"Sharing the Air"

Written by Melissa Hendricks
Illustration by Michelle Chang

Teacher, coach, critic, guide….A good mentorso crucial to the success of the scientific enterpriseis all of these and more.
One sheet of paper. That’s what it comes down to. Doctoral student Jessica Gill has spent months planning her research study of women with posttraumatic stress disorder (PTSD). She’s hung out in the waiting room of a health clinic for days and days to recruit volunteers. And she’s logged hundreds of hours interviewing those participants and collecting blood and saliva samples. All of these data fit tidily in one table on this single sheet of paper, which Gill now places on the desk of her mentor, professor Gayle Page, RN, DNSc, FAAN.

“This is what I’ve got so far,” she states.

Page briefly glances at the paper, then leans back in her chair. “Okay, tell me,” she says.

Gill begins to talk, and the figures on the page consume the next hour’s discussion, as the researchers scrutinize every facet. At first, Gill does most of the talking, speaking calmly. This is her study, the basis for her doctoral dissertation.

Patients with PTSD have a high frequency of medical problems. Gill wants to learn whether she can detect clues to these illnesses or to PTSD itself in the immune and neuroendocrine systems of her volunteers. Lab tests of the volunteers’ blood and saliva might reveal such clues. She speaks calmly, with her hands folded in her lap. But the composed exterior belies Gill’s anxiety about meeting her goals for this study.

Jessica Gill (left) and Gayle Page, Photo by Will Kirk

Gill was aiming for 250 participants, but she has exhausted her potential pool of volunteers, at a local health clinic, and managed to recruit only 244. Some of the women submitted blood samples but no saliva. Some gave saliva but no blood. And then there is this other complicating factor that has emerged: While many of the women currently have PTSD, many also appear to have had it in the past.

Page pulls off her glasses and bites one end, then offers her thoughts. She speaks in a low, resonant voice. As for the complicating factors, she sees those as a plus, more to study. And as for the shortfall in volunteers, 250 is a nice round number, but it’s not a necessary scientific goal.

“It’s time to cut it off,” she says. “I think you have enough numbers.” Then Page charts the next phase of the study, which will involve testing the blood and saliva samples. She and Gill set a day and time to begin their experiments, they determine which set of samples they’ll test first, confirm that a chemical they’ll need has not exceeded its expiration date.

“Oh, and I’ll get the samples out of the refrigerator,” says Page. “They’ve got to be at room temperature.”

Science is all about such meticulous attention to details, says Johns Hopkins University School of Nursing Dean Martha Hill, PhD, RN ’64, FAAN. “It is a combination of an intellectual exercise and a complicated logistical expedition. Every step has potential for detours. You have to plan in advance all the things that could threaten the strength of that study.” And new researchers acquire the complex skills needed to navigate this intricate system through mentoring: A student researcher such as Gill conducts a study, and an experienced investigator such as Page guides and directs her charge from the wings of the stage.

This process of teaching, coaching, guiding, encouraging is crucial to the enterprise of scientific research, and probably as old as the enterprise itself. If Aristotle were to venture forth in time to the present day, he would surely be amazed by the discoveries of modern science, and he would marvel at the DNA microarrays, magnetic resonance scanners, atomic force microscopes, and other high-tech instrumentation of 21st-century science.

But one feature of modern research would be familiar to the ancient scientist: mentorship.

Mentoring, however, has no general rule book. Scientific research is enormously diverse. Becoming a researcher might include everything from learning how to mix a .052 molar solution to mastering the skill of writing a winning grant proposal. It can require learning how to recruit participants for a clinical trial or how to persuade a colleague to collaborate on a research project.

At the Johns Hopkins University School of Nursing, mentoring is not limited to a one-on-one relationship of a faculty member mentoring a student. For example, every new faculty member is expected to choose a mentor from among Nursing’s senior faculty. Senior faculty conduct group mentoring sessions with assistant professors, providing advice and guidance on scholarship and career advancement. And the school has other forums for group mentoring. For instance, Gayle Page started a writing group for junior faculty where members can help each other with the writing for grant proposals and scientific research papers.

