COVID-19 has turned me into a silent shamer. When I see someone not wearing their coronavirus face mask properly, I send angry thoughts in that person’s direction, although since I rarely say anything, my anger is mostly inflicting self-harm rather than doing any ostensible good.

People who wear their masks under their noses, on their chins or not at all must not care about others, I think. They’re so self-centered they’d rather get other people (and themselves) sick than follow the scientific consensus on best practices for pushing past the pandemic.

There’s another way to look at the mask-less masses, though. 

Arianna Galligher, associate director of the STAR Trauma Recovery Center at Ohio State, pointed out in a recent issue of Fast Company that bad mask behavior may be the result of “crisis fatigue.”

“There’s a feeling of resignation that sometimes results from having crisis after crisis after stressor to manage,” Galligher explains. “Sometimes, it can feel like it’s all too much.” The result is that “someone might adopt a ‘why bother’ sort of attitude and get into an existential funk about it.”

Dr. Michael Kelley concurs. When humans endure prolonged periods of stress of any kind, they go through phases, he says. We now seem to have entered the “plateau of exhaustion, the ‘is it ever going to end?’ phase,” where you don’t see a way out and you say, “I’m going to stop fighting. I’m not going to wear a mask or social distance.”

This “plateau of exhaustion” might be a COVID-19 expression of one of the five stages of grief, originally outlined by Elizabeth Kübler-Ross in her 1969 book “On Death and Dying.” 

Kübler-Ross describes what human beings go through when we mourn a major loss: denial, anger, bargaining, depression and acceptance.

We don’t necessarily proceed in that order and one could remain in a single stage for months while skipping some of the others entirely. But it’s a useful way of thinking about what’s happening in our psyches in the age of corona.

The entire world is “dealing with the collective loss of the world we knew,” explains David Kessler, who coauthored with Kübler-Ross 2005’s “On Grief and Grieving.”

We are grieving for a world that is (currently) gone and, for many of us in resurgent hotspots, even more for the loss of hope that we had beaten the virus, only to now fall more deeply into the worst of the plague.

That mixes with what Kessler calls “anticipatory grief.” 

“Our primitive mind knows something bad is happening, but you can’t see it,” he explains. It’s like a storm coming. “With a virus, this kind of grief is so confusing for people. [It] breaks our sense of safety.”

My personal default grief stages are a combination of depression and anger, with bits of bargaining thrown in. The latter involves making little deals with myself.

If I meet with family and friends only outside, I’ll be OK. 

If I wear the Israeli-made face mask infused with nanoparticles of zinc, the virus won’t get through and I’ll be safe. 

People who refuse to wear masks or social distance, on the other hand, or who label the pandemic a hoax, seem to be deep in a different phase of the mourning process: denial.

Some of that is a result of political infighting. 

Some is a result of the confusing messaging by officials.

And some may be just how our brains deal with mourning on an individual level. 

Striving to deny the intense feelings that accompany death and disease is natural; it gives us a path towards coping with them. We tell ourselves the issue is not real and it cannot affect us.

When two groups with different grief defaults come in contact with each other, there will inevitably be a clash. I’m angry at those in COVID denial. They, on the other hand, don’t understand why I’m so angry. We are having a hard time seeing each other.

What if, instead of negatively labeling people who approach the pandemic in a way we wouldn’t, we could have compassion. The unmasked may be as psychologically shell-shocked as I am. They may just be expressing it in a very different manner.

To be sure, empathy is not an excuse. Science comes down hard on the side of wearing a mask to control this pandemic. But there’s little we can do to change other people’s behavior. Waving epidemiologists’ opinions won’t move someone from one stage of grief to another. The only behavior you can really change, of course, is your own.

That usually leads to what’s typically the final stage of mourning: acceptance. 

Can we accept that – without dismissing or denigrating either science or law – we all have different ways of coping with the novel situation we’ve found ourselves in? 

