Superwoman Makes a Difference

Kari Nadeau ’88—doctor, mother, teacher, activist—manages to have it all, but wants the sick and helpless to have some, too.

Stanford pediatrician Kari Nadeau ’88 was considering a career in medicine as early as age 14. But she didn’t see herself attending accident victims in emergency rooms, or listening to heartbeats in the pristine confines of a private office. She wanted to treat indigenous Alaskans, or Native Americans on a Southwest reservation. No husband, no children, just herself and her doctor’s bag, changing the world one patient at a time. (She would later realize part of this dream when, in her fourth year of medical school, she volunteered on a reservation in New Mexico.)

“I wanted to make a difference,” she says, “and fit my talents into one career.”

She revealed her hopes to her high school guidance counselor in Plainfield, N.J. The counselor’s response: Women could become nurses, not doctors.

For Nadeau, such an antediluvian statement was a motivator rather than a discouragement. She went on to volunteer with her town’s ambulance squad at age 16, and attended a summer session for gifted students at New Jersey’s Governor’s School. During her senior year she met with physician Ellis Singer ’49, the local representative for students from that area who’d been accepted at Haverford. Nadeau invited Singer and his wife to her house, and they spoke at length about the joys of both the medical profession and his alma mater. They would correspond with holiday letters throughout most of their adult lives.

“I saw right away that she was someone special,” says Singer, who credits Nadeau with influencing him, years later, to convince his 40th reunion class to establish a Class of ’49 Scholarship meant for students excelling in academics and participating in community service — students like Nadeau.

The meeting with Singer was one of several factors that led Nadeau to choose Haverford. She looked at many small
liberal arts schools during her college tours, but what captivated her about Haverford weren’t typical things like the beauty of the arboretum or the warmth of the people, but homey touches, like the golden retriever reclining on the
carpet in the admissions office. “Also, the students leading the tour just seemed so happy,” she recalls.

Nadeau was already well acquainted with the Quaker values and spirit that are Haverford’s hallmarks. Back home in Plainfield she’d become involved with her local Quaker meeting, and with the Friends’ assistance received a scholarship to visit the Soviet Union for two weeks. This was the early 1980s, when the U. S. still viewed Russia as a country populated by technologically-advanced adversaries. Nadeau didn’t know what to expect; she certainly didn’t anticipate how far Russian schools had fallen behind their American counterparts in terms of equipment and materials. Nor did she anticipate the people being so welcoming.

“We took so much for granted in the U.S.,” she says. “It showed how the media can skew your ideas about another population.” She calls the trip her “first reality check.”

At Haverford, she enrolled pre-med without hesitation: “I loved science. It was who I was.” During her first year, she took an “amazing” biology course with the late professor Ariel Loewy, who encouraged her to consider a Ph.D. program.
“The way we’re taught at Haverford parallels the course of a doctorate program,” she says. “We learn to read papers and do our own experiments. Haverford instills in you that power, that self-esteem. It gives you a solid backbone of loving to learn, and makes you realize that you’re only competing against yourself, not anyone else.”

Her professors, she says, inspired her to believe that she’d not only be accepted into a doctoral program, she’d also succeed in one. “And you know, the Ph.D. coursework was actually easier than Haverford’s was,” she laughs. “I tested out of a lot of first-year courses.”

“Kari was an outstanding student,” recalls Melvin Santer, emeritus professor of biology. “She was, and is, a warm, humane individual.”

Jenette Wheeler, Haverford’s premedical advisor, remembers how Nadeau reached out to her classmates. “In the gentlest way, she’d tutor people who were having trouble in biology, passing on information and ways of thinking that helped them develop their own methods,” she says. “She was so supportive of everyone around her, and wanted everyone to live up to their highest potential. She has such a giving heart, a great sense of people, and she never calls attention to herself. She makes the people around her feel like they are the most important people in her world.”
Nadeau was also a mainstay with Haverford’s Office of Community Service, 8th Dimension. As a freshman, she volunteered in the emergency room of Philadelphia’s Children’s Hospital every weekend, and in later years participated in an outreach program at a city homeless shelter. “She’s one of the most energetic women I’ve ever met,” says Marilou Allen, director of 8th Dimension. “She worked relentlessly, getting students involved in service. She has a presence about her—it made it hard for you not to want to get involved, if approached by her.”

It was Allen who helped Nadeau win a scholarship during her sophomore year that allowed her to accompany her hometown Presbyterian church on a service trip to Messiah, Nicaragua, to build a health clinic. It was a complicated time; Daniel Ortega’s Sandinistas were running the country and did not trust the American government to help them. Nadeau and her group spent several days obtaining permission to construct the clinic from government officials, including Nicaragua’s Minister of Health and the mayor of Messiah. “The health system was socialized,” she says, “and the government really prioritized medicine.” Because so many of the citizens’ health concerns were related to bacteria-laden water, Nadeau’s group also partnered with the German government to build a better sewer system for the city.
Before beginning construction, the service team met with many local doctors, nurses and community leaders to understand their vision for the clinic. “It was important to get input from the people, find out what they needed and what made sense to them,” she says. “In South and Central America, for example, they prefer hacienda-style architecture with an open area in the middle for people to meet, so that’s how the clinic was built.” After the project was completed and Nadeau returned to the U.S., she kept in touch with Dr. Josefina Bonilla, the doctor in charge, and as a medical student returned to Messiah with now-husband Paul Jackson (Stanford ’88).

