Meet the Beckers
The Beckers met for the first time twice: once in a university hallway, after Laren’s med school interview and before Nielsen’s, and then again just a few months later, at the first histology class for new MD/PhD students at Albert Einstein College of Medicine in the Bronx.
On the first day of med school, they “kept saying that we looked familiar to each other,” Nielsen explains, and then they remembered the real first meeting, when they’d both been interviewing at Mount Sinai. Laren had gone in first and ended up giving Nielsen some pointers, so she went in more prepared.
Ten months later when they met in their own program, a great partnership was born, eventually leading to a marriage, two kids, a long-haired Chihuahua named Ava, and two faculty positions in the gastroenterology (GI) division of Stanford’s Department of Medicine. (Nielsen is a clinical associate professor, Laren an assistant professor.)
Their paths to medicine were strikingly different. Nielsen, born in the Dominican Republic and from a large family, was among the first in her family to go to college, so her decision to attend medical school was “a really big deal.” Laren, who grew up in Los Angeles, said there was no true dramatic moment in his decision to be a doctor, although he was “always partial to science” and his father was a dentist.
Their MD/PhD program was small, and everyone in the group quickly grew very close. Still, it was probably “two or three years in,” Laren says, before he and Nielsen began dating. It was around that time, too, that Nielsen became interested in GI. Her early PhD research involved pattern formation in the Drosophila embryo, a process that requires many signal transduction pathways. As she explains, “A lot of these pathways turned out to have important biological implications in gastroenterology, particularly in inflammatory bowel disease.” During her third-year clerkships, she was “just hooked” by the subject, largely due to a “fantastic clinical mentor with an impressive breadth of GI knowledge.”
Laren’s interest in GI also had to do with its opportunities. “It covers a large breadth of diseases and organ systems,” he says, “but you also have the ability to perform procedures, giving it a nice balance. Finally, there are plenty of unknowns, making it a field in need of physician scientists.”
Building a Future
Laren and Nielsen graduated from medical school together in 2002 and went on to their residencies in Boston, dating and committed for eight years but not in a hurry to get married. “Our careers were always in parallel,” Laren says, “so it didn’t make sense to rush.”
Other members of their families, though, were in more of a hurry. “I distinctly remember a conversation with Laren’s grandmother,” Nielsen says. “She was in her late 80s at the time, and we went to see a play in L.A. with her. She held my hand and she said, ‘What’s it gonna take for you guys to get married? Do I have to pay for a trip to Vegas?’ and we thought, OK, we have to do this.”
The Beckers on a sunny day. From left: Raymond, Nielsen, Eliana, Ava the chihuahua, and Laren
So they did—in 2004, during their senior year of residency. Then together they started GI training at the Beth Israel Deaconess Medical Center, where they made up half of the fellowship class. It was the first time they worked on the same medical team, and it gave them a flavor of things to come.
Living with Pain
Shortly after, and with their first year of GI fellowship wrapped up, they set their sights on starting a family and were elated when Nielsen became pregnant. Unfortunately, preeclampsia struck in the 28th week and emergent delivery ensued. Ten days later, in a heart-wrenching turn of events, they grieved the loss of their infant daughter. This, more than any other event, “shaped the way we are,” Nielsen says, “but not in a negative way. Our daughter bestowed on us many gifts, which we draw upon every day in our lives.” It also taught them both about “the resiliency of the human spirit. I’m a better listener, better person, better doctor” partly because of this experience, Nielsen says. She adds that both of them “just appreciate things a little bit more. Life is so precious and so fragile. We choose to find the silver lining whenever we can and believe that our daughter lives through us.”
They went on to have two more children, Eliana and Raymond, now 10 and 12, and got a dog named Ava, whom Nielsen calls “the eldest and best behaved of the children.” And in the fall of 2009, they both began at Stanford, working clinically and in research.
For the most part, they enjoy working together, with the challenges and insights that it brings. “It’s great because we see things from different perspectives, and we know enough of each other’s work that we can critique and give suggestions, and difficult patients often get two opinions when we discuss these complicated cases,” Laren says.
“I don’t know if it’s healthy for the kids, though,” he laughs. “They hear stuff they probably shouldn’t be hearing people talk about.”
“Working together is great because we see things from different perspectives, and we know enough of each other’s work that we can critique and give suggestions"
Nielsen adds, “When our son was young, he asked, ‘Mom, why did you and Dad both have to be butt doctors?’” Apparently, his friends at school had parents that were in two different fields, which seemed more normal to him.