Can we accept that we’ll do all we can personally to stay safe and we’ll speak persuasively but non-condescendingly toward those we think are putting society at risk (and let go when there’s nothing left to be said and done)?

Can we accept that as long as the virus is out there, it could get to us and while that would suck, that would be OK too?

Embracing this fifth stage of mourning would certainly be less confrontational than holding in anger every time I go out to walk the dog or open up the news. 

Even – no, especially – towards the mask-less who, it seems, will continue to grieve through denial for some time to come.

I first explored the five stages of coronavirus grief at The Jerusalem Post.

Kubler-Ross chart from U3173699 / CC BY-SA

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Our coronavirus gap year

by Brian on July 19, 2020

in Cancer,Covid-19,Health,Science

My wife, Jody, and I were invited to the wedding of the daughter of good friends. The wedding will be in the U.K. in July – 2021. 

My first reaction was – wonderful! We’d love to come. An opportunity for a much-needed holiday overseas, rejoicing with friends and plentiful vegan food.

My second reaction – do we really think things will be any different a year from now? That the pandemic will be over and a vaccine will be widely disseminated and effective, such that we can return to the life we once knew?

On my gloomiest days, I doubt it. 

With every news cycle we are hit with more questions. Will the virus just fade away? (Not likely.) Become less contagious? (It seems to be doing the opposite.) Become less virulent? (Maybe…or is it just statistics?) Will we be ordered back into quarantine? (For some of us, probably.) 

Israel, which was once the poster child for how to beat a pandemic, now has one of the highest rates of new infections per capita in the world.

In order to cope with the ping pong of good news followed by harrowing aftermath – in what may very well be a repeating pattern of Whac-a-Mole over the course of months if not years – I’ve started thinking of this time as our “coronavirus gap year.” 

Gap years are traditionally about students taking time off between educational institutions. This, however, is a gap year from normal life. 

Whatever we hoped and planned for the rest of 2020, we’d probably be better off just forgetting about. This year might not be entirely lost, but it will certainly be something “different.” 

To wit: a friend of mine who was laid off from his job was fortunate to land a new position at the height of the first wave. It’s boring, he told me, and doesn’t come close to matching his decades of professional experience, but he’s grateful to have any income at all. 

Many others are not as fortunate.

My youngest son, Aviv, is debating whether to continue school in the fall. Most of his classes were switched to Zoom over the past months, which isn’t easy when you’re a musician and you need to practice in person with an ensemble. Should he pay the expensive tuition for another semester (or longer) of virtual classes?

I’ve long since given up on thinking about that trip to Vietnam we’d planned for earlier this year. At this point, I’m just hoping that my cancer stays stable until there’s a vaccine for COVID-19. (My last scan showed my tumors were still there but hadn’t grown.) If I had to go back into treatment before then, the hit to my immune system could mean my body might not be able to handle a vaccine – if and when one becomes available. 

Is there any way to cope with the relentless despair, both personal and global, in the midst of this gratuitous gap year? 

Here’s a parable I’ve found helpful. It was originally written in 1987 by Emily Perl Kingsley about having a child with Down syndrome, but the metaphor works for both the corona crisis and cancer, as well. It’s called “Welcome to Holland.”

You’ve planned a fabulous vacation in Italy. You bought all the guidebooks and your imagination is churning with anticipation. You can envision exactly where you’ll stay, the things you’ll do – touring the Colosseum, lounging on the Spanish Steps – even how much gelato you’ll consume (“just three times a week,” you promise yourself).

You pack your bags and board the plane. But when you land, the flight attendant announces, “Welcome to Holland.”

“Holland?” you cry out. “What do you mean Holland? I signed up for Italy! All my life I’ve dreamed of going to Italy.” 

But there’s been a change in the flight plan, and you have no choice: you must stay in Holland. No Italy for you.

Holland isn’t a terrible place. It’s just not what you expected. So, you have to go out and buy new guidebooks and learn a new language and meet a whole new group of people. 

