From worry to wonder

by Brian on May 23, 2020

in Cancer,Health

Regular readers know that I’m a worrier. Last year, when my wife, Jody, flew to California to visit her parents – well before COVID-19 travel restrictions were even a twinkle in a health planner’s eye – I stayed back in Jerusalem … and worried.

I worried that I would break a leg and there would be no one able enough at home to walk the dog.

I worried that a water pipe would burst, and I’d be thrust into the world of Hebrew-speaking repair people who would growl heatedly in a language I still struggle to understand. 

I didn’t worry that a killer virus would sweep the planet and change life as we know it, although maybe I should have. 

Most of my typical worries now seem, in retrospect, pretty trivial compared to the Big Worry: the return of my cancer nine months ago (and my subsequent at-risk status for COVID-19).

Amber Rae knows all about worry. And she has a mantra for getting past the worst of it: “choose wonder.” That’s the name of her 2018 book, in fact: Choose Wonder over Worry.

Rae explains that there are two types of worry – useful worry and toxic worry. 

Worry can be beneficial when it protects us. It’s evolutionarily coded into our essence: You’re hiking up a mountain and your brain rightly tells you, “Don’t step too far over the edge.” 

Useful worry also prods us to meet our deadlines, lest we step over a ledge of a different kind. 

But worry can easily become toxic “when the beliefs we’ve chosen to buy into begin to paralyze us and prevent us from taking action or moving forward,” Rae says

In her book, Rae quotes Stanford neurosurgeon James Doty who says we spend up to 80% of our lives either with regret about the past or anxiety about the future. In other words, we spend 80% of our time worried. 

And yet, according to a study cited in Robert Leahy’s book The Worry Cure, 85% of the things we worry about never actually happen. Our evolutionary coding no longer seems to be serving us so well.

Instead of worrying, Rae asks, can you approach a difficult situation with a sense of wonder? 

Wonder asks the questions “that tug at your heart,” Rae writes. “It’s getting curious about the parts of our lives that feel scary through a spirit of inquiry and a lens of compassion.”

If worry is your inner critic, then wonder is like “an investigative sidekick that looks at worries and asks, where did that come from?” Rae suggests. “What were you thinking about when you felt that? What story were you telling yourself?”

Rae quotes Plato, who once wrote “all creative efforts, all discoveries and all masterworks are born from wonder.”

Of course, willing wonder over worry is easier said than done. It’s not like you can just slip on a new personality, certainly not after 59 years of going through life with a particular affectation. The best – perhaps the only – way to get there is through practice. 

“Your brain makes anything you do efficient by repetition,” explains Dr. Margaret Wehrenberg in Psychology Today. “You must consciously decide to change habits [like worrying] or they become your default.”

One helpful habit: practice making “wonder statements” whenever a worry arises. That has another benefit: It can short-circuit downward negative spirals. 

“Isn’t that kind of what you’ve been doing over the past two years?” my therapist asked as we were discussing worry and wonder in a recent session.

“What do you mean?” I replied. I wasn’t quite sure where she was going with this.

“You’ve gotten depressed in this room, to be sure,” my therapist continued. “But you’ve also used your cancer as a springboard to explore other topics. To get deeper into questions of meaning and mortality, into how the brain works and how culture and religion shape a society’s responses to illness or sharing bad news.”

That’s true: People expect someone with cancer to present a woe-is-me attitude. Instead, I seem to have “become more willing to dive into the frightening stuff, to embrace vulnerability,” my therapist said. 

I was thrown off guard for a moment. I had been so caught up in the cognitive, intellectual processing of my illness that I hadn’t realized that I’d been changing emotionally. While I was Googling symptoms and side effects, wonder had steadily been replacing worry.

I wonder what my next treatments will be and how I will respond?

I wonder whether this new pain is something I should get checked out or if it’s just a natural part of getting older?

I wonder how I’ll feel when my time comes, however and whenever that will be?