Their schedules, particularly in a pandemic, are complicated, requiring constant balance. Some days Laren is in the lab on the Stanford campus, working on his research. Some days he’s at the VA, seeing patients. Nielsen works from home some mornings, and they trade off. She also sees patients in Redwood City. Fridays are flexible for both of them, so that ends up being the day for kids’ appointments and errands.
“Every so often something falls through the cracks,” Nielsen says, “but it works out for the most part.”
Doing the Research
Laren’s research focuses on the interplay between immune cells and the enteric nervous system, the nervous system that controls gut function, and how these neuroimmune interactions are affected by aging. “There are inflammatory changes that occur and lead to disruption of gut function as we age,” he says, adding that “more recently I've been looking at neurodegenerative diseases. There’s emerging evidence that a lot of these diseases like Parkinson’s actually start in the gut.”
Nielsen’s research deals with food antigen mediated diseases of the gastrointestinal tract, including eosinophilic esophagitis and celiac disease. “Celiac gives you a window into autoimmunity,” she states, “because it’s really the only disease we know of that starts with this reaction to a food protein, gluten, and culminates in an autoimmune disease. Understanding that process more could have many implications for other autoimmune diseases like lupus.”
Both of the Beckers also see patients, and even though they often work at different sites, they end up sharing more than a few. Nielsen specifically changed her name to Fernandez-Becker to avoid confusion, she says, but it still happens. She’ll find herself suddenly with several extra patients, for example, who turn out to be Laren’s, or patients get scheduled with one Becker instead of the other. They anticipate that this will happen again when they start working together in Redwood City. But they don’t mind it all that much.
When Laren left the motility clinic at Stanford for the VA, Nielsen ended up with some of his patients. “I tried to give her the really nice ones,” he says, though he acknowledges that he had no control over that. The patients are often delighted to know they’ve been treated by both halves of a married couple. “It’s very nice to see Laren’s old patients,” Nielsen says. “They always ask about him, and I tell them what’s going on and they’re rooting for him and his research.”
Add a Pandemic to the Mix
Remarkably, they’ve also managed to balance their family and their careers well during COVID, although it wasn’t always easy. “There was a point early on where the internet connection in our house clearly wasn’t good enough for all the Zoom meetings I was doing and the kids’ classes,” Laren remembers. “But then IT came through and upgraded it.”
They both count themselves lucky that their kids are old enough now to be semi-independent, and while acknowledging that homeschooling has been tough (“You basically became the tutor, the lunch lady, and technical support, all while still doing your own work,” Nielsen says), they both seem calm and up to the challenge, even a year into the pandemic.
“The uncertainty has been difficult,” Laren acknowledges, “particularly whether the kids are in full distance learning or a hybrid model, and trying to figure out how to juggle their changing schedules as the year has gone by.”
But both Nielsen and Laren are grateful for the support of others.
“Our community at work is so wonderful,” Nielsen says. “There was some flexibility in those early months so we were able to adjust our schedules. And for a while we were having check-in meetings almost every week, and we also organically developed our own little cliques, groups where people would vent or ask for advice. In a way, it brought our medical community a little closer, even though we weren’t physically seeing each other.”
Laren’s lab was closed down for a while in the early months of the pandemic, but he used that as an opportunity as well. “It actually forced you to think through where you wanted your research to go, and I think that was important,” he says. “I definitely started new directions and different collaborations that I hadn’t been doing before.”
"As bad as last year was, I always felt supported. We knew we had a lot of people in our corner and we were going to get out of it all right. It’s amazing how we humans adapt to anything"
They both also cite the “really nice community” of their apartment complex. “We were basically all social distancing in place together, so the kids didn’t feel isolated,” Nielsen says. “And if we had to go out for an errand, our neighbor could keep an eye on the kids, so that was nice too.”
Speaking to them, it’s hard not to share their optimism, and it’s obvious that whatever life throws at them, they make a good team. Even in an interview they comment, encourage, correct, and interject, but always as a unit. And they see themselves as part of a larger Stanford team as well.
“As bad as last year was, I always felt supported,” Nielsen concludes. “I never thought, how are we going to get through this? It was more like, ‘OK, this is a challenge,’ but we knew we had a lot of people in our corner and we were going to get out of it all right. It’s amazing how we humans adapt to anything.”
She and Laren agree that the Department of Medicine has “risen to the challenge.” And surely the same could be said of the smaller units within the department, from divisions to teams and, yes, even to a marriage.