In Memoriam: Rick Marinelli, ND, LAc (1954-2013)

Rick Marinelli, ND, MAcOM

The president of the Institute of Medicine committee of the National Academy of Sciences that set the nation's "blueprint" toward a future of integrated pain care called

A Dream: The morning after Rick died I (John Weeks) woke with a dream of being with him, harnessed, four of us, as to a ski boat, preparing not to ski but to fly in formation. We would have been ready to go except I had not put myself in the right starting position. We three looked to Rick as to the lead pilot in the Blue Angels, a man accustomed to flight, to speed, to dare-devil antics, and guided by a former military intelligence man's precision. I lined myself up with the other three, Rick at the far end. I realized as we stood there that I did not know the choreography of our next moves in the air. I woke.

I shared this dream with one of Rick's and my mutual buddies, Helena-based Montana naturopathic physician and acupuncturist Michael Bergkamp, ND, LAc. Bergie might have been one of the other two in that foursome. He wrote back: "So spot on for Rick. He was always the lead pilot and I can only hope I was his wing man in your dream and was always glad to be one in waking life. I often told Rick that the expression 'I've got your back covered' felt very secure if I knew it was him as he always was complete and confident in his convictions and leadership." 

"Dr. Rick Marinelli, a naturopathic physician and nationally recognized leader in the advancement of pain management therapies, died in Portland early Tuesday morning at age 58.

Rick with Gov. Kitzauber and Kevin Wilson, ND

"Born Leonard Frederick Marinelli III in San Diego, Calif. in 1954 as the first son of a career naval officer, Marinelli received his naturopathic doctorate from the National College of Natural Medicine (NCNM) in 1982, and a Master of Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine (OCOM) in 1992. He served on the faculties of both his alma maters, as well as the Southwest College of Naturopathic Medicine in Arizona.

"Marinelli's work with the Oregon Association of Naturopathic Physicians and the Oregon Board of Naturopathic Medicine helped Oregon naturopathic doctors gain legal authority to prescribe any pharmaceutical needed in a primary care setting, paving the way for NDs to act as primary care providers.

"He pioneered integrating conventional medical treatments such as neural therapy, prolotherapy, venous sclerotherapy, ultrasonography and others into the naturopathic profession, and trained naturopathic physicians and other healthcare professionals in approaching pain management using a combination of cutting edge and traditional, natural methods.

"'Dr. Marinelli's intense passion and critical mind set the bar for achieving excellence as naturopathic primary care doctors,' said Kevin Wilson, past board director of the Oregon Association of Naturopathic Physicians (OANP) and classmate of Marinelli. 'He motivated and inspired everyone around him to new personal bests. His death is an immeasurable loss to our community.'

	"Dr. Marinelli's intense passion and critical mind set the bar for achieving excellence as naturopathic primary care doctors ... He motivated and inspired everyone around him to new personal bests. His death is an immeasurable loss to our community." Kevin Wilson, ND, Past President, Oregon Association of Naturopathic Physicians

"Marinelli spent his career breaking down barriers to promote the inclusion of alternative therapies for pain management in treatment protocols and to advance the scope of naturopathic medicine in Oregon.

"Among many groundbreaking positions for the naturopathic profession, Marinelli was the first naturopathic doctor appointed to serve on any committee of the Institute of Medicine of the National Academy of Sciences. He served on the on the IOM Committee on Advancing Pain Research, Care, and Education. He was also the first naturopathic doctor to serve as President of the American Academy of Pain Management, the first appointed to the Oregon Pain Commission. He was a founding member of the American Association of Naturopathic Physicians, and one of the co-founders of the Naturopathic Association of Therapeutic Injections.

"Marinelli retired from his private practice in Cedar Hills, Portland, in 2011 after being diagnosed with cancer. A celebration will be held in Wonder Ballroom, Portland, Oregon, on February 16, 2013, open to the public. For more information and updates on the celebration of life, visit the In Memory of Rick Marinelli Facebook page."