My wonder statements, I realized, too, were just as relevant to COVID-19 as they were to cancer.

The key verb to empower wonder, says Amber Rae, is “choose.” 

With wonder, she writes, “I open my mind, question the stories I tell myself and can choose different ways of thinking and seeing.”

“I wonder what I’ll eat this week,” I thought to myself, when Jody was still a week into her California trip. “Maybe I’ll make a point of eating out in all the hamburger joints that my vegan wife wouldn’t accompany me to.” 

That was BC – before corona – of course. But we can still order in. Sushi works wherever you consume it. 

I smiled. That would make for an interesting, exciting, dare I say, wonder-full adventure, now wouldn’t it?

I first worried and wondered at The Jerusalem Post.

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Your exit, not mine

by Brian on May 10, 2020

in Cancer,Health,In the News

It felt better when we were in total lockdown. The sense that we were all in this together – the young and the seniors, the healthy and the immunocompromised – was comforting in a time of chronic uncertainty. 

But now, as we plunge headfirst into the easing of restrictions, with plans to open schools, beauty parlors, beaches and IKEA outlets, the message is clear: the country is done with sheltering in place. Let’s get back to the way things used to be – as much as we can with masks and social distancing. 

But not everyone is down with the emerging climate. For nearly two months, we’ve been told: kids don’t visit your grandparents. If you have a pre-existing condition, stay indoors. The new rules are all happening so fast – what if we’re wrong and there’s a surge of new infections? 

It’s not that this transition to whatever will become the new normal is ill conceived. On the contrary, an economy cannot remain shuttered forever. I’m just saying how it makes me feel, as an at-risk cancer patient, gravely worried as the country opens up again.

I should be thankful I don’t live in Las Vegas, where Mayor Carolyn Goodman offered up her 650,000 constituents as a “control group” against statewide shutdown orders while the virus was still raging. Or that, here in Israel, those in charge didn’t listen to Hebrew University economist Prof. David Gershon, who callously commented that deaths due to illnesses are inevitable, and that the only criterion for assessing how a country should react is whether the health service is in danger of melting down. 

I will not be reduced to a statistic.

But what happens now when some of us can go out again, to shop and to shul, while others are still at risk, even if the danger is dropping?

If my son Aviv’s music school reopens, for example, with mask-less orchestra rehearsals (he plays saxophone, after all), what do we do when he gets home? Must I hide myself in my office, so that he can reenter life out in the world?

He could move out, I suppose. But what about my wife, Jody, with whom I share a bed and much more? Must she give up seeing her clients for the foreseeable future? Or do I separate from her, too? 

No, I refuse! That’s a prophylactic too far. 

And yet, if I compromise for one person, why not them all? Why not go out and see friends or have the kids come visit from Sderot (seeing as how visits to immediate family members have been permitted again, albeit with no hugs or kisses for grandparents)? 

At a certain point, I feel like just throwing my hands up and screaming, “Screw it, I’ll take my chances with whatever’s out there. If I get sick, then that’s my fate. At least it will take one thing off my anxiety list.”

The key for people like me lies in uncoupling uncertainty from risk. 

Writing in The Atlantic, Harvard Business School senior fellow Arthur C. Brooks describes uncertainty as involving “unknown possible outcomes and thus unknowable probabilities.” 

Risk, on the other hand, “can be managed.” Indeed, risk management is a core part of the insurance and finance industries.

The COVID-19 crisis embodies extreme uncertainty. Will you get the virus or not? If you do, will it be mild or severe? Is our government making choices based on sound counsel? How and when will it all end?

Could some sort of risk triage resolve our family’s post-lockdown paralysis? 

We know, for example, that wearing masks, washing hands and maintaining social distance has made a big difference already. 

Could we extend that understanding to create our own at-risk family rules? Such regulations might seem odd to outsiders – for example, Jody could insist that when she meets clients, they both scrupulously wear masks and maintain two meters of distance long after everyone else has gotten lax – but it might give us a better sense of security. 

