupuncturist and rented out office space to friends: a doctor, a massage therapist, and a psychologist. Money was tight as a newly single mother, but credit was easy in those days, so when cash was low I could always put things on a card. After all, interest rates were at zero percent.

There was probably no way I could have seen what was coming: for many years this life had seemed sustainable. Looking back now, I can see how the accumulation of problems that were about to happen in my life were connected with global concerns. At the time, though, it seemed like it was mostly happening to me, and that it was somehow my fault.

It started with a leak in my roof, and then the discovery of termites in the beams. Then two of my colleagues said they could no longer afford to rent office space, which meant our clinic was no longer paying for itself. Patients, many of whom lived more than thirty miles away, started canceling appointments, saying they couldn’t afford the gas. The rates on my old credit card balances suddenly jumped from 0 percent to 11.9 percent, then to 16.9 percent. I got behind in my payments, and late fees piled up. I stopped using credit cards to pay my bills, but I now had some huge debts. Food suddenly seemed more expensive. My electric bill went up, even though I didn’t think I was using more, and then my health insurance went up. The phone started ringing with creditors’ calls. I was embarrassed, and I was scared. I didn’t qualify for public assistance because I “owned” both my house and the clinic. I couldn’t sell the house because I owed more on the mortgage than I would be able to sell it for. What had I done wrong that my life was suddenly so unmanageable?

While I was fretting over my bills, the housing market had collapsed, the world economy had gone into a tailspin, and gas prices had hit an all-time high. As things got worse, patients started quietly and embarrassedly confiding in me about their own economic woes.

Several of my patients lost their houses to bank foreclosures, a couple of them ended up homeless, and many others had to move in with family members. The largest employer in our area, a teaching hospital, called the nurses and administrative assistants in to work one day to “reapply for their jobs.” A large sign on the wall posted jobs that were still available and jobs that were no longer available, as departments downsized, leaving people angry, and humiliated. Even those who still had seemingly good jobs at the hospital started taking on housecleaning jobs on the side. Men who looked like executives were suddenly bagging groceries at the food coop. It started to dawn on me that perhaps this was not my personal failing, and that perhaps it was time to do things differently.

When I decided to move into my clinic, and shifted to a new way of working that put my rates on a dramatically reduced sliding scale, my patients were delighted. My friends (who didn’t realize how much I was struggling financially) were confused. “Why would you want to move out of your wonderful house? Aren’t you going to feel weird sleeping in your office?”

I told them it was to make life simpler. “Instead of never being home, now I’ll always be home.” That was something everyone could relate to.

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On this spring morning, before patients arrive, I come down from my bedroom, fry up some eggs and bacon for myself and my now-teenage boys, and send them out the door, piled high with their backpacks, a saxophone, a bass guitar, and baseball gloves.

“I love you!” I yell, over the sound of a truck full of rocks flying by as they drive off to school.

My home/clinic is very much at that fertile edge where the most interesting parts of life happen. I’m on a noisy state highway in a sleepy little town. I’m sandwiched between two garages, but there are well-worn paths behind my house that lead to nearly a thousand acres of forest and meadow owned by the Army Corps of Engineers. Winding its way through this whole messy world of mine is the Ompompanoosuc River—powerful, peaceful, and stunningly beautiful.

The river is cold today—it’s April, after all, and this is New England—but I strip down, hop quickly through the otter tracks in the mud, and jump straight in, ducking my head under to feel the current sweeping through my hair. As I emerge, the surface of the water smells beautiful, like the wet moss and ferns that line its banks. I swim quickly across to the rocks, calling my small dog, Phoebe, to join me. She swims like a squirrel, her feathery tail wagging back and forth, making me laugh, and we both circle back around and climb out again. Toweling off, I feel my circulation tingling through my arms and legs, and Phoebe shakes herself down. Now I’m awake and ready to face the day. I walk barefoot back to my clinic, looking for wild edibles and medicinal plants along the way.

As I return from my walk, my assistant, Marisa, arrives wearing a brightly colored wool hat that she will likely have on all day. I’ve known her since she was seven years old, but now she works for me. It’s one of several part-time jobs she juggles as a young adult. She also teaches Chinese, helps a local artist in his printmaking studio, gives tango lessons, and manages the organic farm at the nearby Mountain School. As we clean up the living room before patients arrive, we discuss how the peer-support class we are teaching together went last night, and whether the one person of color in the group is getting annoyed with our awkwardness as we try to welcome her into our rural, overwhelmingly white community.