Nadeau graduated summa cum laude from Haverford, and found ways to bring her love of service to a new level at Harvard, where she had been accepted into an M.D./Ph.D. program. She joined Physicians for Human Rights and Amnesty International, and in her second year of medical school arranged for a group to travel to Haiti and verify the presence of torture among political prisoners. They found four who had been tortured, and brought them to a Boston hospital for treatment. Today, one of those prisoners is the mayor of Port-au-Prince.

“This kind of experience drove home the idea that someone like me—no one special—can make a difference,” she says.
Really Starting After receiving her Ph.D. in biochemistry in 1995, Nadeau began considering specializations for her upcoming residency. Her sojourns in various countries had fueled her interest in international medicine, particularly as regards infectious diseases and the biochemistry of parasites. However, she hadn’t ruled out a cancer-related focus; in a twist of bitter irony, both of her parents and her brother had the disease at various stages of Nadeau’s life. (All three are fine today.) She was also influenced by a trip to the Texas/Mexico border with Physicians for Human Rights to document incidences of tuberculosis in children who were harbored with adults in dismal conditions at INS detention centers. The journey brought her love of children to the forefront: “Many of them need advocates, because they aren’t able to speak up for themselves.”

At Children’s Hospital in Boston, she fast-tracked a general pediatric residency fellowship, sub-specializing in hematology/oncology. Although it seemed like the ideal combination of her two primary interests, the fellowship awakened her to a grim reality: The young cancer patients were dying not simply from the disease, but from the chemicals in their chemo, which were destroying healthy cells as well as cancerous ones. It was agonizing for Nadeau to watch that which was designed to heal the children betray them so devastatingly.

Around this same time, biotechnology companies across the country were devising new therapies for cancer, drugs that would target only malignant cells. Some of Nadeau’s colleagues at Harvard (including Roger Breitbart ’77) were involved in the industry and recommended her for jobs. She seized the opportunity as a new—and less wrenching—method of aiding her patients. “The fellowship made me depressed that I couldn’t help more,” she says, “and I thought it might be best for me to work at this type of company and get a drug approved by the FDA.”

In the late 90s and early 2000s, Nadeau worked as associate director of medical research at Biogen, research director at Coulter Pharmaceuticals, and chief medical and scientific officer of Clearview Pharmaceuticals. During these years she won approval for some therapies (Bexxar, for non-Hodgkins lymphoma) while others (anti-CD40L for lupus) did not make it through the approval process because of safety issues. She also testified about the benefits of biotechnology before the Massachusetts legislature.

Nadeau had received some negative feedback about pharmaceutical companies’ profit-focused goals and corporate environment: “Here I was, this social justice person who’d been to all of these countries, and it seemed hypocritical for me to go into the industry.” But she was pleasantly surprised to meet biotech colleagues with similar values to her own, including fellow Haverfordians like Scott Wasserman ’92, who works at Amgen Inc. “These people weren’t in it for the money, but to get drugs approved that would help their patients. The pharmaceutical industry is the major way to get drugs approved for patient therapy,” she says. “Many of these companies had philanthropic activities, outreach to the same patients they’re treating.”

By 2001, Nadeau, her husband and young son Christopher had moved to the San Francisco area to be closer to her husband’s ailing parents. That same year, she gave birth to twin girls, Stephanie and Jennifer. Only a month later, she would be plunged into a parent’s worst nightmare.

Her son brought home a virus from nursery school one day—hardly an uncommon occurrence among toddlers. However, when it caught hold of her newborn daughter, Stephanie, it was respiratory syncytial virus (RSV), the most common cause of bronchitis and pneumonia among infants and children under one year, according to the CDC. Stephanie was admitted to the intensive care unit at Stanford University’s Lucille Packard Children’s Hospital, where she spent a week being intubated (having machines breathe for her) and receiving blood transfusions.

Closer to Home

It sounds like the plot of a tear-jerker: A physician who has treated scores of sick children must now cope with her own child. But here it was, really happening. “It was a scary, stressful time,” she says. “As a resident and doctor, I’d seen parents go through it. Now I was on the other side, and it was life-changing.”

She hadn’t realized just how much she’d missed dealing with patients until she watched Packard’s indefatigable team of doctors and nurses toil round-the-clock to save Stephanie. “My heart missed it. I wanted to go back to my roots.” She already had a connection with the hospital beyond her daughter’s illness; she volunteered in the acute care clinic and taught a biochemistry course to medical students. In 2003, she went to the head of pediatrics at Packard and asked to join the team.

Once she began practicing again, she found that she hadn’t forgotten anything she’d learned in her coursework and her residency. “It’s like riding a bicycle,” she says. “Once you’ve got your medical training, you never really lose it, but you have to keep using your skills to improve.”