You could spend your vacation pining away for Italy, fantasizing about all the things you’re missing out on. 

Or you can accept the reality and make the most of your time. The hotel room is spacious, after all, the stroopwafels are sweet and you discover you really love chips with mayonnaise. You might even begin to notice that there are windmills and tulips and Rembrandts in Holland.

“If you spend your life mourning the fact that you didn’t get to Italy,” Kingsley concludes, “you may never be free to enjoy the very special, the very lovely things … about Holland.”

That’s where we are now conceptually as a world with COVID-19 (and for me personally with my body not where I thought it “should” be at this point in my life). 

We’re in Holland when we wanted to be in Italy. It’s not the worst place to spend a vacation … or a coronavirus gap year. Amsterdam is in fact one of my favorite cities.

And who knows, maybe my pessimistic protestations will turn out to be entirely off the mark and at the end of this crazy alt-world gap year, we’ll all be healthy, safely vaccinated and might actually be able to fly direct from “Holland” to the U.K. to attend our friends’ daughter’s wedding.

I first wrote about gap years and Holland for The Jerusalem Post.

Photo of Amsterdam Centraal Station by Slaunger / CC BY-SA

Photo of Buckingham Palace by Diliff / CC BY-SA

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I ran into Mark while I was walking the dog one afternoon. He’d been through some tough times lately including a near heart attack while he was overseas that landed him in the hospital for a month and a half upon his return to Israel. It was touch and go for a while. Now he was on all kinds of meds, his gate had slowed and, if that wasn’t enough, he was at high risk if he caught corona.

“I just want my body back the way it was, but I know that’s not going to happen,” he lamented, while the dog rolled in the grass, oblivious to the concerns of humans. “If I didn’t have three little kids at home, I’d be ready to move on. I have moments when I think, if I didn’t wake up tomorrow morning, would that really be such a bad thing?”

I tried to be the encouraging friend. “You’ve worked so hard to get to this point, you can’t give up now!” I urged. 

The truth is, I understood him – I feel that way too sometimes. I want my pre-cancer self and the pre-corona world back. 

But I didn’t say any of that to him. Instead, I asked him to tell me more about how his children were doing.

Mark’s face lit up and he seemed like another person. He launched into great detail about his three daughters, regaling me with stories about how this one was excelling in academics while another had discovered a passion for video production.

And I thought: How can that be? How could he be at the end of his rope one moment and then actively engaged in life a second later? 

How is it possible to be both fearful and in pain and also to be excited and full of joy?

It’s because we as human beings are non-binary. Not in the gender identity sense of the term, but in that seeing ourselves and the world around us as being either one thing or the other is not only untrue, it doesn’t serve us well psychologically. 

Rather, we can – and we must – embody both hot and cold, happy and despondent in the same person. It’s entirely OK to feel sad or depressed at times, as long as you remember that’s not all you are.

When I first put this down in writing, it seemed like such an obvious insight, something everyone must know.

Our brains, however, beg to differ. We may actually be hardwired to think in binary.

Dr. Joe Tsien, a neuroscientist at the Medical College of Georgia at Augusta University proposed a few years back that the brain’s basic computational algorithm is organized along power-of-two logic – that is on or off; binary.

In order to grapple with “uncertainty and infinite possibilities,” Tsien writes in the journal Trends in Neurosciences, groups of neurons in the brain “form a variety of cliques to handle each basic [function] like recognizing food, shelter, friends and foes. Groups of cliques then cluster into functional connectivity motifs to handle every possibility in each of these basics. The more complex the thought, the more cliques join in.”

Eventually, the cliques resolve in such a way that the brain makes binary types of choices. 

Tsien tested his theory in seven different brain regions involved with basic functions in mice and hamsters. 

“Surprisingly, we indeed saw this principle operating in all these regions,” Tsien says. 

The brain, with its 86 billion neurons, he concludes, “may operate on an amazingly simple mathematical logic.”