All guests coming into our house would have to wear a mask, as well; that means no food served, not even water. It would be awkward, but then these are awkward times.

The Dubai-based airline Emirates is now conducting rapid coronavirus screening for all boarding passengers. The finger-prick blood draw returns results in just 10 minutes. Israeli startup Nanoscent is working on a technology that can “smell” COVID-19 in less than 30 seconds. If this kind of testing were readily available in Israel, would it be too much to ask my family to get pricked or sniffed before returning home? 

This is not the first time I’ve had to tease out risk from uncertainty. When I was diagnosed with cancer two years ago, I had to make choices about treatment options based on incomplete information. While the risk factors were clearer than they are for COVID-19 – extensive clinical trials showed the percentages of who would go into remission, for how long, with this kind of chemo or that – you could still never know in advance which side of the average you’d be on. 

We made a decision with what we had, and we acted on it. Can we do the same with COVID-19? There are now plenty of ICU beds and ventilators available in Israel. New treatments look promising. Infections and hospitalizations are way down.

Is all this enough? I honestly don’t know. I feel alternately lonely and jealous, although sometimes at peace, too. But I’m clearly at a turning point. The only question is whether it will be because I’m despondently crying “screw it” or it’s a matter of quiet acceptance based on calculated – though far from assured – risk assessment.

I first weighed risk against uncertainty at The Jerusalem Post.

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On September 11, 2001, I was in France on a business trip. I had been up most of the night coaching our company’s CEO on a presentation he was to give the next day. By noon, I couldn’t stay awake any longer: I went back to my hotel to take a nap. 

When I woke up, the world had changed forever. 

As I was walking back to the convention center, my wife, Jody, called me on my cellphone. Terrorists had flown planes into the Twin Towers in New York. The conference was canceled, and our team began a frantic search to find a flight home before, as expected, all air travel was halted.

For many of us, the COVID-19 pandemic is the second time we are seeing the world change in front of our eyes. As Israeli author David Grossman writes, this “plague might become the fateful and formative event in [many people’s] lives.” 

When 9/11 happened, it was difficult to foresee the far-reaching changes the attacks would wreak. It feels much the same now. When this pandemic is finally brought under control, what will our world look like? 

Here are a few examples in three areas I’ve been tracking: work, travel and personal relationships.

Work

By now, many of us have become Zoom power users for classes and community. But video conferencing tools stand to significantly upend the status quo at work. As Jeff Tennery, CEO of Moonlighting, a U.S.-based job site, told me recently, when employers realize that many of their employees are “equally productive working remotely, they’ll ask why they should drag them into the office.” Employees will be wondering the same thing. 

“It turns out, an awful lot of meetings … really could have been an email,” adds Katherine Mangu-Ward, editor-in-chief of Reason magazine. “And now they will be.”

Moreover, once a certain percentage of your staff doesn’t have to come into the office every day, employees won’t have to live as close to their places of employment. Real estate prices drop. Traffic-clogged highways could open up. It might even change the calculus on whether to own a car or use public transportation or ride sharing. 

There’s another side benefit that’s already being observed: without all those cars on the roads, pollution is down. The air quality in Los Angeles is now among the cleanest in the U.S. Could Zoom be the unexpected key to addressing climate change?

Travel

COVID-19 has put a serious crimp in the Israeli penchant to jaunt off for a cheap trip to Europe, Asia or South America. When the planes begin to fly again, will we need proof we’re not a risk in order to board? 

China has already implemented a mobile app that indicates who can travel outside of their homes and who must remain in quarantine. One must scan a QR code in order to enter a school, a grocery store or subway station. Green is good. Yellow or red – not so much. 

To avoid an endless loop of lockdowns, some sort of similar system will be needed for global travel, too – a digital certificate indicating lack of illness or immunization. There are serious privacy concerns that must be addressed; the potential for abuse is not trivial.

