Want to learn more about the Adverse Childhood Experiences Study? Learn more, here.
Nadine describes the disparity in the cost of food in different parts of San Francisco. Use this interactive map to learn more about food deserts in your area.
The story of John Snow and the Cholera outbreak is fascinating. Learn more about it, here.
Kate Bowler: Hey, Lovelies, just a quick hello before we get started today, we’re going to be talking about our childhoods and well, I wrote a hilarious, medium, hilarious, medium sad piece this weekend all about the people we think we might have been. It’s in The New York Times Sunday paper. And if you look it up, you can see they made a cartoon montage of all my amazing ideas of the people I thought I’d be Egyptologist, professional cross-stitcher, Anne of Green Gables character, yes, she was fictitious, that never stopped me. It’s all about how our futures come at the expense of all others and why I think that a bucket list is not a solution. Anyway, check out “Why I’m Not Making a Bucket List” in The New York Times if you want to hear some of my feelings about it. They were some of the ideas I’ve been thinking about in No Cure for Being Human, which is the book I wrote that’s coming out at the end of September. So if that suits you. You can read more about the book at NoCureBook.com. All right, loves. We are so many people over the course of our lives, aren’t we? Let’s dig into that today. I’m so glad you’re here.
Kate: A lot of us wonder if there’s anything we can do about our past. We hear lots of overly simplistic phrases like just look forward, don’t look back, or what doesn’t kill you makes you stronger, even though it might try again tomorrow. I’m Kate Bowler, and this is Everything Happens. I’m here to look into your gorgeous eyes and say it’s OK that everything hasn’t gotten magically better or that our lives and histories and families are complicated. Our childhoods, if we take a hard look, might not be as idyllic as we would have liked or deserved. The more we learn about our past, the more it may have some frightening implications for our present and our future. These are the stories you avoid bringing up on a first date and definitely don’t mention at the dinner table, lest you ruin everyone’s jello salad. Just joking. Jello salads were already ruining everything. But whether we like it or not, we are our whole stories. While nice in theory, trite statements like there are no set backs, just set ups, don’t take into account the growing important literature about how our childhoods might still be impacting us. But there is hope, as today’s brilliant guest reminds us. Dr. Nadine Burke Harris is an award winning physician, researcher and advocate dedicated to changing the way our society responds to one of the most serious, expensive and widespread public health crises of our time. Childhood trauma. She graduated medical school from the University of California, received a Masters in Public Health from Harvard and completed her residency in pediatrics at Stanford. No big deal. She was appointed as California’s first ever surgeon general, and she is the author of a very important book, The Deepest Well Healing the Long Term Effects of Childhood Adversity. Nadine, oh, my gosh. Thank you for doing this today. I am so excited.
Nadine Burke Harris: Oh, it’s my pleasure. I’m super excited. I’m happy to be chatting with you.
Kate: I thought you might love this, but since I’m a historian and I study American mythologies of luck and hard work and what we deserve, one of the most common stories we tell, of course, comes from those dime novels, those rags to riches pamphlets from the Gilded Age. And so we get these stories from the Horatio Alger stories, which is that you can do anything you set your mind to, you could always overcome. They always star a very plucky orphan. You and I have a lot of arguments with this narrative. So could we start there? The bootstrapping story is really incomplete. So what is it missing?
Nadine: Yeah, absolutely. So, you know, we have been told this myth read that anyone can just pull themselves up by their bootstraps if they just work hard enough and have a positive attitude. And in fact, what the science shows is that our experiences, both negative and positive from our childhoods, actually get under our skin and become embedded in our biology. They can affect the way that our brains develop. They can affect the way that our immune system, our hormonal systems develop, and they can affect our health and wellbeing throughout the lifetime. And I think one of the things that is is most interesting about that, when we when we think about childhood adversity, when we think about that orphan.
Kate: Right. Yeah.
Nadine: We typically look at that picture of the person who has pulled himself up by their bootstraps. And we figure, OK, well, since they’ve got a job and they got an education and they’re not dependent on any substances, they’ve done it, they have overcome. Yeah. And actually what the data shows and what we learned from this landmark study called the Adverse Childhood Experiences Study conducted by the CDC and Kaiser, is that folks with a significant childhood adversity are more likely to develop heart disease and cancer and strokes and Alzheimer’s and all these different health challenges. What we now understand is that even if you do get a great job and you’re married and you’re settled down, that the impacts may be there in terms of our health in a way that we largely we’re not recognizing before.