Rick, lecturing at AAPM

Philip Pizzo, MD, Chair, IOM Committee on Pain, Former Dean, Stanford University School of Medicine

Philip Pizzo, MD met Marinelli through Pizzo's work as the chair of the

"I am so very sorry to learn about Rick Marinelli's recent death. I well recall that when we began our work on Pain in America, Rick was one of the most engaged and thoughtful members of our highly talented committee. He was truly interested in the important topic of pain, brought a unique and special perspective, and sought to both learn and teach others about his experiences and practice. It was soon after the committee began its work when Rick first became ill - even with that he tried his best to stay engaged, by participating with conference calls and other communications. From the first Rick Marinelli stuck me as a thoughtful and considerate professional, eager to be engaged and helpful and revealing a very humanistic persona that I deeply respected - and now certainly miss."

"He most always touched his patients when he engaged with them. It was a firm and warm, gentle grip. Always comforting. It conveyed confidence. He dealt with pain in his work - a lot of pain, and his reassuring touch served its purpose. 

"I would watch him, as his intern apprentice, and see that the gesture was never contrived. Rather, it was the most natural thing to him. Maybe it was the Italian in that Marinelli. 

"You were the only person in the world with him when he connected with you. Efficient but never rushed, you wouldn't know he had 3 rooms of patients going at a time...

"He sought to connect deeply with you & hold your attention while he explained what he had discerned, or prepared you for something that might be uncomfortable. 

"It worked, for you trusted him implicitly. And it paid off, for he was masterful in his abilities to diagnose, to treat and to heal. The stories of his clinical successes are innumerable, if not now legendary.

"I first met him at the AANP conference in San Diego in '94, 2 years after I graduated. We met in the elegant hotel's elevator, introduced to him by his classmate, a mutual friend. His classmate & I were in business attire. Rick was wearing swim trunks and flip-flops. He was all wet. He'd just come in from the surf...

"Minutes later, we were in his hotel room, listening as he expounded eloquently on the effects of injecting scars with bee venom or of tonsils with German glandular extracts. Minutes after that, he was hovering over my open mouth, preparing to service my own tonsils with his needle. The next day, oddly relieved of my pharyngitis, I saw several docs around the pool, sporting pink, raised scars, talking about bees and venom. 

"I was pretty much hooked. I asked if I could work with him and thus began my real education in medicine. I made the commute from Seattle to Portland as often as I could for the next several years. I'd stay overnight in order to have 2 full days in the clinic. 

"At that time, he actually lived on the coast and worked near the city, so he stayed overnight too; in the clinic, sleeping on a treatment table, he in one room, I in another. In the early morning we'd awaken and go to the gym to work-out & take a shower. He'd then don his freshly pressed & well-tailored clothes and look every bit the professional that he was. His patients never knew he actually slept half the time in that treatment room they were in...

"Over the years, both our friendship and our professional relationship deepened profoundly.

"Working with him in NATI (the Naturopathic Academy of Therapeutic Injections), an educational body inspired by him and based on his training model, has been endlessly rewarding as I and others carry forth with the work that he incited. My ability to help so many who suffer with pain is wholly attributable to that man; that most inspiring physician. 

"I am so deeply grateful to have had the rich opportunity to know you well, Rick, beloved mentor and friend. Namaste."

Myra Christopher, Director, Center for Practical Bioethics; Member, IOM Committee

Rick with son Aidan, daughter Aysia, niece Ally and partner Dhai Barr, ND

Myra Christopher is a national pain leader whose work includes organizing the Pain Action Alliance to Implement a National Strategy toward pain treatment that integrates diverse practitioners in an integrative manner. She directs the Center for Practical Bioethics and served with Rick on the IOM pain committee.

"A gentle man, committed to helping others. 

"These are the words that come to my mind each time I think of Rick Marinelli.