While Tsien’s theory needs more testing, we know intuitively that much of what we do comes down to binary choices. Otherwise, how could we make an instantaneous fight or flight decision in a dark alley or choose which fork on a ski slope to take where the decision must be made in a split-second to avoid slamming into a tree?

Matthew Fisher and Frank Keil describe a similar phenomenon in a paper published by the Association for Psychological Science called “The Binary Bias,” Fisher and Keil found that people put information into one of two categories – a yes or no, an all or none. 

The Binary Bias cuts across our “health, financial and public policy decisions,” they write. It helps explain why for some people, a B+ on a test is a “fail” or why a politician is either a hero or a crook but rarely something in-between. 

DNA need not define our destiny, though. How the neurons in our brains operate don’t have to determine how we relate to the world outside. Binary is not always best, and in most cases, we’d be a whole lot healthier pushing past our predispositions.

How would that look?

For me, having a chronic cancer means that I’m sick but not dying – that’s non-binary thinking. 

Living in corona times means we can take all the precautions possible and still not be entirely safe. It also means we might engage in riskier behavior at times and not necessarily get sick. The virulence of the virus, it seems, is non-binary, too.

Politics has become binary, but it doesn’t have to be. You can be pro-annexation and still care deeply about human rights. You can wear a facemask and also be a Republican. You can fight against climate change without being branded a socialist.

I’ve been thinking about calling up Mark to give him an alternative pep-talk. Every one of us has pain and joy, sometimes simultaneously, I would tell him.

Because in the end, we are not just this and we are not just that. 

We are both.

I first wrote about the binary blunder for The Jerusalem Post.

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Cancer is not magic

by Brian on June 20, 2020

in Cancer,Food,Travel

When I was first diagnosed with cancer over two years ago, I so much wanted to believe in magic. Not that there would be a cure – follicular lymphoma is a chronic cancer; treatable but incurable, with no magic bullet hovering on the horizon. It’s not unlike the long-term prospects for COVID-19 – mostly manageable but probably with us in one form or another for the foreseeable future.

Rather, the magic I sought was that having cancer would somehow transform me. I would become a different person: my values would change, I would stop stressing over minutia and would spend more time doing what I loved with people who I cherished. 

This “new me” would embrace the moments when I felt well and throw myself fully into whatever I chose to do, without hesitation or regret. 

It was fiction that led me to believe in this kind of magic. 

So often in books, movies and TV, the protagonist who goes through a major crisis always seems to come out conclusively changed. 

Following a panic attack, Randall on the TV show This is Us decides he’s fed up with crunching numbers for a living and runs for city councilman. 

After many repetitions and too much Sonny and Cher, Bill Murray’s character in Groundhog Day turns into a sweetheart who finally gets the girl.

Walter White was a mild-mannered high school chemistry teacher before his terminal cancer diagnosis. By the end of Breaking Bad, he’d become a drug kingpin and a mastermind in cooking crystal meth – changed for sure, albeit not necessarily for the better.

In my experience, however, real life seems to be less about sudden, dramatic transformation and more about making small iterations and incremental adjustments.

We get a new job which is mostly like the old one with a few tweaks. Do that enough over a period of 20 or 30 years, and you’ve built yourself a career. 

Even getting married and having children, which might seem to be the ultimate transformative acts, can be broken down into smaller steps, each of which builds sequentially upon the former.

That’s not to say the end results can’t be deeply satisfying. Still, I was hoping for real magic when cancer came into my life. 

One area in particular where I hoped there could be a change – and which now, with COVID-19 bearing down on us, seems cruelly unachievable – was spontaneity. 

I’ve always been a very planned out kind of guy. If my wife, Jody, and I wanted to go on a vacation overseas (back when you could do such things), I would first exhaustively research where and when to go and what to do. I could easily spend more time looking into all our options than the trip itself would take.

A few weeks before the COVID-19 restrictions began, all three of our adult children announced they were going out of town for Shabbat. 