Kate: Your book reads, kind of like a detective novel. You know, you’re this idealistic young doctor who wants to make a big impact and learning to care both personally and structurally for the patients that you have. And you want to start a clinic in San Francisco, you you’re having all kinds of discoveries.
Nadine: I wanted to work someplace where I was really needed, someplace where I could make a difference and I ended up working in one of San Francisco’s most underserved neighborhoods, which is a gorgeous, vibrant community called Bayview Hunters Point, and it’s the place with the highest rate of homeownership, or at least at the time when I was there, highest rate of homeownership in the city. It was the largest African-American community in the city. And it was a place with a lot of history and also a lot of challenges. For for most neighborhoods in San Francisco, much like the rest of the United States, heart disease was the leading cause of early mortality. For one neighborhood, it was HIV AIDS. And for Bayview Hunters Point, it was violence was the number one cause of early mortality. So that begins to paint a picture of families, communities, multi generation and then also real struggles in terms of disinvestment, community violence, there was an EPA Superfund site like there was a literal toxic waste site in Hunter’s Point. So there was a there was a lot going on in that community. And that was what made me want to go there. Right. To to be of service and to invest a bit of myself in a community that had been and experienced underinvestment in a for a really long time.
Kate: And when you’re seeing these patients and you’re looking at these faces, you just hear how you’re trying to pull apart all these different variables, like when you see a child who might have a statistically rare disease, you’re trying to wonder, is it you, is that your family, is it your environment? How did you come to think about zip codes as being a determinative factor in health?
Nadine: In San Francisco, it was everyone was within one city. And yet in the 94124 zip code, which was Bayview, we were seeing some of the highest rates or hospitalizations for asthma, pneumonia, lots of different health conditions. I actually did a comparison with a 94123 zip code, which is the Marina district across town. And there the differences were so stark, right? There were there, for example, one of the things that we saw was that even though all of the warehouses for the grocery stores were in Bayview, a loaf of bread, we actually did this analysis and research, a loaf of bread cost significantly more in Bayview than it did way over across town in the Marina. Same thing, a piece of fresh fruit cost way more in Bayview even though all of the grocers have their warehouses there. And so you just see the ways in which the zip code makes a difference. And and even, for example, the fact that the warehouses are there, is that’s where all the diesel truck yards are and the bus yards and the you know, it’s close to a freeway. So all of these particulate so you see the way that some of the environmental factors are structured. And then you also see, like, for example, with the difference in prices, the way that these disparities layer on top of each other to just create layers of disadvantage for these communities.
Kate: I’m completely fascinated by the way that we think about agency, what is available to us to choose. And when you describe that, it’s such a powerful visual of just the narrowing and narrowing of choices, when you try to tell somebody, oh, don’t worry, you can help take care of your health, just exercise… Outside near toxic factory, eat healthy… With an expensive loaf of bread. I mean, the the amount in which so many of the things that determine the quality of life is chosen for us, I think would really surprise people.
Nadine: So I am going to say this because when I went to work in Bayview, so a couple of things, I lived two miles away or a mile and a half away in just an adjoining neighborhood called Potrero Hill and I would walk to work. And I am one of those these people, I believe in all of these things. I believe in practicing what I preach. And I found myself, even for myself, trying to find a healthy meal at lunchtime, trying to go for a walk during my lunch hour or something along those lines. And it was really this thing where I was like I came here to address disparities. I didn’t want to become part of the disparities, but I can’t find something healthy to eat. I can’t find a green space to walk. You know, it was really it was really powerful to experience it for myself.
Kate: Yeah. The image that you use in trying to make sense of all of the variables that are changing the health outcomes of the patients you’re seeing, you imagine a well, the deepest well, why did you choose that and why is it so helpful in in accounting for what primarily changes are now our health?