"I first met Rick when he was President of the American Academy of Pain Management (AAPM) at their annual meeting.  I was predisposed to like him based on what I had heard about him from my friend, Lennie Deunsing, who serves as AAPM's Executive Director.  Meetings like this one are always crazy for staff and board.  I expected a "so nice to meet you", but Rick took time to talk with me; he told me that he was aware of the Center for Practical Bioethics work, and expressed interest in the notion that I was going to speak about, i.e., that there is a moral imperative for all those in the healing professions to treat pain to the fullest extent of their ability, and to collaborate with other healthcare professionals to assure that their patients have access to a comprehensive menu of treatment options, including complementary and alternative medicine.

"The credibility and respect Rick gained early on in our process neutralized those (hegemonic) views if they were held by any members of the committee." - Myra Christopher

"It was several years later before I encountered Rick again. In the fall of 2009 he and I were both appointed to the Institute of Medicine Committee on Advancing Pain Research, Care and Education that had been mandated in the Patient Protection Affordable Care Act of 2010.  Frankly, as neither a clinician nor researcher, I was a bit intimidated by the austere group that had been convened.  

"We did little more on our first day than hear our charge, learn how the IOM process works, and go through a conflict of interest vetting process.  That evening, we walked together as a group to a local restaurant.  Rick and I walked together; I was touched that he remembered our meeting and asked about my work.  By the time we arrived at the restaurant, I knew that there was at least one kindred soul on the committee.

"As it turned out, the committee was as collaborative and convivial as any on which I have ever served.  Each of us established a special role or niche but all of us were committed to improving the lives of those who struggle to live with chronic pain day-after-day.  Rick's special contribution was to remind us of the importance of a bio-psychosocial or integrative pain management approach.

"Rick did not speak often, but when he did, his comments were thoughtful and made an impact.

"Everyone in healthcare is aware of the traditional hegemony in medicine, but I must say it never reared its ugly head in the IOM committee's discussion.  Traditional biomedical providers often challenge or negate the value of complementary and alternative approaches, but the credibility and respect Rick gained early on in our process neutralized those views if they were held by any members of the committee. 

	Someone commented that Rick was the "E.F. Hutton" of our committee - "when he spoke people listened."  His presence was always with us, and his impact is clearly reflected in our report, Relieving Pain in America. - Myra Christopher

"Unfortunately, Rick was diagnosed with a very serious cancer in the midst of our process, and he was not able to attend several meetings at the end of our process.  All of us missed his input. Someone commented that he was the "E.F. Hutton" of our committee, "when he spoke people listened."  His presence was always with us, and his impact is clearly reflected in our report, Relieving Pain in America, which calls for a new approach to pain management - an interdisciplinary, bio-psychosocial, integrated approach that addresses the complexity of chronic pain.  We called for a "cultural transformation in the way pain is perceived, judged and treated."  I'm not sure who spoke these exact words, but it may have been Rick. 

"He knew an integrative pain management approach is required to improve the lives of those with persistent chronic pain.  I believe we are on the path to the "cultural transformation" we called for becoming widely accepted as the approach to this problem.  I regret that he will not be with us to witness this change, but his thumbprint will be all over it.  Rick Marinelli was a gentle man committed to helping others who was way ahead of the curve."

Rick, lecturing, AAPM

Lennie Duensing and Robert Bonakdar, MD: American Academy of Pain Management (AAPM)

Rick's interest in pain management led him to begin to attend the meetings of the AAPM. While dominated by conventional medical pain experts and with significant pharmaceutical funding, the AAPM had been multidisciplinary organization from its founding. Rick became a member of the board and subsequently was elected to two terms as president. This marked the first leadership of a major pain organization, and possibly of any mainstream, national medical organization, for a professional from any of the licensed integrative health and medicine disciplines. The current president is Scripps' Institute pain doctor Robert Bonakdar, MD, ABIHM. 

Bonakdar: "Rick's presence is missed at the American Academy of Pain Management on so many levels.  As the President of the Board of Directors, he inspired us and moved us in a truly integrative direction; as a practitioner, he brought the healer's art to his patients; as a teacher, he inspired so many to learn and collaborate. His natural spirit-which will live on-has touched so many and encouraged them to do their best work. We are all so grateful for the chance to have shared in his journey."