While my boys are at school, my clinic is open for business. Patients walk through my kitchen on their way in and out of my small consultation office, and share my living room during community acupuncture hours. In the evenings, I teach classes on personal and community resiliency, deep self-care, and peer support for community leaders. I have spent eight years trying to define (and bring into practice) what a truly resilient system of care might look like.

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We have developed an extraordinary system of medicine over the past 100 years. We can look inside bodies, map the human genome, restore vision with lasers, transplant hearts, and create new legs that can run at Olympic speeds. For generations, my family has been on the cutting edge of medical and technological innovation, and I know the kind of ego and intense focus that is necessary to explore new and controversial territory. I also know the costs.

Although in many ways science and technology have given us better lives, they also have been used—increasingly—to mine and manipulate the natural resources, biological systems, and communities we rely on for health. That’s because for several hundred years both science and religion in Western culture have seen humanity, with its hugely developed frontal lobes, as something quite separate from, and superior to, the rest of nature: more intelligent, more conscious, more spiritual. (Read the introduction to almost any philosophical, spiritual, or scientific book written by a man in the past two centuries and you will likely find a line that lauds humanity’s unique capacity for consciousness, intelligence, and/or spirituality.) This perspective has changed the world we are observing, in profound ways. We temporarily lost track of the fact that our existence, our health, and even our consciousness itself is inextricably linked to our environment, and to other organisms, both inside and around us. We are waking up to a world that is almost unrecognizable to our souls and our cells.

Our over-reliance on technology threatens to create new problems as quickly as it solves the old ones. How do we deal with the health challenges of flooding, drought, and wildfires due to climate change; runoff from large industrial farms and factories; and dwindling clean water supplies? How could chronic illness be increasing when scientists know so much more about the human body than they used to? Why are our immune systems becoming compromised or even attacking our own bodies with autoimmune disorders? What do we do about antibiotic-resistant strains of bacteria or “superbugs”? Why are doctors and nurses so burned out?

All these problems stem from our insistence on isolating parts, rather than thinking in terms of our place in the whole. Just as my own personal debt crisis turned out to be related to much larger forces than I could see, our growing “debt” of health and environ mental problems is related to larger, more complex issues than we usually assume, and will not be solved by merely fixing individual parts of the system.

We live within a vast interdependent web of relationships, and whatever happens in one part of the system affects the whole. There is no such thing as “human health” apart from the rest of the planet; there is only health. So when I use the word “medicine,” I mean something much more profound and far reaching than medical care for humans.

Our current ways of caring—for people, for farm animals, and for land—are based on a limited definition of health and on outdated ideas of “progress,” and are mostly directed by corporate interests. Because of this, we have created a situation in which the planet itself has become something like a field hospital, with new species limping in each day in need of help.

The solutions are out there—in fact, they are surprisingly simple—but in order to see them we need to look at larger frames of reference than the ones we’ve been taught about in school. In particular, we need to pay close attention to places where things are going well.

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When people thrive, you can generally observe that the natural environment around them is also thriving, their relationships are solid, they have abundant, nutrient-dense food to eat and a just society to live in, and they are living in relatively peaceful times.

There are other aspects of health that are harder to see. A person’s “microbiome,” which comprises the microorganisms residing in and on the body (microorganisms that are constantly repopulated from the landscape around them) turns out to be one of the most important modulators of health, influencing physical and emotional well-being, immunity, and even proper brain development.

Likewise, the microbiology of the soil—which influences local and global water cycles, the climate, and the nutritional quality of our food—is another important modulator of our health, and even of our actual survival. As a health-care provider, I see these two flowing biomes as the essential systems with which, and within which, I work. They are my allies, my teachers, and part of the provenance of my care.

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Living in my workspace turned out to be practical in many ways. I didn’t have to pay to heat my home when I was at work, or to heat my clinic when I was at home, or waste all that fuel either. I could pay one electric bill, one oil bill, one phone bill, and have one Internet service. Being able to spread out into the living room and kitchen, I started treating my patients in a group setting so they could split the costs of their appointments, which meant more people could afford to come back and see me. Slowly I started paying down my credit card balances with the money I was saving.

I could chop some onions during a break and keep an eye on supper as I treated patients. My kids could jump on the school bus in the morning, and get off in the afternoon, and I could spend several days at a time without needing to even start the car. After school, I could send my kids down to the post office to mail out a package of medicine, or they could do their homework, and I could do my accounting, side by side. We helped each other figure out problems when we were stuck—and learned a lot about each other’s work that way.

If one of my sons had a cold, I didn’t have to cancel the whole day’s work—I could stash him up in his room and check on him periodically while he slept it off. Snow, sleet, rain, floods? No problem, I was already at work. If patients didn’t get here, well, I could catch up on paperwork, or take a nap.