“Let’s go away, too. We could get a Daka 90,” I said to Jody, citing the name of an Israeli website specializing in last-minute, low-budget trips.

I immediately jumped online. There were amazing deals for a weekend in Crete, Kos or Rhodes: a short flight and a 5-star all-inclusive resort for not much more than buying food for a Shabbat at home. 

But then reality sunk in. Jody had clients she’d have to cancel on Thursday and Sunday. I’d need travel insurance, which is not a simple (nor inexpensive) thing when you have cancer. I’d have to scramble to get a note from my doctor. 

“Maybe we should do this another time, when we can plan it out properly,” Jody suggested.

Jody was right, but I felt crushed – I wanted to be impulsive for once. I wanted the magic. 

That decision feels doubly depressing now: who knew then that, just a few weeks later, the very concept of vacation would become verboten?

“I feel like I’m stuck in perpetual status quo,” I complained to my therapist. “Not just about being spontaneous. Nothing seems to have changed since the cancer.”

“Do you really have to transform yourself into someone entirely brand new?” she asked. “Maybe small steps are enough. What could you do this weekend that would be modest but still spontaneous?”

I was quiet for a moment. “We could go out to a nice brunch, in Israel, instead of flying to Greece,” I suggested. That would at least be different: Fridays for me are usually a day of doing errands – washing clothes and cleaning the kitchen – before squeezing in just a little more work before the sun sets.

“There’s a place I’ve been dying to try out up in the hills outside Jerusalem,” I added. “It’s supposed to be really gourmet.”

“How would that feel?”

“Good, I think.” I paused. “Yes, very good.”

And that’s how, with just a day’s notice, we made reservations to eat at Rama’s Kitchen – a rustic restaurant in the Judean hills with a spectacular view over Nahal Kfira, its own organic garden and some very creative dishes (two thumbs up for the eggplant knafeh).

We followed up our meal up with a leisurely mountain walk to work off our food. 

It wasn’t the big transformation I originally had craved. But, looking back now, in light of the health and economic devastation to come, it was truly magical.

A COVID-19 update: Rama’s Kitchen has added a magic new option: take-away picnic baskets fit for a foodie – collect yours at the restaurant, then pick a tree in the nearby woods under which to feast. 

I first wished for magic at The Jerusalem Post.

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I remember exactly when the pandemic started: March 11, 2020. That’s the date the World Health Organization upgraded COVID-19 from “public health emergency” to the formal status of “pandemic.” 

In Israel, it was actually several days earlier. “We are in the midst of a global pandemic, even if this has not been declared officially,” Prime Minister Benjamin Netanyahu told his cabinet on March 8.

While the beginning may be a matter of public record, when this pandemic ends will be different for every individual. 

“Pandemics typically have two types of endings,” writes Gina Kolata in The New York Times. “The medical, which occurs when the incidence and death rates plummet, and the social, when the epidemic of fear about the disease wanes.”

“When people ask, ‘When will this end?,’ they are asking about the social ending,” Dr. Jeremy Greene, a historian of medicine at Johns Hopkins, tells Kolata. 

In other words, “an end can occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease,” Kolata sums up. “Many questions about the so-called end are determined not by medical and public health data but by sociopolitical processes.”

That pretty well describes what happened the last week in May in Israel as restaurants, synagogues, schools and stores re-opened at a dizzying pace.

We’ve seen pandemics of fear abate before. Remember the Hong Kong flu of 1968, that killed a million people worldwide, including 100,000 in the United States? You don’t? That’s because whatever fear accompanied that flu (and in a pre-social media age, it wasn’t nearly as much as we see today with COVID-19) dissipated. The virus, by the way, didn’t disappear; it still circulates as a seasonal flu to this day.

My personal pandemic of fear around corona came to a tentative end on the Jewish holiday of Shauvot. That was the day that we allowed our children (those who didn’t already live with us) to come into our home for the first time in more than two months.

We didn’t open up because I was entirely OK with it – on the contrary, I am still quite concerned about catching the virus, even more so now with the alarming spike in infections over the last week. 