"Thank you, Rick, my colleague, my mentor, my friend.

"You never know when some extraordinary, different-from-all-else, being is going to pop into your life and positively change the very way you think; the way you work; your work itself; and, even, the way you play. I was already in my mid-fifties when Rick came into my life-and he did just that.

"I had been at the American Academy of Pain Management for more than two years as the communications director, when the previous director left and I accepted the role as interim executive director. At that time, our great, always multi-disciplinary, and once-financially stable organization was on the verge of bankruptcy. And, honestly, I thought my job was going to be shutting it down. Shortly after that, Rick came in as the President of the Board of Directors, and over the next year, he worked with me on almost a daily basis (in spite of his busy clinical schedule), not only to face a myriad financial "challenges," but, more significantly, to transform the organization into one that today fully embraces an integrative model of pain management.

	"Rick came in as the President, and over the next year, he worked with me on almost a daily basis (in spite of his busy clinical schedule), not only to face a myriad financial 'challenges,' but, more significantly, to transform the organization into one that today fully embraces an integrative model of pain management." - Lennie Duensing, Executive Director, American Academy of Pain Management

"Now, working alongside Rick was not always easy. It was tough working with someone whose mind functioned at lightspeed. Sometimes impulsive, and sometimes demanding, Rick would have an idea that he wanted implemented before my much slower brain could even begin to process it.

"Here's one example: about five years ago, Rick, Gerry Greenfield (who also serves on the Academy's Board), and I paid a visit to Robert Bonakdar (the Academy's current President) at his integrative pain clinic at Scripp's in Torrey Pines, CA. We went to observe Robert using a new device that provided continuous electrical stimulation to auricular acupuncture points, and to interview Robert for our magazine.  Most importantly, the four of us met to begin conceiving a sister organization for the academy that would be an Integrative Pain Management think tank. Right after some heavy duty thinking and talking, discussion, Rick flashed me one of his charmingly devilish smiles, said, 'Okay, okay,' real quick-the way he would say it, and told me that the Academy needed to have a hands-on pre-conference day at the annual meeting. Within minutes after coming up with the idea (while I still had the "What?" look on my face), he was on the phone getting funding for one of the sessions. So, in celebration of Rick's success, we went to La Jolla, had some drinks, and Rick regaled me with stories about the wild surfing adventures he had had there.

"Note: Fortunately, Rick's concept worked, enriched the meeting, and we have been doing successful hands-on pre-conference days ever since.

"An exceptional teacher and leader, how proud we, at the Academy, were when Rick was nominated (by ACCAHC) to serve on the Institute of Medicine's (IOM) Committee on Advancing Pain Research, Care, and Education. And from what we've heard from Myra Christopher, leader of the Pain Action Alliance to Implement a National Strategy (PAINS), and member of the IOM committee, although Rick participated for just a short time before becoming ill, his contributions were significant.

"So, thank you, Rick, for: guiding me and the American Academy of Pain Management through tough  times; for expanding and transforming the way so many of us are rethinking  the management of pain, and, in a much greater sense, the way we are rethinking the very meaning of 'healthcare.'  Thank you, Rick, for making my personal journey through this life so much richer and so much more fun."

"I first met Rick in the 1990's when I was the President of the Oregon College of Oriental Medicine (OCOM). After talking with him for a very short while, I immediately knew that he would be an excellent faculty member and was a very gifted and skilled practitioner of both naturopathic and Chinese medicine. Rick's level of integrity, honesty, knowledge and skill in both these health care systems was exemplary. He was also a very lovely, kind and compassionate person and completely dedicated to patient-centered health care and integrative medicine. Rick died way too young and will be very sorely missed." 

"Rick touched the lives of so many. The tributes you shared from his friends, admiring colleagues, and students speak eloquently to his impact, integrity and legacy. However, conspicuous in its absence is a voice from whom he dedicated his life to serve:  the patient. 