Nadine: I’m a total science nerd, as you probably know, and in public health school. Right. So it’s like day one of public health school. One of the things that you learn about is the the cholera outbreak in Soho at the turn of the century where all these people were getting sick. And there is a public health hero that we all learn about John Snow, not the Jon Snow from Game of Thrones, but there’s Jon Snow on that show, too. But this guy, Jon Snow, he they’re trying to figure out what to do about this cholera outbreak. And all these people are getting sick. And at the time when they would take the waste or whatever from their homes, from their bathrooms, and they would dump it out into the gutters and into the sewers. And this guy who’s an epidemiologist, he went and tracked all of the people who got sick and he looked at all of the outbreaks. Ultimately, what he deduced was that all of the folks who got sick, the thing that they had in common was that they all were getting their water supply from the same well. And so he told the public health officials, please take the pump handle off of this well and watch these people will stop getting sick. And people thought he was crazy. People thought he was insane because no one knew that illness was caused by germs. Right. This was before germ theory. People thought that illness was caused by foul airs. And so they said, you know, what are you talking about? Pump, handle and water. This doesn’t make any sense. But he convinced them to do it. And when they remove the pump handle so no one could could access the well anymore, the cholera outbreak subsided. And so the parable of the well is really about going to the source. It’s about going- getting to the root cause. And that is the thing about childhood adversity. The reason it felt like a very fitting metaphor is because for so many of us, we believe that the challenges that we are seeing. Right. For example, when we look at the impact of childhood adversity, we see profound impacts on educational outcomes, on kids ability to learn. We see profound impacts on risk of incarceration. Yeah, right. One of the biggest challenges our society faces. We see profound impacts on health as I talk about, you know, risk of heart disease and stroke and cancer and even infection, we think of those as totally different things as opposed to going to the source to figure out how we can get to the root cause. And so my hope and in in writing the book and writing the deepest well was for folks to be able to have the tools to start to recognize the extent to which early adversity is one of these root cause issues, and that if we get to the source and do something about it, we can profoundly transform outcomes in so many different areas.
Kate: So what qualifies as an adverse childhood experience, ACE, I think, is the acronym for it, because it helped me in reading your work to help understand some of the distinctions between daily stressors and what you’re describing as toxic stress and then trauma, for instance.
Nadine: So the term adverse childhood experiences actually comes from the big research study from the CDC and Kaiser Permanente. And so when we use the term adverse childhood experiences, we’re referring to the 10 criteria that they evaluated.
Kate: And they were so concrete like like a parent removed from the home or-
Nadine: That’s right. So it refers specifically to physical, emotional or sexual abuse, physical or emotional neglect, or growing up in a household where a parent was mentally ill, substance dependent, incarcerated, where there was parental separation or divorce or intimate partner violence. So those are the 10 traditional criteria. What we now know is that how they work, right. The way that they lead to harm is that they lead to this prolonged activation of the biological stress response so that when the biological stress response is activated over and over again, it has a hard time shutting itself off after a while. And so you get this prolonged activation and that prolonged activation we now refer to as the toxic stress response. So what we’re talking about toxic stress we’re actually talking about the body’s response, the adrenaline levels and the cortisol levels and all of that stuff, like we measure it. And we say, well, this is a toxic stress response. Yeah, but what’s interesting is that we now understand that there are other things that can lead to the development of the toxic stress response. Those include discrimination, for example, or the accumulated hardships of poverty. That’s another one. The atrocities of war, medical trauma like that wasn’t included in the original. But knowing your history, probably you can say.
Kate: What no, it was amazing. I loved it.
Nadine: Yeah, but that is. But that’s exactly right. So we’re now understanding that other things that weren’t part of the original 10 ACEs may also be risk factors for development of the toxic stress response. And so that is where understanding how that works, understanding how we intervene and understanding how we help the body get back to reregulating the stress response is really important.
Kate: So what happens in our bodies when we experience stress?
Nadine: What happens in our body? So imagine and the example I like to give is if you’re walking in the forest and you see a bear. Right, just think about what that feels like. Yeah. Your heart starts to pound. And the reason for that is because your body releases a surge of stress hormones, including adrenaline, which is a short term stress hormone. Right. That really gets your heart pumping. Cortisol, which is a longer term stress hormone, and that helps to raise your blood pressure, your blood sugar. Right, so you have lots of energy to fight that there. So all of that stuff, I think, is pretty intuitive. One of the things that’s less intuitive is that when your body activates your stress response system, it also activates your immune system because you imagine that if that bear gets his claws into you, you actually want inflammation, your immune system to be primed to bring inflammation so you can stabilize that wound so you can either live long enough to beat the bear or get away. So this is brilliant. It was evolved over millennia to save our lives from a threat. Yeah, but the problem is what happens when that bear comes home every night and this biological response gets activated over and over and over and over again. So you have you know, the brain is activated. You have this flood of stress hormones. You have your immune system revved up. And over the long term, if this happens over and over and over again, and especially if it happens early in development, because that’s the time when children’s brains and bodies are just developing what that could lead to is a change in the way that children’s brains and bodies develop that can be lifelong.