For those who are involved in the more traditional one-on-one mentoring relationship, the challenge remains: How does a mentor pass down such a large and diverse body of wisdom … all of those details?

Compatibility is a good start. Megan Hoffmann ’04, who is pursuing a master’s in pediatric nursing, says she felt inspired from her first interactions with associate professor Marie Nolan, DNSc, RN, who is now her mentor for a study aimed at understanding how prospective kidney donors make their donation decision. “I remember being so impressed with her zeal for research and evidence-based practice. Her enthusiasm was contagious, and it wasn’t long before I could see myself doing nursing research someday.” Assistant professor Cheryl Dennison, PhD ’01, CRNP, felt a similar spark when, as a graduate student, she talked to Martha Hill about the possibility of studying ways to improve care and cardiovascular health among inner-city black men with high blood pressure. “We really clicked. From the first meeting it was clear that she’d be interested in my learning, and that this would be a good learning experience. I left feeling confident about going down a new career path.”

One of Page’s first tasks as mentor was to help Gill hone her research project. Gill had first proposed a study involving rape victims. She would compare the biology of those victims who developed PTSD to those who did not. She also intended to concentrate on the immune system, specifically to explore whether any changes in immune functioning seemed to accompany PTSD. Gill now calls this plan her “grand overarching idea.”

Page immediately saw problems. Gaining access to victims would be fraught with practical and ethical problems, she cautioned. Instead, she suggested that Gill recruit volunteers from a local health clinic. The results from an earlier study suggested that Gill would find a relatively high rate of PTSD among the patients there.

In addition, Page advised Gill to expand her study to include the neuroendocrine system. Other studies, including some of Page’s own, had pointed to an interesting interplay between the immune and neuroendocrine systems. Gill could assess the neuroendocrine system of her volunteers by measuring levels of the stress hormones cortisol and DHEA.

So with her mentor’s guidance, Gill designed her current study. It involves a lengthy diagnostic interview with each volunteer to determine whether the woman has (or has had) PTSD. (Many of the women treated at the clinic have been victims of abuse or witnessed violence, and appear to have suffered PTSD as a consequence. So far Gill has found a PTSD rate of 16 percent, about triple the national average.) In addition, the interview involves an extensive inventory of each volunteer’s health status, in which Gill records all major and minor medical problems. And finally, the women submit blood and saliva samples.

With a freezer now full of these samples, Gill and Page will next test each blood sample for levels of cytokines, an immune system component. They will also assay each saliva sample for another immune system factor called secretory IgA, and for cortisol and DHEA.

Gill and Page hypothesize that women with PTSD have dysregulations in their neuroendocrine systems and dysregulations in their immune systems, and that one set of problems may be linked to the other. They also suspect that these changes may somehow make the women more prone to the array of medical problems that are seen in PTSD.

Back in Page’s office, the conversation moves on to publication. “Do you know where you want to go [to publish]?” asks Page. Gill would love to publish three additional articles by the time she completes her degree. But she has to juggle writing these with the time required to conduct her experiments, and work around the fact that she is due to have her second child in a few months. Page suggests that three papers might be too ambitious. Two publications, in addition to the ones she has already written, would impress her dissertation committee. (Indeed, Page says later, Gill is extremely ambitious and conscientious. Part of her role as mentor, says Page, “is to help her chill a little bit.”)

When Page first started mentoring Gill, a lot of their time together was devoted to reworking Gill’s writing. Gill would give Page a draft of a grant proposal or research review paper; Page would edit the paper and return it with numerous changes. “Sometimes it seemed that almost everything on the page had been changed,” recalls Gill. Then Page would explain, “This is the process. If you can’t take it, you’d better try something else.”

Page says she understands, having gone through the same painful experience herself. She did her doctoral research in a windowless laboratory, three floors below ground, among a vibrant group of graduate students, post-docs, and technicians. These young scientists taught each other the methods of laboratory science. Meanwhile, her mentor, John Liebeskind, a world-renowned pain researcher, oversaw the whole operation from an office 11 floors up.