Nadeau decided to retrain as a fellow in allergy, asthma and immunology since her Ph.D. and post-doctoral learning had focused in the field of immunology. This area of specialization combined her previous research interests with a prevalent present-day malady. “In this country, and other Western civilization countries, the incidence of asthma in children is increasing steadily,” she says, putting forth the “hygiene hypothesis” as a possible reason: “We’re such a clean society, and we vaccinate ourselves so well, that our immune systems haven’t been trained by microbes that would normally be identified as foreign. Our bodies are tricked into thinking that dog and cat hair, or peanuts, are foreign, and they make antibodies against them.”

Her current research focuses on the T-cell’s dysfunction in asthma patients. “The T-cell is important in immune education,” she explains. “It should know what’s foreign to the body and what’s not. If the immune system can be fooled into thinking that, say, a peanut is foreign, it can create an allergic reaction to that food.” At Packard, Nadeau has helped start a pediatric clinical trial to see if an experimental asthma treatment called anti-IgE could be beneficial for children with food allergies and eczema. She hopes to halt what she calls the “allergic march,” when an allergy travels from skin to nose to lungs and becomes an asthmatic condition.

Nadeau doesn’t deny that dealing with sick children—some seriously so—on a daily basis can be harrowing. “Sometimes I wake up in the morning and wonder if I can balance all of this,” she admits. “The trick is to not be overly confident, try the best you can, and understand that failure will happen, and clinical and research failures will lead to more questions.”

She sees the emotional effects of her vocation as a kind of blessing. “It would be really sad if you didn’t take pause sometimes,” she says. “All pediatricians have moments when they can’t do anything, feeling weak because they can’t help a family.” The head of Packard’s pediatrics department told her that when every other method has failed, compassion is what helps a physician succeed, as both a doctor and a human being.

“Compassion helps you be there for your patients and yourself,” she says. “And thank goodness you have that feeling. If you’ve done all you can, holding a hand or spending extra time in ICU sometimes works much more.” The philosophy of training doctors used to be focused almost exclusively on fixing what’s wrong. But now, says Nadeau, future physicians learn that “it’s OK to say ‘I don’t know’ and be there for the patient on a compassionate level.”

Nadeau’s compassion and empathy comes from an even deeper place than her medical training: She herself is a patient, and has lived with an extremely rare cancer of the T-cell since 2001. She was not diagnosed until 2003; she had not been feeling well for some time and, after she was taken to the emergency room with a kidney infection, her blood work revealed the presence of the disease.

“The diagnosis hit me like a hammer,” says Nadeau, who initially was led to believe by medical literature that she would only have two years to live. However, after consulting with an expert on this disease at Penn State, she learned that her particular type of cancer was slow-growing. She’s been stabilized for several years, and was even able to carry her second set of twins, Katherine and Elizabeth, born in 2005 (there’s about a one in 16,000 chance of two pairs of twins being born in one family). Unfortunately, there’s no cure or chemotherapy that can stop this form of cancer. “If my cells start growing out of control, nothing can be done. I have to accept it.”

And she has, with her usual brand of optimism. “Everything happens for a reason,” she says. “Now I know how patients feel when they get these diagnoses, and how they deal with their illnesses.” The ordeal has also made her more sensitive to issues of insurance coverage; if it hadn’t been for her own insurance, she says, she never would have received reassurance from the Penn State expert. “I realize how important it is for patients with rare diseases to have access to doctors with expertise in these fields.”

There are a few bitter ironies to Nadeau’s situation—she’s a T-cell immunologist with cancer of the T-cell, she’s the fourth member of her immediate family to have developed cancer—but rather than dwell on it, she chooses to intellectualize the disease. “It’s made me more focused in terms of my research helping other people,” she says. “In a way, I’ve been given a new lease on life—I’m so lucky not to have a [worse] form of this cancer.”

These events have irrevocably altered Nadeau’s outlook on her professional and personal lives, and she’s managed to fashion a manageable, accessible everyday routine for herself and family. She wakes up around 7 a.m. to play with her babies. At eight she jogs (“I need the time for meditation”), then heads either to the clinic, the classroom or the laboratory, depending on the day. She picks her kids up from daycare or school around 3:30, and spends time with her family at home until 8 p.m., when she returns to her office to write grants and read e-mail until 11 p.m.

“For many academic women trying to balance careers and family, this schedule seems to be successful,” says Nadeau, who wants to concentrate fully on her family when she’s with them: “I love spending time with them and when I do, they’re my sole focus.”

She notes with some amusement that she’s miles away from her teenage fantasies of living a single life in a remote location. But she feels nothing but fortunate to be part of this family of five children. “Sometimes life gives you gifts that you didn’t know were gifts until you got them.”

She sees herself at Stanford for the duration, pursuing a tenure-track faculty position, volunteering at the Arbor Free Clinic for people lacking health insurance, and mentoring promising medical students like recent Haverford graduate Angel Callejas ’06. “It is a true privilege to be part of her research team,” says Callejas. “Not only does she embody Haverford’s Quaker values, she’s the ideal mentor, physician, mother and role model.

“She should be recognized as the Superwoman that she is.”