"I was his patient. He was my doctor. He healed me. I'd like to share this story to offer, at the very least, one patient's experience.

"Several years ago, I had a rafting misadventure. I fell into a hole and painfully hyperextended my leg. Assuming that this was a simple muscle strain, I did the usual self-treatment. But weeks passed with no relief- and I had trouble walking. In an act of surrender, I went to see my MD/PCP. Her diagnosis, not having the benefit of any imaging tests,  was simple strain and prescribed oxycodone +  a few thousand dollars worth of physical therapy. 

"Whoa.

"I took the oxycodone, took a pass on the PT,  and, instead, reached into my medical network for counsel. Three NDs from three different states offered this unanimous recommendation:  go see Rick.  As one ND put it: "Why go to the rest when you can see the best?"

"In my 40 years in healthcare, I've seen a lot! And though I've read of gasoline additives injected via percutaneous transhepatic catheters into gallbladders (living patients, folks) in explosion-proof rooms at Mayo, I'd never heard of PRP. Live and learn.

"Keeping an open mind to prolotherapy (with admittedly a raised eyebrow), and in respecting advice from doctors I trust, I went to see Rick.

"He diagnosed the avulsion fracture my MD ignored. 

"A true teacher, he carefully explained the pathophysiology and proposed treatment plan, sending me home with a stack of research to read before my next visit. His confident, caring, compassionate and vibrant spirit was unlike anything I've experienced before. He demonstrated recommended exercises with a focus and connection I'd not before felt.  This was a powerfully intimate patient:doctor moment.

"He healed me with an intervention some view as voodoo.

"Rick embodied, and fiercely lived, the spirit of naturopathic medicine. I am blessed for having experienced his healing powers. 

"Rick: Surfs up. Shine on."

"Today I received a call from Pamela Snider [ND]. I'd been thinking of her for a few days, since we'd been on a conference call together. Her voice had sounded a little raspy, and I was concerned she might have a recurrence of throat cancer. It's no secret that Pamela, John Weeks, and Rick Marinelli all had this same type of cancer.  I told Pamela about my concern, and she assured me that she was fine, that her voice had remained a little weak since her radiation therapy.  She then told me that Rick had passed last night. It was not a total surprise, as I knew that Rick had not regained his health after treatment in the way that Pamela and John had.

"I regarded Rick as a brother.  We had a spiritual connection, a deep respect for each other as physicians and scientists.  He was one of the best, if not the best, teachers I have ever had.  He taught me prolotherapy and platelet rich plasma injections during two week-long seminars in Hawaii.  He amazed me with the logic of his approach, the supportive science behind it, and his compassion and wisdom. He seemed at home in the islands, wearing a tank top and board shorts and having a passion for surfing and kite-surfing. 

"For several years I have been nominating Rick to be awarded Physician of the Year by the American Association of Naturopathic Physicians.  I believe he is most deserving of this distinction, and I hope that this year the honor is finally bestowed upon him posthumously.  I know I speak for all who knew Rick - you were a great man.  And we will miss you terribly.   All blessings to you, our friend.

"Here's to absent friends, and to those who are present." 

Inturrisi: "I met Rick when we served together on the IOM committee on Pain Relief in America. He was both personally and professionally dedicated to helping patients in pain. Rick was deeply interested in improving the education of patients about their pain and how to relieve it and in the pain clinicians who treat these patients. Although our time together was brief, I learned a great deal from Rick. He was an important contributor to our Committee."

Stith-Butler: "I was so very saddened by the news from Myra.  I have thought of Rick often in the last couple of years and wondered how he was doing.  He was such a thoughtful and open person, and so committed to his life and work. He approached all things with such a wonderful spirit.  I know he will be deeply missed. I send my thoughts to his family."

"Jared Zeff ND, LAc has a saying about naturopathic medicine's rise from the ashes of its near demise in the late 70's and early 80's when 200 or so naturopathic doctors remained in North America. In an interview in NDNR is 2006 he said: "Our little profession went out into the wilderness over the last 40 years. We survived. The young Jedis gathered bits of wisdom and the history of our elders. We are now in a position to articulate this to the next generation. We are in the midst of that process."