As for meal service, “passengers might grab their own beverages and snacks as they board through the jet bridge,” writes Erich Schwartzel in The Wall Street Journal. On the upside, expect cleaner planes as citizen crews wipe down every tray table and toilet seat, adds Chris Shipley, the former executive producer of the DEMO tech conference series.

Personal relationships

Post COVID-19, will people resume hugging and shaking hands? Guy Winch, author of How to Fix a Broken Heart, isn’t so sure. He suggests we may face “a prolonged emotional and psychological crisis, even after a vaccine or treatment for the disease is found.”

Interviewed in Haaretz, Winch posits that “it will take a long time before we feel secure enough to draw close to and touch other people.” And the longer we refrain from human contact, “the more difficult it will be to reverse course.”

Feeling comfortable in public spaces may also remain difficult, once the lockdown is over. Would you risk getting sick by dining in a restaurant? Intimate dinner parties at home with trusted friends and food delivery may become the new way of eating out. “Watch parties” from your living room may replace movie theaters and concerts for a while to come. 

Dating could radically change, too, when hook-ups culture could kill you. 

The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,” Elena Conis, a historian of medicine at UC Berkeley, explains. “The use of condoms became normalized. Testing for STDs became mainstream.” 

What is the equivalent for COVID-19? Netflix and chill that’s really Netflix and chill?

Many of these points ignore perhaps the most important question: do we even want to go back to the way things were? Is this an opportunity to make substantive changes to the political, economic and environmental standards that have, to date, seemed immovably entrenched? 

“There is an implicit contract between modern states and their citizens based on the capacity of the former to ensure the physical security and health of the latter,” writes Eva Illouz, a research fellow at Jerusalem’s Van Leer Institute. “Without health and a healthy public, economic transactions become meaningless.”

The truth is, just as after 9/11, we really have no idea what’s coming next. And that, like COVID-19 itself, is perhaps what’s most unsettling about the coming new age.

I first pulled out my COVID crystal ball at The Jerusalem Post.

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Our family desperately wanted to spend Pesach together. But like many Jews around the world, COVID-19 was making that difficult.

The student village in Sdeort where Merav & Gabe live

When the new regulations regarding sheltering-in-place were taking hold in Israel, we had four people living at home: my wife Jody and me, 22-year-old music student Aviv who is now studying online, and our oldest son, 28-year-old Amir, who had moved back home to save money while building a startup. Our daughter Merav and her husband Gabe have their own apartment in Sderot.

As long as the four of us stayed in our lockdown, not leaving the house except to shop or walk the dog, we should have been fine. We didn’t know if Merav and Gabe would be able to make it home for Seder – trying to plan anything even a day in advance these days is an exercise in dashed expectations – but we figured we could read the Haggadah together on Zoom. 

The problem was that Amir has a girlfriend, Tal, and she has her own apartment – not far from ours in Jerusalem but definitely more than a 100-meter walk.

The real issue was not the distance but rather our understanding that mixing households is about the worst thing to do if you want to keep this virus at bay. Every additional person you meet means potential exposure to everyone they’ve been in contact with. 

In Tal’s case, that meant her family (in another city, so all the people from that town who her parents and siblings might have been exposed to) and Tal’s roommate (and all the people she’s been exposed to).

This was not just a theoretical exercise in how best to flatten the curve. In my case, there’s real danger: I’m in several of the most at-risk categories, which includes those who are over a certain age, have a pre-existing medical condition or are immunocompromised. 

My cancer is no longer in remission and past treatments have left my white blood count so depressed that if I came down with COVID-19 – at least at this early point when we still know little about how to treat the disease – I might not make it. 

Indeed, in the U.K., follicular lymphoma patients like me have been getting text messages from the National Health Service telling them to plan for a self-isolation period of up to 12 weeks. While that might not be what Israel’s Ministry of Health ultimately recommends, I’ve been taking it seriously. I haven’t been out of the house for weeks and I’m ready to keep that going for as long as necessary.