But I was exhausted shouldering the burden of being the sole gatekeeper for our family, the one on whom it constantly fell to decide – given that my cancer makes me the person most at risk in our unit – what we should wear (mask or gloves?), who can come in, when we can go meet with friends again, under what conditions.

I’ve written before about balancing risk and uncertainty. Every day we know more about this virus. 

Robin Schoenthaler, an oncologist in Boston who has gathered a following for writing plainly about the pandemic, describes it like this: People talking normally – low risk. People shouting or singing – higher risk. Wearing a mask – low risk. Standing more than six feet away – low risk. Spending less than 15 minutes together – low risk. Touching packages and groceries: very low risk.

That’s “not no risk,” stresses Schoenthaler, “but lower risk.”

We are now in the second phase of Tomas Pueyo’s virally shared article, “The Hammer and the Dance,” where, after the pounding of the initial lockdown, we dance with precautions – mini-closures, contact tracing and quarantines when cases spike, as they inevitably will – until the virus is gone or a vaccine arrives. 

Still, it was bewildering at first. Haaretz’s Ofri Ilany describes the post lockdown period as “reverse culture shock … a characteristic of people who have spent a significant amount of time in a different cultural milieu, on their return to their regular environment.”

With reverse culture shock comes disorientation. In an interview with the newspaper Neue Züricher Zeitung, Swiss psychiatrist Josef Hättenschwiler notes that during lockdown, “everyday worries and hardships wereperceived as negligible in view of the immediate physical threat.” As we open up again, though, our anxieties return, whether that’s exams, projects and deadlines we may secretly have hoped might be delayed or scrapped entirely because of the crisis, or the hard choices of whether, when and how to see family and friends again.

As the numbers shot up over the Shavuot holiday – mind you, the news broke after we’d welcomed our children home – outgoing director general of the Health Ministry Moshe Bar Siman Tov attributed the growing number of cases to an “atmosphere of euphoria and complacency.” 

Dina Kraft has another explanation. 

“Israelis are good foot soldiers when ‘under attack,’ willing to listen to public safety orders like entering bomb shelters during times of war,” she writes for NBC News. Where they have trouble is “dealing with anything in the middle when it comes to a crisis.”

Kraft wonders whether Israel’s fast-moving return from isolation is an example of “the smart, nimble, Israeli chutzpah style” – the one manifested by the Start-up Nation – or if what we’re experiencing is more of a “sloppy rush that leaves Israelis more vulnerable than necessary.”

“This is completely in our control,” Bar Siman-Tov emphasized. “If we are meticulous about the rules, we’ll succeed in blocking the spreading of infection.” 

In that respect, maybe the uptick is a good thing – a much needed wake up call. 

But it also calls into question: did one of the pandemics – the pandemic of fear – even end last week? I’m not so sure anymore. Maybe, like the medical pandemic, it too goes in waves, destined to rise and fall for many months to come.

I first wrote about pandemic beginnings and endings at The Jerusalem Post.

Face mask image from https://www.nursetogether.com/ / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)

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From worry to wonder

May 23, 2020

With all the worries in our world – from cancer to COVID-19 – can we choose wonder instead? Amber Rae explains how.

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Your exit, not mine

May 10, 2020

With COVID restrictions in Israel easing, what happens when some of us can go out, while others are still at risk, even if the danger is dropping?

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How will the world change after COVID-19?

April 26, 2020

How will the world change after COVID-19? Here are a few predictions: for work, travel and personal relationships (including sex).

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Corona calculations for the Seder

April 12, 2020

Our family went to extraordinary lengths to try to be together for Pesach Seder and to keep me, a high-risk patient, safe. Did we succeed?

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Preparing for death

March 29, 2020

OK, that headline is a bit of a red herring. I’m not dying now nor am I planning to any time soon. But lately I’ve been thinking about death a lot. Four ways that human beings grapple with a world in which we no longer exist.

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