"Rick Marinelli ND, LAc was a true Jedi - knight, warrior and highly respected truth teller of our medicine. After graduating from NCNM in 1982, he built upon the old wisdom, leading naturopathic medicine into new terrain in key areas, a process with which we remain engaged. Others have written about his legion accomplishments and the critical terrain we stand on today which he built with his piercing vision, his excellence and great intelligence. These things make him a deeply respected hero of our discipline and its potential.

	"He spoke truth with a twinkle in his eye, and without the friction of rancor. He got things done. He engaged in the kind of intelligent, ethical and skillful action that made me very proud to be in the same  tribe with him, to stand with him." - Pamela Snider, ND

"I also honor and give loving tribute to the Rick who unflinchingly spoke truth to power, who would not countenance negativity or dignify "low grade sniping." He gave energy, kindness, his mind and considerable heart to the councils of the naturopathic "tribe." I had the gift of seeing him from the perspective of being so very close yet just a layer away. In phases, in our life and our medicine together, we were deeply connected, sharing in intense, sudden or "action critical" moments a joy, a decision point, an accomplishment, a challenge, a strategy. The times we've shared are a series of lights and smiles bedecked by his vitality and big intelligence-his heart, and joy of life.

"Rick acted boldly. He acted with courage. He spoke truth with a twinkle in his eye, and without the friction of rancor. He got things done. He engaged in the kind of intelligent, ethical and skillful action that made me very proud to be in the same tribe with him, to stand with him. I could reach for Rick and trust him, his judgment and actions-without fail.

"And, he was beyond all of this, at the heart of things - his home with Dhai was a hearth, where the Jedis came to ground, to celebrate, to rest, to revitalize, to play. He gave to us what he held in his hands. He loved this tribe.

"Rick was the Jedi who sent to a group of us who were collaborating on getting a piece of legislation passed a copy of the lyrics from Leonard Cohen's famous song "First We Take Manhattan." He was celebrating this victory as he aimed his sights on the next.

"Rick- Know that you are in our consciousness constantly right now...may this connection blanket you with the great peace of an unconditional and grateful love, surrounding you and bringing you ease, light and the knowing that you are seen, respected and beloved upon this earth. Your life and you, live in our hearts. We love you very much and will miss you greatly Rick Marinelli: leader, visionary, pioneer, bright and vital light; our brother and soul friend."

John Weeks, Publisher-Editor, The Integrator Blog; Executive Director, ACCAHC

The core Lake T clan

John Weeks, the present writer, is the publisher editor of this blog piece, writes for other publications in the integrative health and medicine space and has served in a variety of organizing and executive capacities in the movement for integrative health, including a present position as executive director of ACCAHC. I told others to use 200-300 words. I am not the only one to violate that.

"When I was recovering from my own throat cancer - the diagnosis of which was two years to the day before Rick's - I shared with him a life lesson I took from facing the arc of my life possibly ending at 58. A mundane thing, really: we are what we have invested ourselves in.

"Rick's and my families invested in each other. For 5-6 years in the prime of our child-rearing time - late 1990s into the middle of the next decade - Rick's family with Dhai and his kids Aidan and Aysia who Dhai helped raise, our mutual friends Kevin Wilson and Jan Munsterman and their son Nick, and my spouse Jeana Kimball and our children Lucas and Roz, journeyed to a campsite on Lake Tahklahk, 4,000 up Mt. Adams' flanks in the Cascades. This 5-day excursion, sometimes with a few others (including both Jo Forwell and Pamela Snider, who wrote things here), is prime real estate in the memories of all of our children, and in each of us. The other adults were all NDs. I had been given an honorary one. I enjoyed their love of science, bantering in the smoke of the campfire, with striking precision despite the G&Ts in hand - at least until early in the night - the refreshing lake in our bones. Their talk moved well beyond medicine to other frontiers. I often could only follow it like a poem in a poorly known language. I was just plain happy to be co-habiting life with people such as these in a place like that.