Nadine: In fact, it can even change the way our DNA is read and transcribed and those changes can be handed down to the next generation. This is really a profound biological impact, we now understand that the way significant adversity, repeated stress, trauma, adversity in childhood without adequate buffering, what it can do to our brains and bodies, the good news is that safe, stable, nurturing relationships and environments actually can biologically arrest that stress response.
Kate: I love hearing you describe this kind of like a hydraulic image, right? That your body is doing its best. Your body has- it may have strong or dampened responses to things based on what it’s been through. And so, so often I hear- I’m in cancer world. And, and so often one of the qualities that’s really valorized among sufferers and also those who care for them are, of course, the resilience, like we want the resilient patient. Sometimes what I hear us glamorizing is like an endless bounce back, bounce forward. I would say like theology, like a story we tell about how good and righteous and well-behaved people can take what happened to them and not just have like a setback, but a set up. This seems to put resilience in kind of a a richer conversation. So how how do we think about resilience in this framework?
Nadine: So I have a particular perspective on resilience, I will say. So true story. I was speaking at a conference and someone came up to me and said, “oh, you’ve got to talk to my friend. She’s experienced a lot of ACEs and she really pulled herself up by her bootstraps and she’s doing great. And she wrote a book about resilience and she’s amazing. You got to talk to her.” And I was like, great, wonderful, you know, put me in touch. And she says, “Oh, but you can’t talk to her now. She’s actually in the hospital. She just had a heart attack.” Oh, I’m not making this up. And I was like, I think our definition of resilience is incomplete. I think it has to- it has to include mind, body, soul, spirit, like the whole the whole thing, right, because that’s really important. If your mental health is fine, but you’ve got autoimmune disease, then we haven’t finished doing our job yet. Right. There’s still more work to do. Yeah. What I would love to see is in the unfortunate event where someone experiences ACEs to a certain amount of which are going to be unavoidable right? I’m working very hard to advance the science to get to the point where the negative outcomes are truly, truly preventable and that when we attend to someone, we are attending to their mental and behavioral well-being, their physical well-being. And we don’t stop until all of that is where we want it to be.
Kate: I really hate cliches because they’re they just can’t possibly be true. Like when they say, well, kids are resilient or or they do that after we have mass atrocities like a mass shooting and they say, oh, like the country is resilient. We love that word because it tells a story about, you know, that our best getting back up.
Nadine: I think people use it to try to absolve us of our responsibility or to say, like, there’s we don’t need to do more work when it’s the exact opposite. The kids have the capacity for resilience, but we have to create the circumstance that allows them to be resilient. And the key, the take home, their number one is that now that we understand what’s happening biologically, one of the things that the science shows us is that early detection and early intervention improves outcomes. Yeah. Right? So then if we intervene early, that gives us the opportunity to take advantage of that science, of nurturing relationships and exercise and nutrition and exposure to green space and all of those things and apply these interventions so that children’s brains and bodies are now developing in the context of these healing factors, help to regulate the stress response as opposed to doing the opposite.
Kate: I did a recent interview with the author of The Body Keeps the Score and it was very, you know, for someone in the humanities, it was quite an introduction to epigenetics and the way where nature and nurture, but also our parents nature and nurture and also their parents nature and nurture. And so for people who might not be familiar with epigenetics, what is it and how, in your opinion, how determinative should we imagine it to be like are we all sort of just going to be reduced to our great grandmothers stress levels? My great grandma was pretty stressed out.