My own kitchen quickly became the heart of the clinic, and food became even more a part of my interaction with patients. I started purposefully cooking soups and stews while working, to help tap into patients’ sensory memory of the pleasures of slow food. As people started asking about things they smelled cooking, I started teaching patients more about the connections between diet, health, and soil; about the importance of replenishing their inner ecosystems with nutrient-rich foods brimming with enzymes, natural yeasts, and beneficial bacteria, and how important grass-finished meat, dairy, and eggs are for neurological health.

When patients were unfamiliar with the foods I was describing, I could duck into the kitchen and offer a taste of sauerkraut, kefir, or raw jersey cream, or hand them a recipe for collagen-rich bone broth or eggs benedict, rich in omega-3s. A local foods movement was sprouting up around me, as well, and I started keeping lists of local farms that had the best ingredients. In this way, my patients’ lives became more interconnected with my own, in an organic way. Patients often commented that they loved the feeling of entering through my kitchen and being in my home: it tapped in to a sense of care, comfort, and trust that was rarely found in clinical settings. In a sense, I had reinvented the small-town doctor’s life, or the village herbalist’s.

Meanwhile, my patients started getting healthier, and more interested in taking care of themselves and their families, and a little less dependent on me to help them feel better.

The more I wrote and taught about these ideas, the more I noticed how problems in the areas of health, economics, politics, farming, food, and community are all connected. The solutions are interconnected, as well, as I was discovering in my new life as a health-care provider in the center of a rural village. Things worked better for me and for my patients when my life was scaled down, multipurposed, local, and based on mutual caring and a debt-free microeconomy.

Much of my current life and thinking can be traced back to a piece of paper that I handed out at the Sunfest Expo, in 2007. Sunfest celebrated two themes: Sustainable Living, and Alternative Health. The night before the expo, I was preparing materials to hand out. As I gathered up articles on acupuncture, addictions, herbal medicine, nutrient-dense diets, and more, I was thinking about the expo’s two themes, and the connections between ecological sustainability and alternative medicine. I wondered if it were possible to interweave the two ideologies, and if so, what a sustainable model of health care might look like. Who or what would it sustain? Was it just about people, or would it encompass a broader definition of care? Could our current model of medicine fit into it, or was it too dependent on unsustainable technologies? Was all alternative medicine sustainable by default, or would that model need to change, as well?

That night, I began to write down my ideas on what I called “ecological medicine.” I came up with a manifesto with defining points that connected human health and environmental health, and the next morning I handed out hundreds of copies. That manifesto grew into a website, which, as my life shifted over the next couple of years, sparked a re-framing and renaming of my clinic from the “Two Rivers Clinic” to “The Center for Sustainable Medicine.” For many years I used the term “sustainable medicine,” rather than my initial term “ecological medicine,” to define my work. But now I think my first take on it was correct: the issue is not so much about sustainability; the issue is about relationships.

The ideas from that original manifesto evolved into a series of talks I presented at hospitals, Transition Town initiatives, conferences, and other gatherings. They wove together with personal conversations— with patients around my kitchen table and with scientists around the world—and finally became this book.

As my understanding has grown, my medical practice has expanded: from treating individuals to treating whole systems. In addition to seeing patients, I now spend time teaching at agricultural conferences and in schools about the interrelationships between healthy soils, shifting weather patterns, economic forces, and human health. I help community leaders create resilient networks of shared support, and I work with farmers and ranchers to restore the quietly powerful living systems that run the underground carbon and water cycles that make life on this planet possible.

The hidden question at the heart of this book is: how do we get close enough to each other so that we can really look out for each other? People are disconnected from each other and nature, and it’s obvious in the way we approach health care.

In this book, I will show you how it is all interrelated: care for the land and care for people. I’ll show the odd story of what I call the “sterile” industrial model of care, and how we can shift things to a more interconnected, “fertile” way of living and working—from an entire country, to a regional hospital, to the smallest backyard. This approach not only restores our own health, but also restores health to struggling ecosystems both inside and outside the body.

I invite you to contact me, engage with me about these ideas, and let me know if you spot any errors I have made. (A few small details of patients’ lives have been changed to protect anonymity.) The benefit of what I call “revolutionary interdependent publishing” (including crowd-source funding, community editing, title brainstorming on social media, and print-on-demand distribution) is that future editions of a book can easily evolve to reflect the larger wisdom of the community that reads it. Welcome to that community.

Click here for the next chapter!

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Do you want to discuss this? We are having a series of international online gatherings on the topic!

For information on upcoming gatherings, courses, our ongoing Land and Leadership Development Community, and many more resources, please visit my website or go to our course catalogue.