"Rick and my friendship began earlier, about 20 years ago. A group of NDs in Portland contracted with me to cold call insurers for them, to begin to create relationships. Rick and I met regularly for dinner on my trips down, sometimes with Kevin. They were deeply involved in Oregon naturopathic politics. I had just completed 3 years as the director of the ND's national association. We talked tribal politics, internecine and external, and relationships, and family, and about the beauties of (and in) naturopathic medicine. The family ties grew from this. Jeana and I began to make a point of bringing the kids down and camping out at Rick and Dhai's, or all of us at Kevin's, for another weekend of the year. Now and then they came north.

"Mostly Rick and I were in parallel play, professionally. His stories intrigued. He attended orthopedic and pain meetings. He introduced me to the existence of the American Academy of Pain Management. This MD-dominant association, funded in part by pharma, elected Rick onto the board and made him president. He presided over a recovery from $800,000 in debt. This leadership by an ND, LAc was and remains historic for his profession and for any MD-dominant group in the US. I who prided myself on covering the waterfront knew nothing of this organization. Rick introduced me to Myra Christopher, his IOM colleague, and to Lennie Duensing of AAPM, each of which introduction opened doors to work projects and writing that are part of how I am investing myself in life today. Rick lives in me nearly daily, in these engagements.

"Jeana and I chose to not knock often on Rick and Dhai's door when it became clear he was not recovering from his treatment - a treatment considered among the most brutal of all the invasive approaches in cancer treatment. We regret it now. Knowing his love of the surf and warmth and the sea, we imagined him visiting us in the surfing capital of Rincon, Puerto Rico where we have begun a sojourn. Learning to paddleboard surf, I daily commune with him. I can almost hear the mentoring on the waves that Rick, the teacher and extreme kayaker, surfer, wind-surfer and kite-boarder, would have given. I've put out of mind the imagined pleasure of actually being on the waves together. 

"I was with Rick when he came home from his oncologist with his diagnosis. Through my ACCAHC work, we'd nominated him for a position on the Institute of Medicine's pain committee. He was selected. Finally we could "kick some ass" on something directly working together. As his staff to his IOM work, I was to be the one person, in the controlled secrecy of IOM committee proceedings, with whom he could share the details. I'd traveled to Portland for a debriefing on the first committee meeting, to learn about the others, to brainstorm strategy and to see how I might support him. He'd had a doctor's appointment mid meeting. As I was making my way through the IOM binder he returned with the news. While his IOM input was necessarily limited, Rick clearly had his impact. He could, as someone said, "stand toe to toe with anyone" on pain issues and on most issues of medicine. I missed the richness of playing with him there, at that level, in the prime of our professional lives.

"I spoke the last time with him in early December as dark fell over Bahia Mayaguez. I'd been thinking of him while paddle-boarding the edges of the jungly forest-rimmed flats. He'd have enjoyed it, but found it tame. He'd just found his cancer was advancing. He'd decided that he wasn't going to fight it but was planning to ease out on his own. He'd reconnected, post original cancer treatment, with past meditation and Buddhist practices. It was like him, to seek to control his exit. My view is that his body that loved all he loved wouldn't let him and held him with us on this earth for those 6 more weeks, tended by Tommy Reece and Kevin and Bergie and Dhai and his kids Aiden and Ariana.

"Crap. And crap that there are times he didn't listen when some of us wished he would have. And crap that his love of kiting led him away from our summers at Lake T. And crap that this seems to be the way life works, that those who accomplish much have such challenging traits. And crap that Jeana and I didn't get down there more often before we left Seattle. And crap that this big chunk of my life and our life is history.

"Jeana put up a small altar to Rick in our house here mid-December, with some things we love and photos of him athletic, and photos of him wizened as he'd come to look, with a candle which we will keep burning the evenings through his 21 day vigil. Miss you, Rick, big time."