Nadine: So to start with, what’s epigenetics? I like to the way I like to describe it is that if we think about our DNA as musical notes, right. I’m a super science person. You’re in the humanities. I am terrible at music. I have not a musical bone in my body, however, I did learn to read music when I was a kid in school, and so they have the musical notes on the page and that tells you what note to play. But then there’s also the musical notation, right? And there’s little kind of scribbles in the margins and it tells you to play this next section really loud, right? Forte. Or play it really soft, really gently, or skip this next section or play this next section twice. Right? That’s what the musical notations tell us. And very similarly, when we talk about epigenetic regulation, we’re not talking about changes to our genetic code. So if we think about our DNA as those musical notes, if we think about these epigenetic markers, they’re just chemical signals that get stuck on to our DNA. They’re likely musical notations that tell our body how to read and transcribe a section of DNA so it can say, you know what, don’t even bother to transcribe this piece. Right, like just- just we’re going to leave this part silent or it’s going to say, hey, you know, this this section of DNA, whatever it’s supposed to make, make a ton of it. Right? Or no, just make a little bit of it, you know, whatever it is. So if it’s the section that makes stress hormones, it’s like pump it up! Make a ton of it. And the reason is because you need a ton of stress hormones, because this environment is threatening. And so in order to survive, right, we’ve created a shortcut where parents have a way of handing down information to their kids about what is the environment like. Right? Like, OK, we give you your DNA, but these epigenetic markers are like a shortcut to say, OK, we need for you to make a lot of this, because that’s what you’re going to need to survive today. We’re not going to wait for gene mutations in the DNA three generations from now to give you a competitive advantage. We want you to have the competitive advantage now. And so stress hormones actually can make changes to your epigenetic regulation that can put chemical signals on your DNA to tell your body how your DNA should be read and transcribed. That’s how epigenetic regulation works. And what’s to your question that like, are you kind of stuck with your great grandmother’s stress level? The answer, which I think is so fantastic, is no. Our epigenetic markers, tell us how our DNA should be read and transcribed. And if your great grandmother experienced a lot of stress and adversity and then your grandmother did and then your mom did, the likelihood that your stress hormones are going to be more wired up is high. But, and this is what is so fabulous is that if we in this generation or let’s say our mom. Right. If our mom realized, oh, my goodness, I experienced all the stress, but I’m actually going to do something different for my kids, I am going to give my kids lots of licking and grooming, lots of nurture and love and care. I am going to create an environment that feels safe and stable for my kids, and I’m going to give them lots of support. Then the epigenetic markers will also go according to environment. Amazing. We have the capacity to change the way that happens and actually the way that we learned that was from studies in rats, where actually what they did was they took the puppies from moms who were not very nurturing and cross fostered them. So essentially put them in foster care with mom, who did lots of nurturing care. And it turned out that those baby rats, they took on the epigenetic markers of the mom who reared them, not their biological mother. So this is the point like when we say which makes a bigger difference, genes or environment, the answer now is undeniably that it is an inextricable mix of both.
Kate: Wow. The story of the rats who had low-lick situations where they were not very nurtured and then they were given to high-lick moms when they were very nurtured and then they did so much better in high-lick situations. I just thought that’s such a comforting takeaway for people who had low-lick lives that like they don’t necessarily have to surface the same stress level and fear and exhaustion if they can structure a more nurturing surrounding for themselves.
Nadine: That is exactly right. And I will tell you that I am so glad that I read that research before I got married because I’m not joking. I am telling you for real that when I met my husband I’m like this man is a nurturer. Yes. Like that is going to make my life so much better. And so I mean, aside from the fact that he’s also really handsome. But it was I have to say, it was so powerful because I tend to be a nurturer, you know, getting a little too much into my personal life. Like, I, I dated some some some projects, come with their own work done. And it was so wonderful for me in a I do think that the science really actually did inform my personal life and in many really important ways because I was like, oh, you know what, my choice of a partner really makes a difference, because not only is this person nurturing to me, but they’re going to nurture our kids as well. And that is going to make a world of difference.
Kate: I’m glad, I’m glad that’s just such a perfect example, especially if you have a life in which you have to exhibit a lot of courage and then we need that sheltering, loving bubble in which not just to have a space to recuperate from being brave, but also to be able to raise your kids who who go out into a world knowing it is full of sorrow and full of hard structural and personal tragedies every day.
Nadine: Yeah, that’s right. You know, the point of this research and the science is not to somehow construct a world made out of bubble wrap. Right. Like adversity happens, life is hard, hard things happen. But what we can do is understand how we set up our systems and structures that promote healing.
Kate: Yes, healing and justice and love. I wonder, too, as the world is imagining emerging out of this pandemic that there is, I hope, a little bit more language around collective trauma, which of course varies in degrees, and I wonder how your research and your experience might help us think about how we might better parent to limit the impact that it’s had on kids and their health.