So, when it came to being together for Seder, no one wanted to be responsible for getting me sick. 

Clearly, given the risks, we couldn’t invite Tal to stay at our house, and Amir couldn’t go back and forth between their two apartments, especially since we couldn’t restrict where Tal’s roommate might go, even if that was just to buy groceries.

That put Amir in a dreadful dilemma. He had to choose between his girlfriend and his father, both of whom he loves.

The safest thing for him to have done would be to stay at home and not see Tal – at least until Seder. I love my son but I’m also quite fond of Tal and I didn’t want to stand in the way of their budding relationship.

The next option would have been for Amir to move in with Tal but not to come home. I would have missed him terribly, but I would understand.

Could there be a third, more out-of-the-box option? 

“What if Tal and I strictly self-quarantined ourselves for the two weeks prior to Pesach?” Amir proposed. “We’d do our shopping in advance and not leave the apartment.”

The idea made a certain epidemiological sense: if they showed no signs of infection in that fortnight, which seems to be the average incubation period for COVID-19, they should be OK to come home for Seder.

But where could they self-quarantine? They couldn’t go to Tal’s because her roommate presented an uncontrollable vector. They could try to rent one of the many vacant holiday apartments in Jerusalem, but that would be expensive.

What about Sderot? Merav and Gabe live in a student village attached to Sapir College. With many students now at home with their parents, there were plenty of empty apartments. Could they do their self-quarantine there? 

The irony was not lost on any of us: in order to keep me safe from coronavirus, two of my children and their partners would be living under another threat, that of missiles from Gaza.

To sweeten the pot, Merav and Gabe also volunteered to go into their own two-week self-quarantine.

Merav found a friend willing to rent out her place to Amir and Tal for a low rate. 

Before Amir left, he said solemnly, “You know that if there’s a complete lockdown in place by then and the police have checkpoints at the entrances to cities, we might not be allowed to come home for Seder at all.”

“I know,” I replied. “But it’s the only compromise that makes any sense in this crazy time.”

The deadline for this column was several days before Pesach, so I can’t report how the story ends, whether the kids were able to make it for Seder or whether we were alone together on Zoom. 

But I will never forget the incredible self-sacrifice my children made to keep me safe and to give our family the best chance to be together for the holiday.

I first wrote about our Pesach calculations for The Jerusalem Post.

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Preparing for death

by Brian on March 29, 2020

in Cancer,Health,In the News,Science

OK, that headline is a bit of a red herring. I’m not dying now nor am I planning to any time soon. But ever since I was diagnosed with an incurable, albeit mostly treatable cancer, one that compromises my immune system and puts me in the most at risk category during the current coronavirus pandemic, I’ve been thinking about death a lot. 

Preparing for coronavirus in Jerusalem

When the time comes, I want to be prepared – mentally at least (there may not be a whole lot I can do about it physically).

That turns out to be a challenge. Research last year from Bar-Ilan University in Israel claims that our brains may be hard-wired from childhood to shield us from thinking about our own deaths. 

Call it the “mortality paradox” – we all know we’re going to die someday, but our brains are not able to fully grasp the concept of no longer being alive.

“We cannot rationally deny that we will die,” the study’s leader, Yair Dor-Ziderman, says. So instead, “we think of it more as something that happens to other people. When the brain gets information that links the self to death, something tells us it’s not reliable, so we shouldn’t believe it.”

The Bar-Ilan researchers developed a test where they monitored participants’ brain activity while showing them photographs of themselves as well as pictures of strangers. They did this several times in succession. Half the photos were accompanied by words relating to death. The other half had no such connotation. 

The participants were then shown an entirely new face, which the brain would normally react to with a signal of “surprise,” since the image clashed with what the brain “predicted” from the previous sequence.

However, when death-related words appeared alongside the participants’ own faces, their prediction systems essentially shut down, registering no surprise when the “new” face appeared. 