“John came in at the paper stage,” says Page. When a researcher had gathered sufficient data and written her results, she would step apprehensively onto the elevator, ride up 11 flights, typewritten paper in hand, and knock on Liebeskind’s door.

“We sat at the desk and went through every word,” Page recalls. “He’d ask you questions: What does this mean? Are you sure? Everything took a dramatic change. It was brutal.”

After as many as two hours of this, the mentee would leave Liebeskind’s office and ride back down the 11 flights, carrying a manuscript now covered in blue ink and affixed with a patchwork of amended scraps of papers. The mentee would make the necessary changes, and then return to Liebeskind’s office some days later to repeat the process.

Page says the ordeal taught her how to write scientific papersas well as something about mentoring. Liebeskind could evince an insight from a student by asking just the right questions, so that by the end of the process the answer or solution would seem to have emerged from the mentee.

Scientific research does not just take place in the cozy confines of an office or lab. A scientist must also go out into the worldmake connections with colleagues, launch collaborations, pitch her theories, and persuade others that her ideas are worth following (and funding). In essence, it requires an ineffable quality that might be called leadership. But how does a mentor teach leadership?

Cheryl Dennison, Photo by Will Kirk

Cheryl Dennison, whose work with mentor Martha Hill started when she was a doctoral student and continues today, almost 10 years later, says that Hill never sat her down and delivered a disquisition on leadership. Instead, Dennison learned a lot by simply watching Hill and taking advantage of the leadership opportunities that Hill offered her. “I observed her in ongoing research meetings, how she allowed others, like the project manager, to function with a high level of independence. She provided guidance and then gave them the freedom to learn what is successful, what is not going to be successful. She was always accessible, willing to brainstorm to address a problem and provide positive feedback by acknowledging and celebrating the successes.”

She also saw that Hill strived to find ways to include other faculty members and students in her research. If a colleague had something to contribute to a research studyeven a small piece of the workthat person was included and given credit. “Martha has said that you have to ‘share the air’,” says Dennison. “That is, elicit input from others and really listen to what they have to say. Don’t think you have all the answers. Although it may take more time, the product is usually much better.”

Hill says she believes that leadership is learned by doing, so she looks for occasions for her mentees to take the lead, for instance by encouraging them to submit their findings for talks at scientific conferences. Before a presentation, Hill guides a mentee in planning the talk and critiques the talk in rehearsals. Dennison, who went through this process as a doctoral student, says that speaking in front of hundreds of fellow scientists taught her a lot about communicating science and “how to think on my feet.”

“Members of the audience, often experts in the field, ask questions after a presentation,” says Dennison. “In those early presentations it gave me confidence to know that Martha was in the audience and available to provide support if I needed it.”

Mentoring has been compared to parenting. In some ways, this is an apt analogy. Parents and mentors are teachers and guides, but perhaps their biggest responsibility is to encourage the novice to take a first step when she is ready and to walk off in a new direction: her own.

Before Page became her mentor, Gill took a class from her on the philosophy of nursing. The reading list featured an eclectic mixnovels as well as journal articlesincluding the novel Flatland, by Edwin A. Abbott. In the story, characters live in a two-dimensional world and cannot conceive of any shape beyond a point or line. The message of the book might apply to science, says Page. “It’s about learning to take a different perspective, to think on your own. You don’t want to be on the line.”

Research is not about making the same widget every time. It is about inventing a new widget or a new way to make a widget. And because research is about original ideas, the mentorship process might come full circle, with the student bringing new knowledge to the mentor, just like the pre-teen who introduces his mom or dad to this century’s new electronic gadgetry.

Thus, in Page’s lab the circle may be closing. As she’s learned more about PTSD and learned more about the lives of women who have been abused, says Page, “I’ve gotten more passionate about it. Passion for me translates into animal models.” So after a career spent studying the roots of physical pain, Page now has a new project in mind.

She plans to develop an animal model of PTSD.

Melissa Hendricks is a freelance writer based in Annapolis, Maryland.  She writes frequently on health and science issues.

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