Nadine: We as parents and caregivers and I know you’re a mom, I have- my husband and I have four boys. So we care for and nurture the kids who are in our lives. But asking our caregivers to do this again in a vacuum is doesn’t make sense and is not sustainable. I think some of these structural factors became so apparent during covid where the caregivers or the parents nurture the child. But the community has to nurture the caregivers. It has to work that way. Again, it’s that bootstraps mentality that people think that somehow this one little family is going to pull together all the resources and overcome, even in the face of unbelievable hardship. What the reality shows us and what I think that covid has shown is really starkly is that that doesn’t work. No. Right. That is very difficult to do at scale successfully. It requires us, and this is a whole notion of public health, you can have every single person, again, you know, being treated for cholera, or you could have one person to say, what is the public health implication here? And let me take this pump handle off of this well. Yeah. So when we look and we can say every single family, you’ve got to do this and this and this and this and this, or we can say, you know what, as a society, what are some fundamental things that we recognize and that we value and that we’re willing to invest in order to help families be successful? Yeah, one of the things that we also understand about adverse childhood experiences is just knowing this information is powerful and it allows us to do things differently. My office actually works together with an initiative called the ACE Resource Network, and they created something called NumberStory.org. And it is an amazing resource where folks can go online, learn about their ACE number story, what does it mean in terms of their health, and then also connect to resources, which I think is the best part of the platform, is really connecting the resources and understanding, what do ACS mean for them? How do you parent with ACS? How do you break the cycle for the next generation? And then also what are resources for healing.
Kate: That’s so great? And we’ll make sure to include all that information in our show notes if anyone happens to be driving and wants to find it later. Thank you for your unbelievably compassionate presence in your research and the way that you are really asking us to learn how we belong to each other. And if we knew it would change the way we imagine what we owe and what we want to pour into one another. That is a big calling. And I am I’m so grateful you’re leading the charge. Thank you.
Nadine: Thank you so much. I have to say, it’s been just such a joy. This has been such a fun conversation.
Kate: Nadine’s work reminds me that there really is no such thing as other people’s children. We all belong to each other. We’re actually wired that way, providing a way toward hope and healing and justice just by setting up some high-lick environments. And yes, I promise to continue using that metaphor in very uncomfortable situations. If you’re someone in a caregiving role: parents, teachers, doctors, nurses, social workers, pastors, people who see the pain and broken systems up close. We see you. And our leaders and institutions need to do better to go back to the well, to get to the source of the problems, making it easier for all of us to love and teach and serve each other. And if you’re someone who’s wondered if your past will always be stuck with you, then these next words are for you. Here’s a blessing for if you’ve had a painful childhood. So let’s just settle in and let this one wash over you. Blessed are you who come with your sorrow, allowing your pain to convey all its truth. For here in the arms of Jesus is where reality is a welcome guest, here is where grief is understood at its core, where the dark shadow of betrayal is seen from the inside. Here, my dear, is where the work of healing begins. Blessed are you who mourn as you meet yourself once again as that little child who needed protection but did not receive it, who deserved respect but was not afforded it. The things that should have happened but didn’t. The things that happened but shouldn’t. The broken systems and corrupt powers and systemic evils that allowed your pain to continue far beyond what it should have. For you have come now to the God who is alive, to your past, present and your future, who’s already moved heaven and earth to restore your dignity and return you to yourself. Take a minute to remind your past self that you are loved now, tomorrow and forever and rest. You are safe, you are held, you are loved.
Kate: Our work on the Everything Happens podcast and with the Everything Happens initiative is made possible because of our partners and generous donors. Lilly Endowment, the Duke Endowment, Duke Divinity School and Faith in Leadership, an online learning resource and a huge thank you to my team who makes this work not only possible, but fun. Jessica Richie, Harriet Putman, Keith Weston, Gwen Heginbotham, Katie Mangum, AJ Walton, Katherine Smith, Mary Jo Clancy, JJ Dickinson and Jeb and Sammi. And if you’d like to be a human with me, come find me online at KateCBowler. I also have a weekly email that might be the right dose of love and courage you need. Sign up at KateBowler.com/newsletter. This is Everything Happens with me, Kate Bowler.