This dulling of the brain’s predictive function, the researchers posit, demonstrates the mind’s inability to process the idea of our own deaths.

Such an incapacity to imagine a world in which we no longer exist, despite knowing that our deaths are inevitable, has led human beings to develop a number of imaginative narratives where death is not what it seems. 

In his 2012 book Immortality: The Quest to Live Forever and How it Drives Civilization, philosopher Stephen Cave describes four main coping strategies we mortals – the “aspiring undying” – have cooked up to deal with the mortality paradox.

The first path Cave calls simply “staying alive.”

“Almost all cultures contain legends of sages, golden-age heroes or remote peasants who discovered the secret to defeating aging and death,” Cave writes. 

Since no one has ever found this long sought-after magical “elixir of life,” a second strategy has evolved. 

The “resurrection narrative” is the belief that “although we must physically die, nonetheless we can physically rise again with the bodies we knew in life.” In addition to the clear Biblical allusions, we see this reflected in the modern-day concept of cryonics, in which people pay to be frozen upon their death in the hope of one day being “repaired.” 

A third path, Cave writes, is “surviving as some kind of spiritual entity or soul,” where we give up “on this earthly frame and believe in a future consisting of some more spiritual stuff.” This is where the concept of an afterlife, a heaven or olam haba (”next world” in Hebrew) finds its most evocative expression.

The fourth and final path is “legacy,” where we achieve life after death through our creative works or the influence we have on the world even after we’re gone. 

“The Greeks believed that culture had a permanence and solidity that biology lacked,” Cave writes. “Eternal life therefore belonged to the hero who could stake a place for himself in the cultural realm.” 

From the view of science, our genes, as continued through our children, are both a legacy and a kind of immortality, since DNA represents “a traceable line to the very beginnings of life and, if we are lucky, [one that] will also continue into the distant future,” Cave says.

Cave’s four paths are intellectually engaging, to be sure, but they haven’t really helped me all that much in getting comfortable around my future non-existence.

That’s because my biggest fear about death may be a much more familiar one: Fear of Missing Out. FOMO “is very often at the heart of people’s fear of being dead,” says Dr. BJ Miller, a palliative care physician at the University of California, San Francisco Cancer Center and the co-author of the book A Beginner’s Guide to the End.

When it comes to death, FOMO is about “all the things you’re not going to get to see,” Miller said on an episode of the NPR program Fresh Air, and “the idea that the world’s going to continue on without you.”

But FOMO around death can be turned on itself, Miller continues. It points us “very squarely towards all the things we love and care about. And then that becomes a nice compass for our way forward – how we’re going to live until we die.” The things we’re afraid we’re going to miss out on are exactly where “we should uptick in terms of our attention now.”

That won’t necessarily help us break past the mortality paradox. And it’s little hard to do all the things you love when you’re in an extended COVID-19 lockdown. But it’s a clever reframing that provides some small comfort when facing the ineffable. 

I first began my preparations for death at The Jerusalem Post.

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Is Jewish “fear of the other” driving Israel’s response to the new coronavirus?

March 15, 2020

Israel’s response to the new coronavirus has been proactive and strong. Is it driven in any way by classic Jewish “fear of the other?”

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“Patience is a virtue”

February 29, 2020

When you start running a fever, when do you head to the hospital and when is it best to practice patience? Relevant for cancer and COVID-19.

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What’s on your travel bucket list?

February 15, 2020

Jody and I were supposed to go on vacation in Asia this week. The COVID-19 virus changed all that. Where on our bucket list should we go instead?

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Foiled by the flu

February 1, 2020

It was the flu that finally felled me. And for one of the only times in my somber saga of cancer, cataracts and chronic pain, I broke down and sobbed.

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One-eyed bowling

January 19, 2020

I’ve never been a great bowler. Now try doing it with only one eye. Thoughts on growth through loss and overcoming negativity with the rule of four.

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